Why the therapist using ICT will replace the one who doesn t. Kamiar Aminian

Transcription

1 Why the therapist using ICT will replace the one who doesn t Kamiar Aminian 1

2 How ICT helps therapist for... 2 Evaluation Instrumented functional tests and gait analysis Activity monitoring Fall detection Intervention Exergames Biofeedback Social interaction Exercises Apps Smarthome

3 How ICT helps for evaluation: Instrumented functional tests 3 Gait analysis 20m, 6 min walking test Dual task Timed Up& Go Turning Gait initiation Sit-Stand 5 sit-stand 30s chair stand-sit Smartphone Reaction time Reaching Stepping

4 Outcome measure fallers vs. non-fallers: Effect size in different categories of fallers by The Royal Society D. Hamacher et al. J. R. Soc. Interface 2011;8:

5 Gait metrics vs. disease, age, and dual task PD (ON) (Dual Task) 71+ (Dual Task) PD (OFF) B. Mariani, EPFL Thesis, 5434, Stride Velocity (m/s) Stride Length (m) N=1850

6 Instrumeneted TUG 6 Zampieri et al., (2010), J Neurol Neurosurg Psychiatry

7 Measuring tilt, duration and force during Sit-stand in frail and fit subjects 7 Can you do it? without sensors? Si-St Stand-up velocity (m/s) TT Nora Millor et al. JNER, 2013 Ganea et. al., Med.Eng.&Phys., 2011

8 Non ICT gait analysis 8

9 ICT-based gait analysis 9,... Ready for The last 48 trials again Where is no the wifi... foot...

10 How ICT helps for evaluation: activity metrics 10 Activity monitoring Type Frequency Lying 36% Duration Intensity Pattern Fractal behavior Entropy of activity level Walking bouts

11 Contribution of wearable sensors: Risk of fall using daily life monitoring 11 Trunk accelerometer 8 days Walking quantity and gait characteristics was associated with fall Highest fall prediction when accelerometer is used ROC for logistic fall prediction model Van Schooten, et.al, Journals of Gerontology: MEDICAL SCIENCES, 2015,

12 Eight-Week Remote Monitoring Using a Freely Worn Device: unstable Gait Patterns in Older Fallers 12 independent-living older people (mean age 83 years) More shorter walking bouts in fallers Different Mode of Step variability Brodie et al. IEEE TBME, 2015

13 Added value of ICT-based evaluation: Relationship between daily activity complexity pattern, falls and fear of falling 13 Standard metric Complexity metric % of time spent walking Weighted permutation entropy FES=100 FES=100 NF=0 NF 1 (n=20) (n=10) FES=100 FES=100 NF=0 NF 1 (n=20) (n=10) FES<100 FES<100 NF=0 NF 1 (n=19) (n=21) FES<100 FES<100 NF=0 NF 1 (n=19) (n=21)

14 Smartphone: activity decline with aging 14 Subjects: N=254, Age: y.o Smartphone recording: 7 days, 9hours/day Activity states & Barcodes: n n n n type: lying/sedentary, active, gait intensity: activity counts, cadence duration: walking (gait) bouts 18 states barcodes 0.5 Complexity metric age Plateau then drop just before 80 years (~ 75)

15 Smart home 15 Ambient sensors IR detector Gas, temperature RFID Push-button switches Electrical usage Sensors Smart home

16 Smart home 16

17 Velocity distribution 17 Austin D, et al.(embs), 2011 Annual International Conference of the IEEE. 2011:

18 How Sensors can help therapist in Monitoring fall 18 Fall detection and characterization Pre-fall Fall Impact Rest World s largest database of real fall Becker et al., Zeitschrift für Gerontologie und Geriatrie

19 19 Falls=208"

20 How ICT helps for intervention 20 Exergames studies Szturm et al. PHYS THER Sensbalance MiniBoard Cho et al, Tohoku I. Exp.Med, 2012

21 How ICT helps for intervention 21 Exergames studies Pichierri et al. BMC Geriatr., 2012 Armeo

22 How ICT helps for intervention 22 Similar or better effects of exergaming compared to traditional forms of exercise Outcome measures indicate Improvement of balance and gait Less fear of falling Less fall Skjaeret,et al. International Journal of Medical Informatics studies Recommendations Personalization Address multiple Physical functions Adherence and Safety measures Studies for long-term effects

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24 Make ICT-based effective exercise therapy: Serious Computer Game to Assist Tai Chi Training for the Elderly 24 Create a virtual instructor using acquired images from the real instructor Challenge the player to mimic gestures presented by the virtual instructor Compute the similarity of a measured gesture with a known prerecorded gesture template In progress: Sahlgrenska University Hospital in Gothenburg, Sweden N. Wickström, IEEE 1st International Conference on Serious Games and Applications for Health 2011

25 Merging social and physical activity by involving users: jdome Bike Around 25 Encourage physical and social activity among people with dementia Users feel happy when recognizing themselves they've decide their own trip (e.g. trip on their birth place or place where they have never been) Get outdoor, lead anywhere they prefer with the help of Google Street View do exercise safely and a have a good time Halmstad University and

26 ICT-based intervention can do better that standard intervention? Closed-loop system for personalized and at home rehabilitation of people with 26 PD 18 sessions (3 X 6 weeks) of personalized rehabilitation exercises for people with Parkinson s disease at home. 30 minutes of continuous gait training 20 active control, 20 Cupid training through smartphone Freezing of gait detection and prevention Biofeedback for gait training Both groups significantly improved on the primary outcomes (single and dual task gait speed) at post-test and follow-up. The CuPiD group improved significantly more on balance (MiniBESTest) at posttest. The CuPiD group maintained quality of life (SF-36 physical health) at follow-up whereas the control group deteriorated. The CuPiD system was well-tolerated and participants found the tool user-friendly. Ginis et al. Parkinsonism and Related Disorders, 2016

27 Tablet-based exercises: T&E Elderly 27 Work in progress... Home-based exercise programs using mobile application (Tablet) based on the Self-efficacy concept 400 participants in 2 French-speaking and in 2 German-speaking areas in Switzerland Compare the short and long-term effects of 3 home-based exercise programs on falls, quality of life and exercise-adherence in older people at risk of falling.

28 "The Multisensory Interactive Window: Immersive Experiences for the Elderly, L. Angelini, M. Caon, N. Couture, O. Abou Khaled, E. Mugellini. UbiComp/ISWC'15 Adjunct. Social interaction: Interactive Window 28 Based on Tangible and Natural Interaction Use the window metaphor to facilitate remote communication Seamlessly connect remote people Stimulate social interaction 3 tangible interactive windows are connected today (2 in Switzerland, 1 in France)

29 Social interaction through ICT 29 Motivation for online social interaction connectedness with family (e.g. where one or more members of a family live far away) Receive information, recent photo, video Advantages asynchronous nature of online interactions (e.g. put message, do not annoying member at work, connect when not busy) Obstacles Lack of knowledge, poor user interface Hartnett et al(2013). The UKAIS International Conference on Information Systems (UKAIS), March 2013, Worcester College, University of Oxford.

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31 Conclusions 31 ICT provides unseen detail of subject functional performance Gait instability, variability, foot clearance ICT-based intervention outcomes: Balance and gait improvement ICT should/can merge social and physical activity social interaction Physical contact with therapist ICT needs: personalization Usability test Adherence and safety Data protection Still in infancy for intervention ICT needs long-term effect evaluation

32 Even Dawn uses ICT 32