Exploring Patterns of Activities of Daily Living in the Home Environment

Background: Senior citizens tend to live longer and longer independently. Judging whether a senior person is still capable of living on his own is often based on the occurrence of incidents, with all consequences thereof. In the specific case of early dementia, the symptoms are not immediately apparent and the occurrence and severity of incidents progress gradually over time. In this case, the children or grandchildren are burdened by the question whether or not the elderly adult can still live safely and independently in his or her own home. This decision is only based on input obtained through incidental visits. We believe that the capability of independent living can only be objectively judged, by a health professional, if long term objective information on the elderly person's daily activities of living (ADL) is available

Optimal sensor placement for measuring physical activity with a 3D accelerometer

Accelerometer-based activity monitors are popular for monitoring physical activity. In this study, we investigated optimal sensor placement for increasing the quality of studies that utilize accelerometer data to assess physical activity. We performed a two-staged study, focused on sensor location and type of mounting. Ten subjects walked at various walking speeds on a treadmill, performed a deskwork protocol, and walked on level ground, while simultaneously wearing five ProMove2 sensors with a snug fit on an elastic waist belt. We found that sensor location, type of activity, and their interaction-effect affected sensor output. The most lateral positions on the waist belt were the least sensitive for interference. The effect of mounting was explored, by making two subjects repeat the experimental protocol with sensors more loosely fitted to the elastic belt. The loose fit resulted in lower sensor output, except for the deskwork protocol, where output was higher. In order to increase the reliability and to reduce the variability of sensor output, researchers should place activity sensors on the most lateral position of a participant's waist belt. If the sensor hampers free movement, it may be positioned slightly more forward on the belt. Finally, sensors should be fitted tightly to the body

Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation

Background Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs). Methods A user-centered design approach was used. Through semi-structured interviews (n = 10 LC patients and 6 HCPs), focus groups (n = 5 HCPs), and scenarios (n = 5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs. Results The developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71 % of LC patients and 78 % of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score = 70, range 35–95) was rated acceptable. Conclusions A telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine

Interpreting streaming biosignals:in search of best approaches to augmenting mobile health monitoring with machine learning for adaptive clinical decision support

We investigate Body Area Networks for ambulant patient monitoring. As well as sensing physiological parameters, BAN applications may provide feedback to patients. Automating formulation of feedback requires realtime analysis and interpretation of streaming biosignals and other context and knowledge sources. We illustrate with two prototype applications: the first is designed to detect epileptic seizures and support appropriate intervention. The second is a decision support application aiding weight management; the goal is to promote health and prevent chronic illnesses associated with overweight/obesity. We begin to explore extending these and other m-health applications with generic AI-based decision support and machine learning. Monitoring success of different behavioural change strategies could provide a basis for machine learning, enabling adaptive clinical decision support by personalising and adapting strategies to individuals and their changing needs. Data mining applied to BAN data aggregated from large numbers of patients opens up possibilities for discovery of new clinical knowledge

Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD

Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness), and readiness to change activity behavior. Methods. Thirtynine patients with COPD (66.0 years; FEV 1 % predicted: 44.9%) and 21 healthy controls (57.0 years) participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm). Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls (864 ± 277 cpm versus 1162 ± 282 cpm, P < 0.001). COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3%) were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels

Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: A case control study

Deviations in daily physical activity patterns may play an important role in the development and maintenance of fatigue in the chronic fatigue syndrome (CFS). The aim of this study is to gain insight into the objective daily physical activity pattern of patients with CFS in comparison with healthy controls. The secondary objective is studying the awareness in performing physical activities. Methods: The objective daily physical activity pattern was measured with a tri-axial accelerometer in 35 patients with CFS and in 35 age- and gender-matched healthy controls. The objective daily physical activity level and distribution of physical activities at low, medium and high intensity levels during the day were measured. Moreover, variability in performing physical activities within and between subjects was computed. Subjective ratings of self-reported daily physical activity levels were assessed at a visual analog scale. Results: CFS patients were significantly less physically active in the afternoon and evening, and spent fewer activities at high intensity levels and more at low intensity levels. Moreover, CFS patients showed more variability in their own physical activity pattern during the afternoon. The heterogeneity in the physical activity pattern between subjects within the CFS and control group did not differ. Finally, CFS patients were more aware about their daily physical activity level than healthy controls. Conclusion: CFS patients showed deviations in the objectively measured daily physical activity pattern. Future research should elucidate the relation between impaired balances in daily physical activity patterns and fatigue severity in CF

Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD

Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness), and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9%) and 21 healthy controls (57.0 years) participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm). Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( cpm versus  cpm, ). COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3%) were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels

Biosignal and context monitoring: Distributed multimedia applications of body area networks in healthcare

We are investigating the use of Body Area Networks (BANs), wearable sensors and wireless communications for measuring, processing, transmission, interpretation and display of biosignals. The goal is to provide telemonitoring and teletreatment services for patients. The remote health professional can view a multimedia display which includes graphical and numerical representation of patients’ biosignals. Addition of feedback-control enables teletreatment services; teletreatment can be delivered to the patient via multiple modalities including tactile, text, auditory and visual. We describe the health BAN and a generic mobile health service platform and two context aware applications. The epilepsy application illustrates processing and interpretation of multi-source, multimedia BAN data. The chronic pain application illustrates multi-modal feedback and treatment, with patients able to view their own biosignals on their handheld device

Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation

Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs). A user-centered design approach was used. Through semi-structured interviews (n = 10 LC patients and 6 HCPs), focus groups (n = 5 HCPs), and scenarios (n = 5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs. The developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71 % of LC patients and 78 % of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score = 70, range 35-95) was rated acceptable. A telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicin