IT applications that IT applications that support aging in place:support aging in place:

seven categories of needseven categories of needMike RosenMike Rosen

Outgoing DirectorOutgoing DirectorRehabilitation Engineering LabsRehabilitation Engineering LabsNational Rehabilitation HospitalNational Rehabilitation Hospital

Disclaimer: This talk is about meeting the needs of elders by using technology. Therefore it will focus on technology. It is, however, the position of the speaker, his colleagues and family that IT must be applied in the context of an integrated consumer-centered system of health care and support for independent living.

Seven killer app’s that Seven killer app’s that support life and livingsupport life and living Emergency detection and response-cuingEmergency detection and response-cuing Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s Enhanced communication with the outsideEnhanced communication with the outside Access to information and stimulationAccess to information and stimulation

Note: first three are about service delivery; last three are assistive; fourth one can be either depending on one’s model of health care.

First application …First application … Emergency detection and response-Emergency detection and response-

cuingcuing Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s Enhanced communication with the outsideEnhanced communication with the outside Access to information and stimulationAccess to information and stimulation

Talking Lights

For example:For example: Critical medical events (e.g. stroke, Critical medical events (e.g. stroke,

coronary, diabetic coma)coronary, diabetic coma) incapacitatedincapacitated some capacities intactsome capacities intact

FallsFalls conscious but immobileconscious but immobile

at homeat home awayaway

unconsciousunconscious at homeat home awayaway

Wandering (secondary to dementia)Wandering (secondary to dementia) aware aware unawareunaware

Note 1: Engineering challenges vary dramatically across these examples; e.g. sensor integration and knowledge-based processing for automated fall detection.

Note 2: Automated solutions must take into account the costs of false positives and false negatives.

Second application …Second application …

Emergency detection and response-cuingEmergency detection and response-cuing

Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s Enhanced communication with the outsideEnhanced communication with the outside Access to information and stimulationAccess to information and stimulation

For example:For example: Detection, timing, counting of Detection, timing, counting of

environmental use, e.g. bed, chair, environmental use, e.g. bed, chair, bathroom use …bathroom use … to sample elder’s energy and to sample elder’s energy and

engagementengagement to note indications of depressionto note indications of depression to track the progress of rehab or disease to track the progress of rehab or disease

statestate In situIn situ motion analysis motion analysis

Crude cumulative accelerometry for Crude cumulative accelerometry for overall (“Actigraphs”)overall (“Actigraphs”)

Targeted processing of wearable sensor Targeted processing of wearable sensor signals to detect/measure particular signals to detect/measure particular symptoms, e.g. tremor, spasticity, o.c.d. symptoms, e.g. tremor, spasticity, o.c.d. ……

Note 1: This kind of instrumented monitoring may

be felt as less intrusive than

video.

Note 2: Wireless solutions are

nearly essential.

Note 3: Either modular retro-fittable senor products (like

X10) or “smart home”

integrated systems*.

*MIT, GA Tech, Intel,

GE, Rochester

Third application …Third application …

Emergency detection and response-cuingEmergency detection and response-cuing Activity tracking for status monitoringActivity tracking for status monitoring

Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s Enhanced communication with the outsideEnhanced communication with the outside Access to information and stimulationAccess to information and stimulation

the premise…the premise… Unobtrusive monitoring of selected ADL’s Unobtrusive monitoring of selected ADL’s

in the home is technically feasible and in the home is technically feasible and practical.practical.

Performance of ADLs is the most direct Performance of ADLs is the most direct and ecologically valid indicator of and ecologically valid indicator of functional status (and rehab outcome).functional status (and rehab outcome).

ADL event time records can be processed ADL event time records can be processed to return meaningful estimates of global to return meaningful estimates of global functional status for display to OTs and functional status for display to OTs and other remote service providers …other remote service providers …

without videowithout video

NRH project design …NRH project design … First:First: develop develop

and and demonstrate a demonstrate a

prototype prototype sensor package sensor package

and data-and data-acquisition acquisition

hardware and hardware and software for software for

installation in a installation in a kitchen: kitchen: donedone “Wired

Independence Square” at NRH

unobtrusiveunobtrusivesensors: so sensors: so far just far just switchesswitches

Is the faucet running?Is the

cabinet open?

Is the stove on?

in-lineflow switch

micro-switch

magnetic proximity switch

project design …project design … ThenThen: formulate and : formulate and validatevalidate estimators estimators

Hypothesize Hypothesize performance metrics (PMs) performance metrics (PMs) based on timing and countingbased on timing and counting

RegressRegress linear combinations of PMs linear combinations of PMs against AMPS sub-scores (as the validated against AMPS sub-scores (as the validated standard measure) across subjectsstandard measure) across subjects

Test the hypothesis: Test the hypothesis: look for correlations look for correlations between PMs and AMPS scores; i.e. show between PMs and AMPS scores; i.e. show that our objective automated sampling of that our objective automated sampling of selected task performance can estimate selected task performance can estimate overall functionoverall function

possible performance possible performance metrics …metrics …

Durations, e.g. event-to-eventDurations, e.g. event-to-event Counts, e.g. # times refrigerator was Counts, e.g. # times refrigerator was

openedopened Categorical: yes/noCategorical: yes/no Spatial distance moved Spatial distance moved Rates, events per timeRates, events per time Normalized by optimal or norm or Normalized by optimal or norm or

“contract” with therapist“contract” with therapist

status …status … Sensor package in place in Sensor package in place in

Independence Square at NRH …Independence Square at NRH … with funding from NIDRR via the RERC with funding from NIDRR via the RERC

on Telerehab, and from the U.S. Army on Telerehab, and from the U.S. Army Medical Research and Materiel Medical Research and Materiel CommandCommand

OT research partner, trained in AMPS OT research partner, trained in AMPS (Assessment of Motor and Process (Assessment of Motor and Process Skills), has tested five subjects with left Skills), has tested five subjects with left CVACVA

In-home validation studies proposed, In-home validation studies proposed, both cross-subject and longitudinalboth cross-subject and longitudinal

development plan …development plan …

Bring to market the CARE package Bring to market the CARE package ((CCollection of ollection of AAdls for dls for RRemote emote EEvaluation):valuation): Wireless switch packageWireless switch package Data logging and transfer box (H.323 Data logging and transfer box (H.323

protocol)protocol) Hub-site data capture and processing Hub-site data capture and processing

softwaresoftware Interactive display software for OTs and Interactive display software for OTs and

other service providersother service providers

Fourth application …Fourth application … Emergency detection and response-cuingEmergency detection and response-cuing Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring

Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s Enhanced communication with the outsideEnhanced communication with the outside Access to information and stimulationAccess to information and stimulation

For For example:example: Sensing of medication use and prescribed Sensing of medication use and prescribed

therapeutic activities to monitor compliancetherapeutic activities to monitor compliance ““Home health technology” for regular sampling Home health technology” for regular sampling

of physiological signals and video visitsof physiological signals and video visits integrated into home environment, e.g. the smart integrated into home environment, e.g. the smart

toilettoilet special purpose table-topspecial purpose table-top wearablewearable implantedimplanted

Telerehab, e.g. Telerehab, e.g. speech pathologyspeech pathology psychological counselingpsychological counseling neuropsych evaluationneuropsych evaluation wound managementwound management assistive technology assessment assistive technology assessment follow-up post-discharge follow-up post-discharge web-enabled video-enhanced robotic PTweb-enabled video-enhanced robotic PT**

Note 1: an engineering challenge is the processing of instrumentation signals to yield clinician-friendly results; OR educate clinicians to be instrumentation-friendly

Note 2: always-on streaming video monitoring may be viewed as Big Brother by some, Guardian Angel by others.

*MIT MANUS, Greg Burdea’s hand and foot

systems, Dave Reinkensmeyer’s Java

Therapy

Fifth application …Fifth application … Emergency detection and response-Emergency detection and response-

cuingcuing Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance

Cognitive support in Cognitive support in ADL’sADL’s

Enhanced communication with the Enhanced communication with the outsideoutside

Access to information and stimulationAccess to information and stimulation

For example:For example: Application of mass-market Application of mass-market

technologies such as PDA’s and GPStechnologies such as PDA’s and GPS Purpose-designed software and Purpose-designed software and

human interfaceshuman interfaces** for prompting for prompting during home-based ADL’s, e.g. during home-based ADL’s, e.g. cooking: “cognitive orthoses”cooking: “cognitive orthoses”

Integrated smart home solutions, Integrated smart home solutions, e.g. networking contents-e.g. networking contents-monitoring refrigerator with monitoring refrigerator with shopping service; or digital voice shopping service; or digital voice prompts about safety issues such prompts about safety issues such as door locking or remembering to as door locking or remembering to shut off the stoveshut off the stove

Note: this need is not limited to elders. This is universal assistive technology.

*Elliot Cole, Institute for Cognitive Prosthetics

Sixth application …Sixth application …

Emergency detection and response-cuingEmergency detection and response-cuing Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s

Enhanced communication with the outsideEnhanced communication with the outside Access to information and stimulationAccess to information and stimulation

For For example:example: PhonePhone Email, instant messaging, …Email, instant messaging, … Cell-phone-based short text message serviceCell-phone-based short text message service Televisits with remote family (via H.324 Televisits with remote family (via H.324

videophones; H.323 Internet-based standard; videophones; H.323 Internet-based standard; or coming 3G video cell phones)or coming 3G video cell phones)

Special-interest chat rooms, blogs, …Special-interest chat rooms, blogs, … On-line photo albumsOn-line photo albums Web-based advocacyWeb-based advocacy

and politicsand politics Amazon.com etc.Amazon.com etc.

Note: Evidence is convincing that old age itself is not a barrier to use of sophisticated IT. The habits, expectations, experience and attitudes of this particular generation of elders can be.

Seventh application …Seventh application … Emergency detection and response-cuingEmergency detection and response-cuing Activity tracking for status monitoringActivity tracking for status monitoring Task sampling for status monitoringTask sampling for status monitoring Health maintenanceHealth maintenance Cognitive support in ADL’sCognitive support in ADL’s Enhanced communication to the outsideEnhanced communication to the outside

Access to information and stimulationAccess to information and stimulationARMCHAIR TRAVEL.COM

For example:For example:

Unlimited access to all interest areas Unlimited access to all interest areas via specialty Web sitesvia specialty Web sites

Virtual travelVirtual travel On-line news and other publicationsOn-line news and other publications Health information Web sitesHealth information Web sites Internet-based music browsing and Internet-based music browsing and

downloadingdownloading

More notes: More notes:

The majority of the products noted The majority of the products noted here are sold to the here are sold to the mass marketmass market. . Elders are themselves a huge and Elders are themselves a huge and growing market; but many of these growing market; but many of these IT app’s or their core technologies IT app’s or their core technologies suit virtually the entire population.suit virtually the entire population.

In telehealth, communication and In telehealth, communication and cognitive support, mass-market cognitive support, mass-market convergence productsconvergence products can become can become specialty tools -- 3G video smart specialty tools -- 3G video smart phones, for example, for telehealth.phones, for example, for telehealth.

New Yorker Cartoon by Gregory

Swissmemory USB by Victorinox