What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare

Telehealth and telecare research has been dominated by efficacy trials. The field lacks a sophisticated theorisation of [a] what matters to older people with assisted living needs; [b] how illness affects people's capacity to use technologies; and [c] the materiality of assistive technologies. We sought to develop a phenomenologically and socio-materially informed theoretical model of assistive technology use. Forty people aged 60–98 (recruited via NHS, social care and third sector) were visited at home several times in 2011–13. Using ethnographic methods, we built a detailed picture of participants' lives, illness experiences and use (or non-use) of technologies. Data were analysed phenomenologically, drawing on the work of Heidegger, and contextualised using a structuration approach with reference to Bourdieu's notions of habitus and field. We found that participants' needs were diverse and unique. Each had multiple, mutually reinforcing impairments (e.g. tremor and visual loss and stiff hands) that were steadily worsening, culturally framed and bound up with the prospect of decline and death. They managed these conditions subjectively and experientially, appropriating or adapting technologies so as to enhance their capacity to sense and act on their world. Installed assistive technologies met few participants' needs; some devices had been abandoned and a few deliberately disabled. Successful technology arrangements were often characterised by ‘bricolage’ (pragmatic customisation, combining new with legacy devices) by the participant or someone who knew and cared about them. With few exceptions, the current generation of so-called ‘assisted living technologies’ does not assist people to live with illness. To overcome this irony, technology providers need to move beyond the goal of representing technology users informationally (e.g. as biometric data) to providing flexible components from which individuals and their carers can ‘think with things’ to improve the situated, lived experience of multi-morbidity. A radical revision of assistive technology design policy may be needed

`Everyone is a winner, help is just a push of a button away. . . ' : the Telecare Plus service in Malta

This paper reports on a research study on the role of assistive technologies in later life. Re- search questions included what is the impact of assistive technologies on the quality of life of older service-users, and to what extent does assistive technology lead to an improved quality of life for subscribers and in- formal carers? The chosen method of enquiry was a case-study of the Telecare Plus service in Malta. A total of 26 semi-structured interviews were held with a convenience sample of 26 people aged 60-plus about their use and experience of this particular telecare system. The Telecare Plus service was found to contribute positively to subscribers' levels of emotional and physical wellbeing, interpersonal relations and personal develop- ment, as well as towards the quality of life of informal carers. However, research also highlighted a range of challenges that stood in the way of increased adoption rates of the Telecare Plus service by older people. The fact that the fi eld of assistive technologies in Malta lacks effi cient and clear business models constitutes another barrier towards the take up of such services.peer-reviewe

Ubiquitous healthcare profile management applying smart card technology

Nowadays, the patient-centric healthcare approach is focused on ubiquitous healthcare services. Furthermore, the adoption of cloud computing technology leads to more efficient ubiquitous healthcare systems. Moreover, the personalization of the delivery of ubiquitous healthcare services is enabled with the introduction of user profiles. In this paper, we propose five generic healthcare profile structures corresponding to the main categories of the participating entities included in a typical ubiquitous healthcare system in a cloud computing environment. In addition, we propose a profile management system incorporating smart card technology to increase its efficiency and the quality of the provided services of the ubiquitous healthcare system

Independent living program evaluation for Rebuilding All Goals Efficiently

This paper evaluates the outcome of independent living (IL) services provided to clients with Spinal Cord Injuries (SCI) by a local non-profit organization, Rebuilding All Goals Efficiently (RAGE). Agency services are directed at increasing client self-sufficiency, self-advocacy, and maintenance of least restrictive living environment. Secondary data provided by RAGE for 22 SCI clients who received services in FY10 was used in the evaluation. Outcomes were measured for living arrangement at case closure, impact of services on client’s life, and cost effectiveness of services provided. Descriptive statistical analysis of the data revealed successful outcomes for all 22 SCI clients. All clients reported a decrease in functional limitation allowing them to maintain or attain the least restrictive living arrangement following provision of services. Service costs were higher for clients with 0-14 years post disability onset indicating that services were provided to the clients with the most need, either at onset of injury or to upgrade services. The report includes short and long-term recommendations to the agency for service delivery enhancement and improvement in data collection for future studies

Emotional robots: principles and practice with PARO in Denmark, Germany and the UK

As societies age there will be a significant increase of those over 80 and a predicted increase in people with dementia. We know that loneliness increases with old age, and those living with dementia are at risk of social isolation. Also opportunities for sensory stimulation and engagement in pleasurable activities are reduced in old age. The question is what technologies can be used to extend the range of available interventions that can enhance well-being. Emotional robots have been developed for activity and therapeutic purposes. This article explores experiences of the emotional robot PARO in Denmark, Germany and UK, and provides principles of this robot as an activity or activity with a therapeutic purpose

Designing assisted living technologies 'in the wild' : preliminary experiences with cultural probe methodology

Background There is growing interest in assisted living technologies to support independence at home. Such technologies should ideally be designed ‘in the wild’ i.e. taking account of how real people live in real homes and communities. The ATHENE (Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography) project seeks to illuminate the living needs of older people and facilitate the co-production with older people of technologies and services. This paper describes the development of a cultural probe tool produced as part of the ATHENE project and how it was used to support home visit interviews with elders with a range of ethnic and social backgrounds, family circumstances, health conditions and assisted living needs. Method Thirty one people aged 60 to 98 were visited in their homes on three occasions. Following an initial interview, participants were given a set of cultural probe materials, including a digital camera and the ‘Home and Life Scrapbook’ to complete in their own time for one week. Activities within the Home and Life Scrapbook included maps (indicating their relationships to people, places and objects), lists (e.g. likes, dislikes, things they were concerned about, things they were comfortable with), wishes (things they wanted to change or improve), body outline (indicating symptoms or impairments), home plan (room layouts of their homes to indicate spaces and objects used) and a diary. After one week, the researcher and participant reviewed any digital photos taken and the content of the Home and Life Scrapbook as part of the home visit interview. Findings The cultural probe facilitated collection of visual, narrative and material data by older people, and appeared to generate high levels of engagement from some participants. However, others used the probe minimally or not at all for various reasons including limited literacy, physical problems (e.g. holding a pen), lack of time or energy, limited emotional or psychological resources, life events, and acute illness. Discussions between researchers and participants about the materials collected (and sometimes about what had prevented them completing the tasks) helped elicit further information relevant to assisted living technology design. The probe materials were particularly helpful when having conversations with non-English speaking participants through an interpreter. Conclusions Cultural probe methods can help build a rich picture of the lives and experiences of older people to facilitate the co-production of assisted living technologies. But their application may be constrained by the participant’s physical, mental and emotional capacity. They are most effective when used as a tool to facilitate communication and development of a deeper understanding of older people’s needs

Assessment and counseling to get the best efficiency and effectiveness of the assistive technology (MATCH): study protocol

Clinical Trials ID: NCT04723784[Abstract] Aims: To determine the psychosocial impact of assistive technology(AT) based on robotics and artificial intelligence in the life of people with disabilities. Background: The best match between any person with disabilities and its AT only can be gotten through a complete assessment and monitoring of his/her needs, abilities, priorities, difficulties and limitations. Without this analysis, it's possible that the device won't meet the individual's expectations. Therefore, it is important that any project focused on the development of innovating AT for people with disabilities includes the perspective of outcome measures as an important phase of the research. In this sense, the integration of the assessment, implementation process and outcome measures is crucial to guarantee the transferability for the project findings and to get the perspective from the final user. Methods: Pilot study, with prospective, longitudinal and analytical cohort. The study lasts from July 2020 until April 2023. The sample is formed by people with disabilities, ages from 2-21, that will participate from the first stage of the process (initial assessment of their abilities and needs) to the final application of outcome measures instruments (with a complete implication during the test of technology). Discussion: Only with the active participation of the person is possible to carry out a user-centered approach. This fact will allow us to define and generate technological solutions that really adjust to the expectations, needs and priorities of the people with disabilities, avoiding the AT from being abandoned, with the consequent health and social spending.Ministerio de Ciencia e Innovación (España); PID2019-104323RB-C31Ministerio de Ciencia e Innovación (España); PID2019-104323RB-C32Ministerio de Ciencia e Innovación (España); PID2019-104323RB-C33Ministerio de Ciencia e Innovación (España); PID2019-104323RB-C3

Assistive Robot with an AI-Based Application for the Reinforcement of Activities of Daily Living: Technical Validation with Users Affected by Neurodevelopmental Disorders

In this work, we propose the first study of a technical validation of an assistive robotic platform, which has been designed to assist people with neurodevelopmental disorders. The platform is called LOLA2 and it is equipped with an artificial intelligence-based application to reinforce the learning of daily life activities in people with neurodevelopmental problems. LOLA2 has been integrated with an ROS-based navigation system and a user interface for healthcare professionals and their patients to interact with it. Technically, we have been able to embed all these modules into an NVIDIA Jetson Xavier board, as well as an artificial intelligence agent for online action detection (OAD). This OAD approach provides a detailed report on the degree of performance of a set of daily life activities that are being learned or reinforced by users. All the human–robot interaction process to work with users with neurodevelopmental disorders has been designed by a multidisciplinary team. Among its main features are the ability to control the robot with a joystick, a graphical user interface application that shows video tutorials with the activities to reinforce or learn, and the ability to monitor the progress of the users as they complete tasks. The main objective of the assistive robotic platform LOLA2 is to provide a system that allows therapists to track how well the users understand and perform daily tasks. This paper focuses on the technical validation of the proposed platform and its application. To do so, we have carried out a set of tests with four users with neurodevelopmental problems and special physical conditions under the supervision of the corresponding therapeutic personnel. We present detailed results of all interventions with end users, analyzing the usability, effectiveness, and limitations of the proposed technology. During its initial technical validation with real users, LOLA2 was able to detect the actions of users with disabilities with high precision. It was able to distinguish four assigned daily actions with high accuracy, but some actions were more challenging due to the physical limitations of the users. Generally, the presence of the robot in the therapy sessions received excellent feedback from medical professionals as well as patients. Overall, this study demonstrates that our developed robot is capable of assisting and monitoring people with neurodevelopmental disorders in performing their daily living tasks.This research was funded by project AIRPLANE, with reference PID2019-104323RB-C31, of Spain’s Ministry of Science and Innovation

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program