Evolution of Activities of Daily Living using Inertia Measurements: The Lunch and Dinner Activities

In the context of designing eHealth services for fragile people, we propose to monitor Activities of Daily Living (ADL) in order to anticipate the potential loss of autonomy by behaviour changes. Nowadays, the availability of non-stigmatising sensors such as inertial sensors embedded on Smartphones allows the estimation of people’s postures in real time in order to evaluate their autonomy in daily life. Our aim is to propose an unconstrained and non-intrusive method based on inertial sensors, which gives an indicator about a person’s autonomy. This method determines the correlation between people’s postures and activities over time in order to compute an index of ADL (IndexADL), specific to each person. The IndexADL variation over time is then a useful feature for positively or negatively evaluating people’s autonomy.  Our experiment, based on data collection of eight elderly people over a 3-month period, analyses the Lunch and Dinner activities with promising performances

Personalized Posture and Fall Classification with Shallow Gated Recurrent Units

Link to final publication : https://ieeexplore.ieee.org/document/8787455International audienceActivities of Daily Living (ADL) classification is a key part of assisted living systems as it can be used to assess a person autonomy. We present in this paper an activity classification pipeline using Gated Recurrent Units (GRU) and inertial sequences. We aim to take advantage of the feature extraction properties of neural networks to free ourselves from defining rules or manually choosing features. We also investigate the advantages of resampling input sequences and personalizing GRU models to improve the performances. We evaluate our models on two datasets: a dataset containing five common postures: sitting, lying, standing, walking and transfer and a dataset named MobiAct V2 providing ADL and falls. Results show that the proposed approach could benefit eHealth services and particularly activity monitoring

Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers

Distributed Computing and Monitoring Technologies for Older Patients

This book summarizes various approaches for the automatic detection of health threats to older patients at home living alone. The text begins by briefly describing those who would most benefit from healthcare supervision. The book then summarizes possible scenarios for monitoring an older patient at home, deriving the common functional requirements for monitoring technology. Next, the work identifies the state of the art of technological monitoring approaches that are practically applicable to geriatric patients. A survey is presented on a range of such interdisciplinary fields as smart homes, telemonitoring, ambient intelligence, ambient assisted living, gerontechnology, and aging-in-place technology. The book discusses relevant experimental studies, highlighting the application of sensor fusion, signal processing and machine learning techniques. Finally, the text discusses future challenges, offering a number of suggestions for further research directions

eHealth's potential in providing healthcare for the elderly with risk of falling due to balance disorders, in a global health perspective

Introdução: O processo global e progressivo de envelhecimento populacional e a vulnerabilidade a doenças crónicas, distúrbios do equilíbrio e quedas têm representado um dos principais desafios aos sistemas de saúde. Isto tem motivado o desenvolvimento de estratégias, incluindo a utilização de tecnologia na prestação de cuidados de saúde. Portugal e Cabo Verde têm acompanhado esta tendência, investindo em sistemas e tecnologias de informação. Contudo, a aplicabilidade clínica das soluções digitais no contexto do idoso com alterações do equilíbrio e risco de queda precisa ser explorada. Objetivo: O objetivo desta investigação foi estudar, elaborar, implementar, demonstrar e avaliar uma solução digital para a prestação complementar de cuidados de saúde a idosos com alterações do equilíbrio e risco de queda no contexto português, alinhando posteriormente a sua utilização numa perspetiva global, com o exemplo de Cabo Verde. Métodos: Utilizando Design Science Research Methodology, foi realizado um estudo de métodos mistos com estratégia explanatória sequencial. Inicialmente, foi disponibilizado um questionário no website da Ordem dos Médicos de Portugal para identificar a satisfação e constrangimentos quanto aos dados clínicos disponíveis e a relevância do eHealth no contexto da prestação de cuidados de saúde a idosos com distúrbio do equilíbrio. Foram conduzidas entrevistas individuais a médicos, explorando estratégias para o desenvolvimento de uma solução digital neste contexto. As sugestões contribuíram para o desenho e elaboração do serviço digital, inicialmente testado por cinco idosas e seus cuidadores, como prova de conceito. Este serviço foi avaliado por estes utilizadores e oito médicos com experiência em coordenação de serviços, através de dois grupos focais. Relativamente a Cabo Verde, foi conduzido um Policy Dialogue Workshop (PDW), incluindo a Direção do Hospital Central Doutor Agostinho Neto (HCDAN), para explorar o interesse e potencial utilização do serviço digital no contexto cabo-verdiano. Resultados: A identificação de constrangimentos médicos quanto aos dados clínicos disponíveis e a verificação da relevância do eHealth neste contexto motivaram a elaboração de uma solução digital. Considerando as sugestões dos entrevistados, foi desenhado o serviço digital “EQUILÍBRIO” para monitorização remota, deteção precoce de agravamento clínico, atempada adequação do tratamento e maior interação médica com os doentes. As avaliações dos doentes, cuidadores e médicos foram positivas, com o reconhecimento de vários benefícios, tais como, conforto do doente, maior proximidade médico-doente e potencial redução de recursos presenciais. No caso de Cabo Verde, a Direção do HCDAN e participantes do PDW manifestaram interesse e reconheceram o potencial de utilização do serviço digital, inclusive junto a doentes mais jovens. Conclusão: O serviço digital “EQUILÍBRIO” foi desenhado, implementado e avaliado em contexto clínico. Verificou-se um significativo potencial para aplicabilidade clínica na prestação complementar de cuidados de saúde, permitindo monitorização remota, maior interação médico-doente e participação ativa dos doentes. A implementação deste serviço em Cabo Verde representa uma oportunidade para futura investigação. O envolvimento de outros profissionais de saúde e outros países podem ser considerados como uma promissora cooperação de cuidados de saúde entre os Estados membros da Comunidade dos Países de Língua Portuguesa.Introduction: The global and progressive aging of the populations and vulnerability to chronic diseases, balance disorders and falls have represented one of the main challenges to health systems. This has motivated the development of strategies, including the use of technology for provision of health care. Portugal and Cape Verde have followed this trend, investing in technology-based information systems. However, the clinical applicability of these digital solutions in the context of elderly people with balance disorders and risk of falling needs to be explored. Objective: The objective of this research was to study, develop, implement, demonstrate and evaluate a digital solution for the complementary provision of health care for elderly people with balance disorders and risk of falling in the Portuguese context, subsequently aligning its use in a global perspective, with the example of Cape Verde. Methods: Using the Design Science Research Methodology, an explanatory sequential mixed methods study was performed. Initially, a questionnaire was made available on the website of the Portuguese General Medical Council to identify the satisfaction and difficulties with clinical data availability, and the relevance of eHealth in the context of elderly people with balance disorders. Individual interviews were carried out with physicians, exploring strategies for the development of a digital solution in this context. The suggestions contributed to the design and development of the digital service, initially tested with five elderly women and their caregivers, as a proof-of-concept. This service was evaluated through two focus groups, including these users and eight physicians with experience in coordinating services. In the case of Cape Verde, a Policy Dialogue Workshop (PDW) was carried out, including the Direction of the Hospital Central Doutor Agostinho Neto (HCDAN), to explore the interest and potential use of the digital service in the Cape Verdean context. Results: The identification of medical constraints with availability of clinical data and the identification of the relevance of eHealth in this context encouraged the development of a digital solution. Considering the suggestions of the interviewees, the digital service “BALANCE” was designed, allowing remote monitoring, early detection of clinical deterioration, timely optimization of treatment and greater medical interaction with patients. The patient, caregiver and medical evaluations were positive, with the recognition of several benefits, such as patient comfort, closer physician-patient interaction and potential lower consumption of face-to-face resources. Regarding Cape Verde, the Direction of HCDAN and the participants of the PDW expressed interest and recognized the potential for using the digital service, including among younger patients. Conclusion: The digital service “BALANCE” was designed, implemented and evaluated in the clinical context. There was significant potential for clinical applicability in the provision of complementary health care, allowing remote monitoring, closer physicianpatient interaction and active patient participation. The implementation of this service in Cape Verde is an opportunity for future research. The involvement of other health professionals and countries could be considered as a promising health care cooperation between the member states of Community of Portuguese-Speaking Countries

Digital innovation in Multiple Sclerosis Management

Due to innovation in technology, a new type of patient has been created, the e-patient, characterized by the use of electronic communication tools and commitment to participate in their own care. The extent to which the world of digital health has changed during the COVID-19 pandemic has been widely recognized. Remote medicine has become part of the new normal for patients and clinicians, introducing innovative care delivery models that are likely to endure even if the pendulum swings back to some degree in a post-COVID age. The development of digital applications and remote communication technologies for patients with multiple sclerosis has increased rapidly in recent years. For patients, eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. For HCPs, eHealth technology may facilitate the assessment of clinical disability, analysis of lab and imaging data, and remote monitoring of patient symptoms, adverse events, and outcomes. It may allow time optimization and more timely intervention than is possible with scheduled face-to-face visits. The way we measure the impact of MS on daily life has remained relatively unchanged for decades, and is heavily reliant on clinic visits that may only occur once or twice each year.These benefits are important because multiple sclerosis requires ongoing monitoring, assessment, and management.The aim of this Special Issue is to cover the state of knowledge and expertise in the field of eHealth technology applied to multiple sclerosis, from clinical evaluation to patient education

Wearable and BAN Sensors for Physical Rehabilitation and eHealth Architectures

The demographic shift of the population towards an increase in the number of elderly citizens, together with the sedentary lifestyle we are adopting, is reflected in the increasingly debilitated physical health of the population. The resulting physical impairments require rehabilitation therapies which may be assisted by the use of wearable sensors or body area network sensors (BANs). The use of novel technology for medical therapies can also contribute to reducing the costs in healthcare systems and decrease patient overflow in medical centers. Sensors are the primary enablers of any wearable medical device, with a central role in eHealth architectures. The accuracy of the acquired data depends on the sensors; hence, when considering wearable and BAN sensing integration, they must be proven to be accurate and reliable solutions. This book is a collection of works focusing on the current state-of-the-art of BANs and wearable sensing devices for physical rehabilitation of impaired or debilitated citizens. The manuscripts that compose this book report on the advances in the research related to different sensing technologies (optical or electronic) and body area network sensors (BANs), their design and implementation, advanced signal processing techniques, and the application of these technologies in areas such as physical rehabilitation, robotics, medical diagnostics, and therapy

State of the art of audio- and video based solutions for AAL

Working Group 3. Audio- and Video-based AAL ApplicationsIt is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living (AAL) technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters (e.g., heart rate, respiratory rate). Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals (e.g., speech recordings). Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary 4 debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely (i) lifelogging and self-monitoring, (ii) remote monitoring of vital signs, (iii) emotional state recognition, (iv) food intake monitoring, activity and behaviour recognition, (v) activity and personal assistance, (vi) gesture recognition, (vii) fall detection and prevention, (viii) mobility assessment and frailty recognition, and (ix) cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed.publishedVersio

Cybersecurity and the Digital Health: An Investigation on the State of the Art and the Position of the Actors

Cybercrime is increasingly exposing the health domain to growing risk. The push towards a strong connection of citizens to health services, through digitalization, has undisputed advantages. Digital health allows remote care, the use of medical devices with a high mechatronic and IT content with strong automation, and a large interconnection of hospital networks with an increasingly effective exchange of data. However, all this requires a great cybersecurity commitment—a commitment that must start with scholars in research and then reach the stakeholders. New devices and technological solutions are increasingly breaking into healthcare, and are able to change the processes of interaction in the health domain. This requires cybersecurity to become a vital part of patient safety through changes in human behaviour, technology, and processes, as part of a complete solution. All professionals involved in cybersecurity in the health domain were invited to contribute with their experiences. This book contains contributions from various experts and different fields. Aspects of cybersecurity in healthcare relating to technological advance and emerging risks were addressed. The new boundaries of this field and the impact of COVID-19 on some sectors, such as mhealth, have also been addressed. We dedicate the book to all those with different roles involved in cybersecurity in the health domain