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

Using whole body technologies to map the mobility of older adults

In this paper we describe the preliminary findings of two-year study that attempted to map the mobility of our oldest citizens using activity monitoring and location-aware technologies. We recruited a group of 100 adults aged between 72 and 92 years old, drawn from a 25 year longitudinal cohort, and collected lifestyle, nutrition, health and social engagement data. We also fitted a subset of the group with accelerometers and location-based tracking devices and asked them to wear these for a week in order that we could generate accurate, live mobility data and assess these data against self-reports. We are now using this data to describe the relationship between mobility, activity and physical and mental well-being, but in this preliminary paper, we outline some of the main challenges we encountered when trying to use these ‘whole body’ technologies to determine mobility

Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

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

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

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

Towards a Theory of Software Development Expertise

Software development includes diverse tasks such as implementing new features, analyzing requirements, and fixing bugs. Being an expert in those tasks requires a certain set of skills, knowledge, and experience. Several studies investigated individual aspects of software development expertise, but what is missing is a comprehensive theory. We present a first conceptual theory of software development expertise that is grounded in data from a mixed-methods survey with 335 software developers and in literature on expertise and expert performance. Our theory currently focuses on programming, but already provides valuable insights for researchers, developers, and employers. The theory describes important properties of software development expertise and which factors foster or hinder its formation, including how developers' performance may decline over time. Moreover, our quantitative results show that developers' expertise self-assessments are context-dependent and that experience is not necessarily related to expertise.Comment: 14 pages, 5 figures, 26th ACM Joint European Software Engineering Conference and Symposium on the Foundations of Software Engineering (ESEC/FSE 2018), ACM, 201

Indoor Positioning for Monitoring Older Adults at Home: Wi-Fi and BLE Technologies in Real Scenarios

This paper presents our experience on a real case of applying an indoor localization system formonitoringolderadultsintheirownhomes. Sincethesystemisdesignedtobeusedbyrealusers, therearemanysituationsthatcannotbecontrolledbysystemdevelopersandcanbeasourceoferrors. This paper presents some of the problems that arise when real non-expert users use localization systems and discusses some strategies to deal with such situations. Two technologies were tested to provide indoor localization: Wi-Fi and Bluetooth Low Energy. The results shown in the paper suggest that the Bluetooth Low Energy based one is preferable in the proposed task

An evaluation of DIADEM assisted online form completion

The DIADEM project aims to develop a web-based application in the form of an Expert System (ES) to assist cognitively impaired older-adult users in the task of interacting with and completing online transactions. Having recently developed the first experimental version of the application, this study reports on the preliminary findings of user trials carried out in three European countries top evaluate this early version of the application. Of the 94 users that took part in the trials, 77 were identified as users that were likely to present with some degree of mild cognitive impairment, and thus were included in the analysis stage. The key findings of the study indicate that users of DIADEM assisted form filling seemed report comparatively high-levels of satisfaction, particularly when considered against what is considered a typical level of satisfaction for this user group. Furthermore, as a result of a statistical analysis, the application appears to provide significantly increased levels of assistance for users presenting with higher levels of cognitive impairments, and therefore achieves its goal of catering for this particular target user group