Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems

Fall prevention intervention technologies: A conceptual framework and survey of the state of the art

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.The Royal Society, grant Ref: RG13082

Is the timed-up and go test feasible in mobile devices? A systematic review

The number of older adults is increasing worldwide, and it is expected that by 2050 over 2 billion individuals will be more than 60 years old. Older adults are exposed to numerous pathological problems such as Parkinson’s disease, amyotrophic lateral sclerosis, post-stroke, and orthopedic disturbances. Several physiotherapy methods that involve measurement of movements, such as the Timed-Up and Go test, can be done to support efficient and effective evaluation of pathological symptoms and promotion of health and well-being. In this systematic review, the authors aim to determine how the inertial sensors embedded in mobile devices are employed for the measurement of the different parameters involved in the Timed-Up and Go test. The main contribution of this paper consists of the identification of the different studies that utilize the sensors available in mobile devices for the measurement of the results of the Timed-Up and Go test. The results show that mobile devices embedded motion sensors can be used for these types of studies and the most commonly used sensors are the magnetometer, accelerometer, and gyroscope available in off-the-shelf smartphones. The features analyzed in this paper are categorized as quantitative, quantitative + statistic, dynamic balance, gait properties, state transitions, and raw statistics. These features utilize the accelerometer and gyroscope sensors and facilitate recognition of daily activities, accidents such as falling, some diseases, as well as the measurement of the subject's performance during the test execution.info:eu-repo/semantics/publishedVersio

Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia

Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials

Fall prevention strategy for an active orthotic system

Dissertação de mestrado integrado em Engenharia Biomédica (especialização em Eletrónica Médica)Todos os anos, são reportadas cerca de 684,000 quedas fatais e 37.3 milhões de quedas não fatais que requerem atenção médica, afetando principalmente a população idosa. Assim, é necessário identificar eficientemente indivíduos com alto risco de queda, a partir da população alvo idosa, e prepará los para superar perturbações da marcha inesperadas. Uma estratégia de prevenção de queda capaz de eficientemente e atempadamente detetar e contrariar os eventos de perdas de equilíbrio (PDE) mais frequentes pode reduzir o risco de queda. Como slips foram identificados como a causa mais prevalente de quedas, estes eventos devem ser abordados como foco principal da estratégia. No entanto, há falta de estratégias de prevenção de quedas por slip. Esta dissertação tem como objetivo o design de uma estratégia de prevenção de quedas de slips baseada na conceção das etapas de atuação e deteção. A estratégia de atuação foi delineada com base na resposta biomecânica humana a slips, onde o joelho da perna perturbada (leading) apresenta um papel proeminente para contrariar LOBs induzidas por slips. Quando uma slip é detetada, a estratégia destaca uma ortótese de joelho que providencia um torque assisstivo para prevenir a queda. A estratégia de deteção considerou as propriedades atrativas dos controladores Central Pattern Generator (CPG) para prever parâmetros da marcha. Algoritmos baseados em threshold monitorizam o erro de previsão do CPG, que aumenta após uma perturbação inesperada na marcha, para a deteção de slips. O ângulo do joelho e a velocidade angular da canela foram selecionados como os parâmetros de monitorização da marcha. Um protocolo experimental concebido para provocar perturbações de slip a sujeitos humanos permitiu a recolha de dados destas variáveis para posteriormente validar o algoritmo de deteção de perturbações. Algoritmos CPG foram capazes de produzir aproximações aceitáveis dos sinais de marcha em estado estacionário do ângulo do joelho e da velocidade angular da canela com sucesso. Além disso, o algoritmo de threshold adaptativo detetou LOBs induzidas por slips eficientemente. A melhor performance global foi obtida usando este algoritmo para monitorizar o ângulo do joelho, que detetou quase 80% (78.261%) do total de perturbações com um tempo médio de deteção (TMD) de 250 ms. Além disso, uma média de 0.652 falsas perturbações foram detetadas por cada perturbação corretamente identificada. Estes resultados sugerem uma performance aceitável de deteção de perturbações do algoritmo, de acordo com os requisitos especificados para a deteção.Every year, an estimated 684,000 fatal falls and 37.3 million non-fatal falls requiring medical attention are reported, mostly affecting the older population. Thus, it is necessary to effectively screen high fall risk individuals from targeted elderly populations and prepare them to successfully overcome unexpected gait perturbations. A fall prevention strategy capable of effectively and timely detect and counteract the most frequent loss of balance (LOB) events may reduce the fall risk. Since slips were identified as the main contributors to falls, these events should be addressed as a main focus of the strategy. Nonetheless, there is a lack of slip-induced fall prevention strategies. This dissertation aims the design of a slip-related fall prevention strategy based on the conception of an actuation and a detection stage. The actuation strategy was delineated based on the human biomechanical reactions to slips, where the perturbed (leading) leg’s knee joint presents a prominent role to counteract slip-induced LOBs. Thereby, upon the detection of a slip, this strategy highlighted a knee orthotic device that provides an assistive torque to prevent the falls. The detection strategy considered the attractive properties of biological-inspired Central Pattern Generator (CPG) controllers to predict gait parameters. Threshold-based algorithms monitored the CPG’s prediction error produced, which increases upon an unexpected gait perturbation, to perform slip detection. The knee angle and shank angular velocity were selected as the monitoring gait parameters. An experimental protocol designed to provoke slip perturbations to human subjects allowed to collect data from these variables to further validate the perturbation detection algorithm. CPG algorithms were able to successfully produce acceptable estimations of the knee angle and shank angular velocity signals during steady-state walking. Furthermore, an adaptive threshold algorithm effectively detected slip-induced LOBs. The best overall performance was obtained using this algorithm to monitor the knee angle from the perturbed leg, which detected almost 80% (78.261%) of the total perturbations with a mean detection time (MDT) of 250 ms. In addition, a mean of 0.652 false perturbations were detected for each correct perturbation identified. These results suggest an acceptable perturbation detection performance of the algorithm implemented in light of the detection requirements specified

A preliminary strategy for fall prevention in the ASBGo smart walker

Fall-related injuries affect a large part of the population and related costs. Thus, there is a concern in studying a fall prevention strategy to minimize the consequences of falls. Walkers are assistive devices used to improve the balance, stability and reduce the load on the lower limb of the user. In this sense, there is a concern to improve the safety in smart walkers and, consequently, to prevent falls in these devices. However, in this field, the only approach is to stop the walker in risk situations. So, the aim of this paper is to define a preliminary strategy to prevent a fall event in the Adaptive System Behaviour Group (ASBGo) Smart Walker. For ASBGo Smart Walker, two modes of security are discussed in this paper. One approach is based on monitoring the center of mass and changing the trajectory when a near fall is detected. The other mechanism consists only in to stop the walker when a dangerous situation is detected. The first or the second mode are activated depending if the user drives the walker with the forearm on forearm support or not.This work has been supported by the FCT – Fundação para a Ciência e Tecnologia - with the scholarship reference PD/BD/141515/2018, by the FEDER funds through the COMPETE 2020 - Programa Operacional Competitividade e Internacionalização (POCI) and P2020 with the Reference Project EML under Grant POCI-01-0247-FEDER-033067, and through the COMPETE 2020 - POCI - with the Reference Project under Grant POCI-01-0145-FEDER-00694

First advances in near fall detection and prediction when using a walker

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)Falls are a major concern to society. Several injuries associated with falls need medical care, and in the worst-case scenario, a fall can lead to death. These consequences have a high cost for the population. In order to overcome these problems, a diversity of approaches for detection, prediction, and prevention of falls have been tackled. Walkers are often prescribed to subjects who present a higher risk of falling. Thus, it is essential to develop strategies to enhance the user's safety in an imminent danger situation. In this sense, this dissertation aims to develop a strategy to detect a near fall (NF) and its direction as well as the detection of incipient near fall (INF) while the subject uses a walker. Furthermore, it has the purpose of detecting two gait events, the heel strike (HS) and the toe-off (TO). The strategies established, in this work, were based on the data gathered through an inertial sensor placed on the lower trunk and force sensors placed on the insoles. Following data collection, the methodology adopted to identify the situations aforementioned was based on machine learning algorithms. In order to reach the model with best performance, many combinations of different classifiers were tested with three feature selection methods. Regarding the detection of NF, the results achieved presented a Matthews Correlation Coefficient (MCC) of 79.99% being possible to detect a NF 1.76±0.76s before its end. With the implementation of the post-processing algorithm, a large part of the false positives was eliminated being able to detect all NF 1.48±0.68s before its end. Concerning the models built to distinguish the direction of the NF, the best model presented accuracy of 58.97% being unable to reliably distinguish the three fall directions. The methodology followed, in this work, was unsuccessful to detect an INF. The best model presented MCC=23.87%, in this case. Lastly, with respect to the detection of HS and TO events the best model reached MCC=86.94%. With the application of the post-processing algorithm, part of misclassified samples was eliminated, however, a delay in the detection of the HS and TO events was introduced. With the post-processing it was possible to reach MCC=88.82%, not including the imposed delay.As quedas representam uma grande preocupação para a sociedade. Várias lesões associadas às quedas necessitam de cuidados médicos e, no pior dos casos, uma queda pode levar à morte. Estas consequências traduzem-se em custos elevados para a população. A fim de ultrapassar estes problemas, várias abordagens têm sido endereçadas para deteção, previsão e prevenção das quedas. Os andarilhos são muitas vezes prescritos a sujeitos que apresentam um risco de queda maior. Desta forma, é essencial desenvolver estratégias para aumentar a segurança do utilizador perante uma situação de perigo iminente. Neste sentido, esta dissertação visa desenvolver uma estratégia que permita a deteção de uma quase queda (NF) e a sua direção, assim como a deteção incipiente de uma NF (INF). Para além disso, tem o objetivo de detetar dois eventos de marcha, o heel strike (HS) e o toe-off (TO). As estratégias definidas, neste trabalho, basearam-se nos dados recolhidos através de um sensor inercial posicionado no tronco inferior e de sensores de força colocados nas palmilhas. Após a aquisição dos dados, a metodologia adotada para identificar as situações anteriormente referidas foi baseada em algoritmos de machine learning. Com o intuito de obter o modelo com melhor desempenho, várias combinações de diferentes classificadores foram testadas com três métodos de seleção de features. No que concerne à deteção da NF, os resultados alcançados apresentaram um Matthews Correlation Coefficient (MCC) de 79.99% sendo possível detetar uma NF 1.76±0.76s antes do seu final. Com a implementação do algoritmo de pós-processamento, grande parte dos falsos positivos foram eliminados, sendo possível detetar todas as NF 1.48±0.68s antes do seu final. Em relação aos modelos construídos para distinguir a direção da NF, o melhor modelo apresentou uma precisão (ACC) de 59.97%. A metodologia seguida neste trabalho não foi bem sucedida na deteção INF. O melhor modelo apresentou um MCC=23.87%. Relativamente à deteção dos eventos, HS e TO, o melhor modelo atingiu um MCC=86.94%. Com a aplicação do algoritmo de pós-processamento parte das amostras mal classificadas foram eliminadas, no entanto, foi introduzido um atraso na deteção do HS e do TO. Com o pós-processamento foi possível obter um MCC=88.82%, não incluindo o atraso imposto pelo pós-processamento

Instrumentation of a cane to detect and prevent falls

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)The number of falls is growing as the main cause of injuries and deaths in the geriatric community. As a result, the cost of treating the injuries associated with falls is also increasing. Thus, the development of fall-related strategies with the capability of real-time monitoring without user restriction is imperative. Due to their advantages, daily life accessories can be a solution to embed fall-related systems, and canes are no exception. Moreover, gait assessment might be capable of enhancing the capability of cane usage for older cane users. Therefore, reducing, even more, the possibility of possible falls amongst them. Summing up, it is crucial the development of strategies that recognize states of fall, the step before a fall (pre-fall step) and the different cane events continuously throughout a stride. This thesis aims to develop strategies capable of identifying these situations based on a cane system that collects both inertial and force information, the Assistive Smart Cane (ASCane). The strategy regarding the detection of falls consisted of testing the data acquired with the ASCane with three different fixed multi-threshold fall detection algorithms, one dynamic multi-threshold and machine learning methods from the literature. They were tested and modified to account the use of a cane. The best performance resulted in a sensitivity and specificity of 96.90% and 98.98%, respectively. For the detection of the different cane events in controlled and real-life situations, a state-of-the-art finite-state-machine gait event detector was modified to account the use of a cane and benchmarked against a ground truth system. Moreover, a machine learning study was completed involving eight feature selection methods and nine different machine learning classifiers. Results have shown that the accuracy of the classifiers was quite acceptable and presented the best results with 98.32% of overall accuracy for controlled situations and 94.82% in daily-life situations. Regarding pre-fall step detection, the same machine learning approach was accomplished. The models were very accurate (Accuracy = 98.15%) and with the implementation of an online post-processing filter, all the false positive detections were eliminated, and a fall was able to be detected 1.019s before the end of the corresponding pre-fall step and 2.009s before impact.O número de quedas tornou-se uma das principais causas de lesões e mortes na comunidade geriátrica. Como resultado, o custo do tratamento das lesões também aumenta. Portanto, é necessário o desenvolvimento de estratégias relacionadas com quedas e que exibam capacidade de monitorização em tempo real sem colocar restrições ao usuário. Devido às suas vantagens, os acessórios do dia-a-dia podem ser uma solução para incorporar sistemas relacionados com quedas, sendo que as bengalas não são exceção. Além disso, a avaliação da marcha pode ser capaz de aprimorar a capacidade de uso de uma bengala para usuários mais idosos. Desta forma, é crucial o desenvolvimento de estratégias que reconheçam estados de queda, do passo anterior a uma queda e dos diferentes eventos da marcha de uma bengala. Esta dissertação tem como objetivo desenvolver estratégias capazes de identificar as situações anteriormente descritas com base num sistema incorporado numa bengala que coleta informações inerciais e de força, a Assistive Smart Cane (ASCane). A estratégia referente à deteção de quedas consistiu em testar os dados adquiridos através da ASCane com três algoritmos de deteção de quedas (baseados em thresholds fixos), com um algoritmo de thresholds dinâmicos e diferentes classificadores de machine learning encontrados na literatura. Estes métodos foram testados e modificados para dar conta do uso de informação adquirida através de uma bengala. O melhor desempenho alcançado em termos de sensibilidade e especificidade foi de 96,90% e 98,98%, respetivamente. Relativamente à deteção dos diferentes eventos da ASCane em situações controladas e da vida real, um detetor de eventos da marcha foi e comparado com um sistema de ground truth. Além disso, foi também realizado um estudo de machine learning envolvendo oito métodos de seleção de features e nove classificadores diferentes de machine learning. Os resultados mostraram que a precisão dos classificadores foi bastante aceitável e apresentou, como melhores resultados, 98,32% de precisão para situações controladas e 94.82% para situações do dia-a-dia. No que concerne à deteção de passos pré-queda, a mesma abordagem de machine learning foi realizada. Os modelos foram precisos (precisão = 98,15%) e com a implementação de um filtro de pós-processamento, todas as deteções de falsos positivos foram eliminadas e uma queda foi passível de ser detetada 1,019s antes do final do respetivo passo de pré-queda e 2.009s antes do impacto

Assessing the feasibility of augmenting fall detection systems by relying on UWB-based position tracking and a home robot

Falls in the home environment are a primary cause of injury in older adults. According to the U.S. Centers for Disease Control and Prevention, every year, one in four adults 65 years of age and older reports experiencing a fall. A variety of different technologies have been proposed to detect fall events. However, the need to detect all fall instances (i.e., to avoid false negatives) has led to the development of systems marked by high sensitivity and hence a significant number of false alarms. The occurrence of false alarms causes frequent and unnecessary calls to emergency response centers, which are critical resources that should be utilized only when necessary. Besides, false alarms decrease the level of confidence of end-users in the fall detection system with a negative impact on their compliance with using the system (e.g., wearing the sensor enabling the detection of fall events). Herein, we present a novel approach aimed to augment traditional fall detection systems that rely on wearable sensors and fall detection algorithms. The proposed approach utilizes a UWB-based tracking system and a home robot. When the fall detection system generates an alarm, the alarm is relayed to a base station that utilizes a UWB-based tracking system to identify where the older adult and the robot are so as to enable navigating the environment using the robot and reaching the older adult to check if he/she experienced a fall. This approach prevents unnecessary calls to emergency response centers while enabling a tele-presence using the robot when appropriate. In this paper, we report the results of a novel fall detection algorithm, the characteristics of the alarm notification system, and the accuracy of the UWB-based tracking system that we implemented. The fall detection algorithm displayed a sensitivity of 99.0% and a specificity of 97.8%. The alarm notification system relayed all simulated alarm notification instances with a maximum delay of 106 ms. The UWB-based tracking system was found to be suitable to locate radio tags both in line-of-sight and in no-line-of-sight conditions. This result was obtained by using a machine learning-based algorithm that we developed to detect and compensate for the multipath effect in no-line-of-sight conditions. When using this algorithm, the error affecting the estimated position of the radio tags was smaller than 0.2 m, which is satisfactory for the application at hand