Sensor-based systems for the measurement of Functional Reach Test results: a systematic review

The measurement of Functional Reach Test (FRT) is a widely used assessment tool in various fields, including physical therapy, rehabilitation, and geriatrics. This test evaluates a person's balance, mobility, and functional ability to reach forward while maintaining stability. Recently, there has been a growing interest in utilizing sensor-based systems to objectively and accurately measure FRT results. This systematic review was performed in various scientific databases or publishers, including PubMed Central, IEEE Explore, Elsevier, Springer, the Multidisciplinary Digital Publishing Institute (MDPI), and the Association for Computing Machinery (ACM), and considered studies published between January 2017 and October 2022, related to methods for the automation of the measurement of the Functional Reach Test variables and results with sensors. Camera-based devices and motion-based sensors are used for Functional Reach Tests, with statistical models extracting meaningful information. Sensor-based systems offer several advantages over traditional manual measurement techniques, as they can provide objective and precise measurements of the reach distance, quantify postural sway, and capture additional parameters related to the movement.

Integrating Abnormal Gait Detection with Activities of Daily Living Monitoring in Ambient Assisted Living: A 3D Vision Approach

Gait analysis plays a crucial role in detecting and monitoring various neurological and musculoskeletal disorders early. This paper presents a comprehensive study of the automatic detection of abnormal gait using 3D vision, with a focus on non-invasive and practical data acquisition methods suitable for everyday environments. We explore various configurations, including multi-camera setups placed at different distances and angles, as well as performing daily activities in different directions. An integral component of our study involves combining gait analysis with the monitoring of activities of daily living (ADLs), given the paramount relevance of this integration in the context of Ambient Assisted Living. To achieve this, we investigate cutting-edge Deep Neural Network approaches, such as the Temporal Convolutional Network, Gated Recurrent Unit, and Long Short-Term Memory Autoencoder. Additionally, we scrutinize different data representation formats, including Euclidean-based representations, angular adjacency matrices, and rotation matrices. Our system's performance evaluation leverages both publicly available datasets and data we collected ourselves while accounting for individual variations and environmental factors. The results underscore the effectiveness of our proposed configurations in accurately classifying abnormal gait, thus shedding light on the optimal setup for non-invasive and efficient data collection.

Active and Assisted Living, a Practice for the Ageing Population and People with Cognitive Disabilities: An Architectural Perspective

The current digital revolution is causing a paradigm shift encompassing all environments in which human beings conduct their daily activities. Technology is starting to govern the world, gradually modifying not only individual and social behaviour, but also ways of living. The necessary adaptation to new information and communication technologies forces societies to rethink both public and private spaces, in which evolution is slower than rapid social transformation. As part of this change, the concept of Active Assisted Living (AAL) has developed. Assisted spaces can be designed to provide older adults, carers, or people who have cognitive disabilities, such as Alzheimer's disease or other dementias, with a healthier, safer, and more comfortable life, while also affording them greater personal autonomy. AAL aims to improve people's quality of life and allow them to remain in their own homes for as long as possible, not in residences. This study conducted a critical review about AAL from an architectural point of view. The research adopted a qualitative approach in which we collected the studies during the last twenty years, then used descriptive, narrative and critical analysis methods. Based on these, this paper aims to explain this new technological paradigm, its characteristics, its main development trends, and its implementation limitations. The results obtained show how the development of AAL will be in the next ten years, and how this concept, and its application, can influence architecture and provide the bases for further research into the design of buildings and cities.

Concept and Pictogram-Based User-Interface Design of a Helper Tool for People with Aphasia

BACKGROUND

Aphasia describes the lack of the already gained ability to use language in a common way. "Language" here covers all variations of forming or understanding messages.

OBJECTIVES

The APH-Alarm project aims to develop a service concept that provides alternative communication options for people with Aphasia to trigger timely help when needed. It considers that a typical user may not be familiar with modern technologies and offers several simple and intuitive options.

METHODS

The approach is based on event detection of gestures (during daytime or in bed), movement pattern recognition in bed, and an easy-to-use pictogram-based smartphone app.

RESULTS

Agile evaluation of the smartphone app showed a promising outcome.

CONCLUSION

The idea of a versatile and comprehensive solution for aphasic people to easily contact private or public helpers based on their actions or automatic detection is promising and will be further investigated in an upcoming field trial.

Remote Assistance for Home Care Workers: Concept and Technical Implementation at a Glance

BACKGROUND

Long-term care faces severe challenges on the supply (shortages of formal and informal carers) as well as on the demand side (increasing number of care-dependent people). To cope with these challenges, new forms of support for the professional care network are needed.

OBJECTIVES

This paper describes the concept and implementation of a Remote Care Assist (RCA) service, consisting of a web-application for the Care Expert Center (CXC) and Remote Support (RS) applications for the HoloLens 2 as well as for Android and iOS smartphones.

METHODS

Using the evidence-based and user-centred innovation process (EUIP), a Remote Care Assist service was conceptualized and implemented for home care service settings in three European countries.

RESULTS

After five iterations within two phases of the EUIP, the final feature set of the RCA-service was determined and implemented.

CONCLUSION

By working closely with the target group, it was possible to identify potential hurdles and additional requirements such as a well-thought-out interaction concept for the HoloLens or a good organizational embedding of the service.

Light as a Possible Guidance in the Toilet Room from the View of Dementia Experts

Digital assistants and guidance systems may support persons with dementia (PwD) during the independent use of the toilet room. The paper investigates the possible use of different light sources to provide visual stimuli for guidance. Demonstrators were presented to dementia experts to gather their views. While there is no evidence yet, it can be concluded that light stimuli in the toilet environment could be a (maybe only additional) option for guidance to be further investigated. The different methods must be always adapted to the local situation and the individual user characteristics.

Coaching Robots for Older Seniors: Do They Get What They Expect? Insights from an Austrian Study

To support the increasing number of older people, new (assistive) technologies are constantly being developed. For these technologies to be used successfully, future users need to be trained. Due to demographic change, this will become difficult in the future, as the resources for training will no longer be available. In this respect, coaching robots could have great potential to support younger seniors in particular. However, there is little evidence in the literature about the perceptions and potential impact of this technology on the well-being of older people. This paper provides insights into the use of a robot coach (robo-coach) to train younger seniors in the use of a new technology. The study was carried out in Austria in autumn 2020, involving 34 participants equally distributed among employees in their last three years of service and retirees in their first three years of retirement (23 female; 11 male). The aim was to assess participants' expectations and perceptions by examining the perceived ease of use and user experience of the robot in providing assistance during a learning session. The findings reveal a positive impression of the participants and promising results for using the robot as a coaching assistant in daily tasks.

Integrating Social Assistive Robots, IoT, Virtual Communities and Smart Objects to Assist at-Home Independently Living Elders: the MoveCare Project

The integration of Ambient Assisted Living (AAL) frameworks with Socially Assistive Robots (SARs) has proven useful for monitoring and assisting older adults in their own home. However, the difficulties associated with long-term deployments in real-world complex environments are still highly under-explored. In this work, we first present the MoveCare system, an unobtrusive platform that, through the integration of a SAR into an AAL framework, aimed to monitor, assist and provide social, cognitive, and physical stimulation in the own houses of elders living alone and at risk of falling into frailty. We then focus on the evaluation and analysis of a long-term pilot campaign of more than 300 weeks of usages. We evaluated the system's acceptability and feasibility through various questionnaires and empirically assessed the impact of the presence of an assistive robot by deploying the system with and without it. Our results provide strong empirical evidence that Socially Assistive Robots integrated with monitoring and stimulation platforms can be successfully used for long-term support to older adults. We describe how the robot's presence significantly incentivised the use of the system, but slightly lowered the system's overall acceptability. Finally, we emphasise that real-world long-term deployment of SARs introduces a significant technical, organisational, and logistical overhead that should not be neglected nor underestimated in the pursuit of long-term robust systems. We hope that the findings and lessons learned from our work can bring value towards future long-term real-world and widespread use of SARs.

Delivering Digital Healthcare for Elderly: A Holistic Framework for the Adoption of Ambient Assisted Living

Adoption of Ambient Assisted Living (AAL) technologies for geriatric healthcare is suboptimal. This study aims to present the AAL Adoption Diamond Framework, encompassing a set of key enablers/barriers as factors, and describe our approach to developing this framework. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. SCOPUS, IEEE Xplore, PubMed, ProQuest, Science Direct, ACM Digital Library, SpringerLink, Wiley Online Library and grey literature were searched. Thematic analysis was performed to identify factors reported or perceived to be important for adopting AAL technologies. Of 3717 studies initially retrieved, 109 were thoroughly screened and 52 met our inclusion criteria. Nineteen unique technology adoption factors were identified. The most common factor was privacy (50%) whereas data accuracy and affordability were the least common factors (4%). The highest number of factors found per a given study was eleven whereas the average number of factors across all studies included in our sample was four (mean = 3.9). We formed an AAL technology adoption framework based on the retrieved information and named it the AAL Adoption Diamond Framework. This holistic framework was formed by organising the identified technology adoption factors into four key dimensions: Human, Technology, Business, and Organisation. To conclude, the AAL Adoption Diamond Framework is holistic in term of recognizing key factors for the adoption of AAL technologies, and novel and unmatched in term of structuring them into four overarching themes or dimensions, bringing together the individual and the systemic factors evolving around the adoption of AAL technology. This framework is useful for stakeholders (e.g., decision-makers, healthcare providers, and caregivers) to adopt and implement AAL technologies.

Design Considerations for Novel Self-Adapting Toilets for Semi-Public Spaces

People with physical limitations face significant challenges when using existing toilets. User requirements work shows the wide range of user needs and confirms the high demand for innovative toilets, enabling people to leave home more often and participate more in societal life. The Toilet For Me too (T4ME2) project aims to implement and test a new ICT-based toilet system capable of physically supporting users, allowing autonomous and safe use outside the home.

Methodological Quality of User-Centered Usability Evaluation of Ambient Assisted Living Solutions: A Systematic Literature Review

This study aimed to determine the methodological quality of user-centered usability evaluation of Ambient Assisted Living (AAL) solutions by (i) identifying the characteristics of the AAL studies reporting on user-centered usability evaluation, (ii) systematizing the methods, procedures and instruments being used, and (iii) verifying if there is evidence of a common understanding on methods, procedures, and instruments for user-centered usability evaluation. An electronic search was conducted on Web of Science, Scopus, and IEEE Xplore databases, combining relevant keywords. Then, titles and abstracts were screened against inclusion and exclusion criteria, and the full texts of the eligible studies were retrieved and screened for inclusion. A total of 44 studies were included. The results show a great heterogeneity of methods, procedures, and instruments to evaluate the usability of AAL solutions and, in general, the researchers fail to consider and report relevant methodological aspects. Guidelines and instruments to assess the quality of the studies might help improving the experimental design and reporting of studies on user-centered usability evaluation of AAL solutions.

Efficient methods for acute stress detection using heart rate variability data from Ambient Assisted Living sensors

Background

Using Ambient Assisted Living sensors to detect acute stress could help people mitigate the harmful effects of everyday stressful situations. This would help both the healthy and those affected more by sudden stressors, e.g., people with diabetes or heart conditions. The study aimed to develop a method for providing reliable stress detection based on heart rate variability features extracted from portable devices.

Methods

Features extracted from portable electrocardiogram sensor recordings were used for training various classification algorithms for stress detection purposes. Data were recorded in a clinical trial with 7 participants and two stressors, the Trier Social Stress Test and the Stroop colour word test, both validated by standardised questionnaires. Different heart rate variability feature sets (all, time-domain and non-linear only, frequency-domain only) were tested to investigate how classification performance is affected, in addition to various time window length setups and participant-wise training sessions. The accuracy and F1 score of the trained models were compared and analysed.

Results

The best results were achieved with models using time-domain and non-linear heart rate variability features with 5-min-long overlapping time windows, yielding 96.31% accuracy and 96.26% F1 score. Shorter overlapping windows had slightly lower performance, with 91.62–94.55% accuracy and 91.77–94.55% F1 score ranges. Non-overlapping window configurations were less effective, with both accuracy and F1 score below 88%. For participant-wise learning, average F1 scores of 99.47%, 98.93% and 96.1% were achieved for feature sets using all, time-domain and non-linear, and frequency-domain features, respectively.

Conclusion

The tested stress detector models based on heart rate variability data recorded by a single electrocardiogram sensor performed just as well as those published in the literature working with multiple sensors, or even better. This suggests that once portable devices such as smartwatches provide reliable hear rate variability recordings, efficient stress detection can be achieved without the need for additional physiological measurements.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12938-021-00911-6.

Development of a Role Model for the Use of Smart Home Based Data in Medical Care

Smart home systems create new opportunities for patient care. In this paper, a role model is created for the different groups of people involved in the care process of an occupant. Based on a systematic literature review seven roles were identified. A second literature review deals with the topic Feedback of Smart Home Systems. Combining both reviews visualization proposals were created and are presented for two of the roles. The role model is adapted to German health system but could be transformed for different countries. To confirm the results an evaluation of role model and visualization proposal should be done in collaboration with possible users of smart homes.

Automated Engineering for Health Smart Homes: Find a Way in the Jungle of Assistance Systems

Health Smart Homes are a promising part of digital personalized health care. However, engineering of the underlying residential assistance systems is a complex process that needs to be supported by computer-based design tools. This paper presents a formal definition for the engineering task and proposes a methodology for model-driven design process automation, that is implemented in a web-based pilot application. Using this approach for design support, the challenge to efficiently compose personalized assistance systems for patients can be coped with in the future, which reduces a major barrier for smart home assistance applications.

An Innovative AAL System Based on IoT Technologies for Patients with Sarcopenia

Sarcopenia is a highly prevalent, age-related muscle disorder associated with adverse outcomes. It is very important from a medical point of view to periodically monitor patients at risk of developing sarcopenia in order to early detect its onset or progression through objective and specific indicators. Today, the emerging Internet of Things (IoT)-enabling technologies allow us to create innovative, wearable, and non-invasive systems that can offer useful clinical support in this area. This work is focused on the use of combined hardware and software technologies, enabling the IoT, in order to monitor people suffering from sarcopenia by offering a high value-added service in the field of the Ambient Assisted Living (AAL). In addition to the description of the proposed system architecture, a validation of the entire system is also included, from both a performance and a functional point of view. Test beds have been carried out by using the independent replications method, and all measurements related to the identified sarcopenia parameters are characterized by a 95% confidence interval with a 5% maximum relative error. The implementation of these technologies as a supporting clinical tool used in a specific setting could significantly impact the life and independence of the sarcopenic frail elderly population.

HABITAT: An IoT Solution for Independent Elderly

In this work, a flexible and extensive digital platform for Smart Homes is presented, exploiting the most advanced technologies of the Internet of Things, such as Radio Frequency Identification, wearable electronics, Wireless Sensor Networks, and Artificial Intelligence. Thus, the main novelty of the paper is the system-level description of the platform flexibility allowing the interoperability of different smart devices. This research was developed within the framework of the operative project HABITAT (Home Assistance Based on the Internet of Things for the Autonomy of Everybody), aiming at developing smart devices to support elderly people both in their own houses and in retirement homes, and embedding them in everyday life objects, thus reducing the expenses for healthcare due to the lower need for personal assistance, and providing a better life quality to the elderly users.

A Behaviour Monitoring System (BMS) for Ambient Assisted Living

Unusual changes in the regular daily mobility routine of an elderly person at home can be an indicator or early symptom of developing health problems. Sensor technology can be utilised to complement the traditional healthcare systems to gain a more detailed view of the daily mobility of a person at home when performing everyday tasks. We hypothesise that data collected from low-cost sensors such as presence and occupancy sensors can be analysed to provide insights on the daily mobility habits of the elderly living alone at home and to detect routine changes. We validate this hypothesis by designing a system that automatically learns the daily room-to-room transitions and permanence habits in each room at each time of the day and generates alarm notifications when deviations are detected. We present an algorithm to process the sensors' data streams and compute sensor-driven features that describe the daily mobility routine of the elderly as part of the developed Behaviour Monitoring System (BMS). We are able to achieve low detection delay with confirmation time that is high enough to convey the detection of a set of common abnormal situations. We illustrate and evaluate BMS with synthetic data, generated by a developed data generator that was designed to mimic different user's mobility profiles at home, and also with a real-life dataset collected from prior research work. Results indicate BMS detects several mobility changes that can be symptoms of common health problems. The proposed system is a useful approach for learning the mobility habits at the home environment, with the potential to detect behaviour changes that occur due to health problems, and therefore, motivating progress toward behaviour monitoring and elder's care.

homeSound: Real-Time Audio Event Detection Based on High Performance Computing for Behaviour and Surveillance Remote Monitoring

The consistent growth in human life expectancy during the recent years has driven governments and private organizations to increase the efforts in caring for the eldest segment of the population. These institutions have built hospitals and retirement homes that have been rapidly overfilled, making their associated maintenance and operating costs prohibitive. The latest advances in technology and communications envisage new ways to monitor those people with special needs at their own home, increasing their quality of life in a cost-affordable way. The purpose of this paper is to present an Ambient Assisted Living (AAL) platform able to analyze, identify, and detect specific acoustic events happening in daily life environments, which enables the medic staff to remotely track the status of every patient in real-time. Additionally, this tele-care proposal is validated through a proof-of-concept experiment that takes benefit of the capabilities of the NVIDIA Graphical Processing Unit running on a Jetson TK1 board to locally detect acoustic events. Conducted experiments demonstrate the feasibility of this approach by reaching an overall accuracy of 82% when identifying a set of 14 indoor environment events related to the domestic surveillance and patients’ behaviour monitoring field. Obtained results encourage practitioners to keep working in this direction, and enable health care providers to remotely track the status of their patients in real-time with non-invasive methods.

Monitoring Activities Related to Medication Adherence in Ambient Assisted Living Environments

A recent trend in healthcare is to motivate patients to self-manage their health conditions in home-based settings. Medication adherence is an important aspect in disease self-management since sub-optimal medication adherence by the patient can lead to serious healthcare costs and discomfort for the patient. In order to alleviate the limitations of self-reported medication adherence, we can use ambient assistive living (AAL) technologies in smart environments. Activity recognition services allow to retrieve self-management information related to medication adherence in a less intrusive way. By remotely monitor compliance with medication adherence, self-management program's interventions can be tailored and adapted based on the observed patient's behaviour. To address this challenge, we present an AAL framework that monitor activities related to medication adherence.

Understanding Through Use: Elderly's Value Identification in a Service Experience

This paper uses a qualitative approach, specifically; narrative analysis, to contextualize user's formulation of an understanding of a personalized meal planning service within the ambient assisted living domain. By focusing on how user's, in this case elderly over 65, formed an understanding of a service, and, what they thought valuable in using the service, based on their understanding. The results indicate how user's compare their initial understanding to their experienced understanding, formed during usage, and how this affects their value formulation of specific service aspects. The paper gives not only provides valuable insight into contextualizing aspects of health and wellness services, but to aspects of importance for implementation, by showing how value aspects of services from a user perspective are important to consider during these processes.

Residence as a Diagnostic and Therapeutic Area - A Smart Home Approach

The "research apartment Halberstadtstraße" (HSS) in Braunschweig, Germany, is the attempt to realize a personal living environment as a room for diagnostics and therapy with the support of health-enabling and ambient assistive technologies (HEAAT). As a research tool, the HSS will enable the efficient implementation of new HEAAT and help in evaluating these under controlled real-life conditions. This new research tool will therefore be the missing link between artificial laboratory and complete real-life conditions. For a defined period, selected subjects can live in the HSS and experience the benefit of such a "Smart Home". The academic support in a real-life controlled living-environment enables continuous monitoring of behavior patterns and habits of healthy and ill persons, evaluation of new HEAAT, and conduction of requirements analysis and acceptance studies.

A configurable sensor network applied to ambient assisted living

The rising older people population has increased the interest in Ambient Assisted Living systems. This article presents a system for monitoring the disabled or older persons developed from an existing surveillance system. The modularity and adaptability characteristics of the system allow an easy adaptation for a different purpose. The proposed system uses a network of sensors capable of motion detection that includes fall warning, identification of persons and a configurable control system which allows its use in different scenarios.

Development and evaluation of SOA-based AAL services in real-life environments: a case study and lessons learned

INTRO

The proper use of ICT services can support seniors in living independently longer. While such services are starting to emerge, current proprietary solutions are often expensive, covering only isolated parts of seniors' needs, and lack support for sharing information between services and between users. For developers, the challenge is that it is complex and time consuming to develop high quality, interoperable services, and new techniques are needed to simplify the development and reduce the development costs. This paper provides the complete view of the experiences gained in the MPOWER project with respect to using model-driven development (MDD) techniques for Service Oriented Architecture (SOA) system development in the Ambient Assisted Living (AAL) domain.

METHOD

To address this challenge, the approach of the European research project MPOWER (2006-2009) was to investigate and record the user needs, define a set of reusable software services based on these needs, and then implement pilot systems using these services. Further, a model-driven toolchain covering key development phases was developed to support software developers through this process. Evaluations were conducted both on the technical artefacts (methodology and tools), and on end user experience from using the pilot systems in trial sites.

RESULTS

The outcome of the work on the user needs is a knowledge base recorded as a Unified Modeling Language (UML) model. This comprehensive model describes actors, use cases, and features derived from these. The model further includes the design of a set of software services, including full trace information back to the features and use cases motivating their design. Based on the model, the services were implemented for use in Service Oriented Architecture (SOA) systems, and are publicly available as open source software. The services were successfully used in the realization of two pilot applications. There is therefore a direct and traceable link from the user needs of the elderly, through the service design knowledge base, to the service and pilot implementations. The evaluation of the SOA approach on the developers in the project revealed that SOA is useful with respect to job performance and quality. Furthermore, they think SOA is easy to use and support development of AAL applications. An important finding is that the developers clearly report that they intend to use SOA in the future, but not for all type of projects. With respect to using model-driven development in web services design and implementation, the developers reported that it was useful. However, it is important that the code generated from the models is correct if the full potential of MDD should be achieved. The pilots and their evaluation in the trial sites showed that the services of the platform are sufficient to create suitable systems for end users in the domain.

CONCLUSIONS

A SOA platform with a set of reusable domain services is a suitable foundation for more rapid development and tailoring of assisted living systems covering reoccurring needs among elderly users. It is feasible to realize a tool-chain for model-driven development of SOA applications in the AAL domain, and such a tool-chain can be accepted and found useful by software developers.

Innovations in health care services: the CAALYX system

PURPOSE

This paper describes proposed health care services innovations, provided by a system called CAALYX (Complete Ambient Assisted Living eXperiment). CAALYX aimed to provide healthcare innovation by extending the state-of-the-art in tele-healthcare, by focusing on increasing the confidence of elderly people living autonomously, by building on the knowledge base of the most common disorders and respective characteristic vital sign changes for this age group.

METHODS

A review of the state-of-the-art on health care services was carried out. Then, extensive research was conducted on the particular needs of the elderly in relation to home health services that, if offered to them, could improve their day life by giving them greater confidence and autonomy. To achieve this, we addressed issues associated with the gathering of clinical data and interpretation of these data, as well as possibilities of automatically triggering appropriate clinical measures. Considering this initial work we started the identification of initiatives, ongoing works and technologies that could be used for the development of the system. After that, the implementation of CAALYX was done.

FINDINGS

The innovation in CAALYX system considers three main areas of contribution: (i) The Roaming Monitoring System that is used to collect information on the well-being of the elderly users; (ii) The Home Monitoring System that is aimed at helping the elders independently living at home being implemented by a device (a personal computer or a set top box) that supports the connection of sensors and video cameras that may be used for monitoring and for interaction with the elder; (iii) The Central Care Service and Monitoring System that is implemented by a Caretaker System where attention and care services are provided to elders, where actors as Caretakers, Doctors and Relatives are logically linked to elders. Innovations in each of these areas are presented here.

CONCLUSIONS

The ageing European society is placing an added burden on future generations, as the 'elderly-to-working-age-people' ratio is set to steadily increase in the future. Nowadays, quality of life and fitness allows for most older persons to have an active life well into their eighties. Furthermore, many older persons prefer to live in their own house and choose their own lifestyle. The CAALYX system can have a clear impact in increasing older persons' autonomy, by ensuring that they do not need to leave their preferred environment in order to be properly monitored and taken care of.