IT applications that support aging in place:

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IT applications that support aging in place:

  1. 1. IT applications that support aging in place: seven categories of need Mike Rosen Outgoing Director Rehabilitation Engineering Labs National Rehabilitation Hospital Disclaimer: This talk is about meeting the needs of elders by using technology. Therefore it will focus on technology. It is, however, the position of the speaker, his colleagues and family that IT must be applied in the context of an integrated consumer- centered system of health care and support for independent living.
  2. 2. Seven killer app’s that support life and living  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring Note: first three are about  Health maintenance service delivery; last three are assistive; fourth one can be  Cognitive support in ADL’s either depending on one’s model of health care.  Enhanced communication with the outside  Access to information and stimulation
  3. 3. First application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication with the outside  Access to information and stimulation Talking Lights
  4. 4. For example:  Critical medical events (e.g. stroke, coronary, diabetic coma)  incapacitated Note 1: Engineering challenges  some capacities intact vary dramatically across these  Falls examples; e.g. sensor integration and knowledge-based processing  conscious but immobile for automated fall detection.  at home Note 2: Automated solutions must  away take into account the costs of false  unconscious positives and false negatives.  at home  away  Wandering (secondary to dementia)  aware  unaware
  5. 5. Second application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication with the outside  Access to information and stimulation
  6. 6. Note 1: This kind of For example: instrumented monitoring may be felt as less intrusive than  Detection, timing, counting of video. environmental use, e.g. Note 2: Wireless bed, chair, bathroom use … solutions are nearly essential.  to sample elder’s energy and engagement Note 3: Either  to note indications of depression modular retro- fittable senor  to track the progress of rehab or disease products (like X10) state or “smart home” integrated  In situ motion analysis systems*.  Crude cumulative accelerometry for overall (“Actigraphs”) *MIT, GA Tech,  Targeted processing of wearable sensor Intel, GE, signals to detect/measure particular Rochester symptoms, e.g. tremor, spasticity, o.c.d. …
  7. 7. Third application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication with the outside  Access to information and stimulation
  8. 8. the premise…  Unobtrusive monitoring of selected ADL’s in the home is technically feasible and practical.  Performance of ADLs is the most direct and ecologically valid indicator of functional status (and rehab outcome).  ADL event time records can be processed to return meaningful estimates of global functional status for display to OTs and other remote service providers …  without video
  9. 9. NRH project design …  First: develop and demonstrate a prototype sensor package and data- acquisition hardware and software for installation in a kitchen: done “Wired Independence Square” at NRH
  10. 10. micro-switch unobtrusive sensors: so far just Is the switches stove on? in-line flow switch magnetic proximity switch Is the faucet Is the running? cabinet open?
  11. 11. project design …  Then: formulate and validate estimators  Hypothesize performance metrics (PMs) based on timing and counting  Regress linear combinations of PMs against AMPS sub-scores (as the validated standard measure) across subjects  Test the hypothesis: look for correlations between PMs and AMPS scores; i.e. show that our objective automated sampling of selected task performance can estimate overall function
  12. 12. possible performance metrics …  Durations, e.g. event-to-event  Counts, e.g. # times refrigerator was opened  Categorical: yes/no  Spatial distance moved  Rates, events per time  Normalized by optimal or norm or “contract” with therapist
  13. 13. status …  Sensor package in place in Independence Square at NRH …  with funding from NIDRR via the RERC on Telerehab, and from the U.S. Army Medical Research and Materiel Command  OT research partner, trained in AMPS (Assessment of Motor and Process Skills), has tested five subjects with left CVA  In-home validation studies proposed, both cross-subject and longitudinal
  14. 14. development plan …  Bring to market the CARE package (Collection of Adls for Remote Evaluation):  Wireless switch package  Data logging and transfer box (H.323 protocol)  Hub-site data capture and processing software  Interactive display software for OTs and other service providers
  15. 15. Fourth application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication with the outside  Access to information and stimulation
  16. 16. For example: *MIT MANUS, Greg Burdea’s hand and foot systems, Dave  Sensing of medication use and prescribed Reinkensmeyer’s Java Therapy therapeutic activities to monitor compliance  “Home health technology” for regular sampling of physiological signals and video visits  integrated into home environment, e.g. the smart toilet  special purpose table-top  wearable Note 1: an engineering  implanted challenge is the processing of instrumentation signals  Telerehab, e.g. to yield clinician-friendly  speech pathology results; OR educate  psychological counseling clinicians to be  neuropsych evaluation instrumentation-friendly  wound management Note 2: always-on  assistive technology assessment streaming video monitoring may be viewed  follow-up post-discharge as Big Brother by some,  web-enabled video-enhanced robotic PT* Guardian Angel by others.
  17. 17. Fifth application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication with the outside  Access to information and stimulation
  18. 18. Note: this need is not limited to elders. For example: This is universal assistive technology.  Application of mass-market technologies such as PDA’s and GPS  Purpose-designed software and human interfaces* for prompting during home-based ADL’s, e.g. cooking: “cognitive orthoses”  Integrated smart home solutions, e.g. networking contents-monitoring refrigerator with shopping service; or digital voice prompts about safety *Elliot Cole, issues such as door locking or Institute for Cognitive remembering to shut off the stove Prosthetics
  19. 19. Sixth application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication with the outside  Access to information and stimulation
  20. 20. For example:  Phone  Email, instant messaging, …  Cell-phone-based short text message service  Televisits with remote family (via H.324 videophones; H.323 Internet-based standard; or coming 3G video cell phones)  Special-interest chat rooms, blogs, …  On-line photo albums  Web-based advocacy Note: Evidence is convincing that old age itself is not a barrier to use and politics of sophisticated IT. The habits, expectations, experience and  Amazon.com etc. attitudes of this particular generation of elders can be.
  21. 21. Seventh application …  Emergency detection and response-cuing  Activity tracking for status monitoring  Task sampling for status monitoring  Health maintenance  Cognitive support in ADL’s  Enhanced communication to the outside  Access to information and stimulation ARMCHAIR TRAVEL.COM
  22. 22. For example:  Unlimited access to all interest areas via specialty Web sites  Virtual travel  On-line news and other publications  Health information Web sites  Internet-based music browsing and downloading
  23. 23. More notes:  The majority of the products noted here are sold to the mass market. Elders are themselves a huge and growing market; but many of these IT app’s or their core technologies suit virtually the entire population.  In telehealth, communication and cognitive support, mass-market convergence products can become specialty tools -- 3G video smart phones, for example, for telehealth.
  24. 24. New Yorker Cartoon by Gregory Swissmemory USB by Victorinox

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