Personalized functional health and fall risk prediction using electronic health records and in-home sensor data

Research has shown the importance of Electronic Health Records (EHR) and in-home sensor data for continuous health tracking and health risk predictions. With the increased computational capabilities and advances in machine learning techniques, we have new opportunities to use multi-modal health big data to develop accurate health tracking models. This dissertation describes the development, evaluation, and testing of systems for predicting functional health and fall risks in community-dwelling older adults using health data and machine learning techniques. In an initial study, we focused on organizing and de-identifying EHR data for analysis using HIPAA regulations. The dataset contained nine years of structured and unstructured EHR data obtained from TigerPlace, a senior living facility at Columbia, MO. The de-identification of this data was done using custom automated algorithms. The de-identified EHR data was used in several studies described in this dissertation. We then developed personalized functional health tracking models using geriatric assessments in the EHR data. Studies show that higher levels of functional health in older adults lead to a higher quality of life and improves the ability to age-in-place. Even though several geriatric assessments capture several aspects of functional health, there is limited research in longitudinally tracking the personalized functional health of older adults using a combination of these assessments. In this study, data from 150 older adult residents were used to develop a composite functional health prediction model using Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Short Form 12 (SF12). Tracking functional health objectively could help clinicians to make decisions for interventions in case of functional health deterioration. We next constructed models for fall risk prediction in older adults using geriatric assessments, demographic data, and GAITRite assessment data. A 6-month fall risk prediction model was developed with data from 93 older adult residents. Explainable AI techniques were used to provide explanations to the model predictions, such as which specific features increased the risk of fall in a particular model prediction. Such explanations to model predictions provide valuable insights for targeted interventions. In another study, we developed deep neural network models to predict fall risk from de-identified nursing notes data from 162 older adult residents from TigerPlace. Clinical nursing notes have been shown to contain valuable information related to fall risk factors. This analysis provides the groundwork for future experiments to predict fall risk in older adults using clinical notes. In addition to using EHR data to predict functional health and fall risk in older adults, two studies were conducted to predict fall and functional health from in-home sensor data. Models for in-home fall prediction using depth sensor imagery have been successfully used at TigerPlace. However, the model is prone to false fall alarms in several scenarios, such as pillows thrown on the floor and pets jumping from couches. A secondary fall analysis was performed by analyzing fall alert videos to further identify and remove false alarms. In the final study, we used in-home sensor data streaming from depth sensors and bed sensors to predict functional health and absolute geriatric assessment values. These prediction models can be used to predict the functional health of residents in absence of sparse and infrequent geriatric assessments. This can also provide continuous tracking of functional health in older adults using the streaming in-home sensor data

Kinematic assessment for stroke patients in a stroke game and a daily activity recognition and assessment system

Stroke is the leading cause of serious, long-term disabilities among which deficits in motor abilities in arms or legs are most common. Those who suffer a stroke can recover through effective rehabilitation which is delicately personalized. To achieve the best personalization, it is essential for clinicians to monitor patients' health status and recovery progress accurately and consistently. Traditionally, rehabilitation involves patients performing exercises in clinics where clinicians oversee the procedure and evaluate patients' recovery progress. Following the in-clinic visits, additional home practices are tailored and assigned to patients. The in-clinic visits are important to evaluate recovery progress. The information collected can then help clinicians customize home practices for stroke patients. However, as the number of in-clinic sessions is limited by insurance policies, the recovery information collected in-clinic is often insufficient. Meanwhile, the home practice programs report low adherence rates based on historic data. Given that clinicians rely on patients to self-report adherence, the actual adherence rate could be even lower. Despite the limited feedback clinicians could receive, the measurement method is subjective as well. In practice, classic clinical scales are mostly used for assessing the qualities of movements and the recovery status of patients. However, these clinical scales are evaluated subjectively with only moderate inter-rater and intra-rater reliabilities. Taken together, clinicians lack a method to get sufficient and accurate feedback from patients, which limits the extent to which clinicians can personalize treatment plans. This work aims to solve this problem. To help clinicians obtain abundant health information regarding patients' recovery in an objective approach, I've developed a novel kinematic assessment toolchain that consists of two parts. The first part is a tool to evaluate stroke patients' motions collected in a rehabilitation game setting. This kinematic assessment tool utilizes body-tracking in a rehabilitation game. Specifically, a set of upper body assessment measures were proposed and calculated for assessing the movements using skeletal joint data. Statistical analysis was applied to evaluate the quality of upper body motions using the assessment outcomes. Second, to classify and quantify home activities for stroke patients objectively and accurately, I've developed DARAS, a daily activity recognition and assessment system that evaluates daily motions in a home setting. DARAS consists of three main components: daily action logger, action recognition part, and assessment part. The logger is implemented with a Foresite system to record daily activities using depth and skeletal joint data. Daily activity data in a realistic environment were collected from sixteen post-stroke participants. The collection period for each participant lasts three months. An ensemble network for activity recognition and temporal localization was developed to detect and segment the clinically relevant actions from the recorded data. The ensemble network fuses the prediction outputs from customized 3D Convolutional-De-Convolutional, customized Region Convolutional 3D network and a proposed Region Hierarchical Co-occurrence network which learns rich spatial-temporal features from either depth data or joint data. The per-frame precision and the per-action precision were 0.819 and 0.838, respectively, on the validation set. For the recognized actions, the kinematic assessments were performed using the skeletal joint data, as well as the longitudinal assessments. The results showed that, compared with non-stroke participants, stroke participants had slower hand movements, were less active, and tended to perform fewer hand manipulation actions. The assessment outcomes from the proposed toolchain help clinicians to provide more personalized rehabilitation plans that benefit patients.Includes bibliographical references