Antonis S. Billis

Design, Implementation, and Wide Pilot Deployment of FitForAll: An Easy to use Exergaming Platform Improving Physical Fitness and Life Quality of Senior Citizens

Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre-postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33±5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

A Game-Like Interface for Training Seniors’ Dynamic Balance and Coordination

The current work focuses on the development of a game platform that can help elderly people to exercise and maintain their physical status and well being through an innovative, low-cost ICT platform, such as Wii Balance Board. As it is widely admitted, Third Age suffers from severe problems such as frailty and instability. Falling remains one of the main causes of severe injuries and death among people aged 65 or older. In the present paper, a set of games that make use of Wii Balance Board will be discussed, in combination with interface design principles that could improve accessibility and force seniors to engage to the training process through gaming. The main scope of the research conducted and presented here, is the design and development of a game-like interface that incorporates the characteristics of a Human-Computer Interaction system such as user input and system feedback according to user’s movement patterns and the investigation of how such a platform could meet the special needs of a target group, such as elderly people and its potential use as a physical training platform in general. Accessibility issues and seniors’ possible ease of adaptation to the system will also be thoroughly discussed.

Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder.

Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen’s d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.

A Decision-Support Framework for Promoting Independent Living and Ageing Well

Artificial intelligence and decision support systems offer a plethora of health monitoring capabilities in ambient assisted living environment. Continuous assessment of health indicators for elderly people living on their own is of utmost importance, so as to prolong their independence and quality of life. Slow varying, long-term deteriorating health trends are not easily identifiable in seniors. Thus, early sign detection of a specific condition, as well as, any likely transition from a healthy state to a pathological one are key problems that the herein proposed framework aims at resolving. Statistical process control concepts offer a personalized approach toward identification of trends that are away from the atypical behavior or state of the seniors, while fuzzy cognitive maps knowledge representation and inference schema have proved to be efficient in terms of disease classification. Geriatric depression is used as a case study throughout the paper, so to prove the validity of the framework, which is planned to be pilot tested with a series of lone-living seniors in their own homes.

A Web services-based exergaming platform for senior citizens: The long lasting memories project approach to e-health care

This piece of research describes an innovative e-health service that supports the cognitive and physical training of senior citizens and promotes their active ageing. The approach is adopted by the Long Lasting Memories (LLM) project, elements of which are discussed herein in the light of the functionalities provided to the users and the therapists. The aim of this work is to describe those technical elements that demonstrate the unique and integrative character of the LLM service, which is based on a modular Web service architecture, rendering the system available in different settings like the homes of seniors. The underlying database as well as the remote user interface empower therapists to set personalized training schemes, to view the progress of training sessions, as well as, adding new games and exercises into the system, thereby increasing the services sustainability and marketability.

Leveraging Web Technologies to Expose Multiple Contemporary Controller Input in Smart TV Rich Internet Applications Utilized in Elderly Assisted Living Environments

This work describes a lightweight framework allowing internet applications to access controllers such as the Wii remote, Wii balance board and MS Kinect irrespective of proximity or configuration. This is achieved by utilizing predetermined schemas for encapsulating the controller information and transferring this data through standard internet communication technologies RESTFUL services and Web Sockets in platform independent, device naive ways. These features of the framework provide Rich Internet Applications RIAs with ubiquitous access to sophisticated human computer interaction schemes for diverse uses. The proliferation of Smart TVs as central information hubs in elderly assisted living environments, along with the need for simple gesture control schemes for these demographics, provides one application of this framework. Thus, we demonstrate how this service can be incorporated for developing internet applications and how it can be utilized for providing intuitive interaction methods for RIAs deployed through Smart TVs in elderly assisted living environments.

Affective computing on elderly physical and cognitive training within live social networks

Emotions play a key role in the user experience, in serious games developed for education, training, assessment, therapy or rehabilitation. Moreover, social network features were recently coined in as key elements for computer based cognitive and physical interventions. In this paper, it is argued that Affective Computing principles may be exploited to increases the motivation of senior users for such computer based interventions. A case study with quantitative results is drawn from the European Commission funded Long Lasting Memories project. Emphasis is placed on how affection, system usability and acceptance might be related to social interaction. Results provide a first evidence that there is indeed a link between how well the intervention and the system is liked when users are placed in groups thereby forming live social networks. It is imperative that such findings could be taken under consideration upon new exergaming designs incorporating social networking capacities over the web.

Towards a hierarchically-structured decision support tool for improving seniors' independent living: the USEFIL decision support system

In the current work, we present our position towards the modeling of a decision support system for health assessment and prevention of risky situations in the life of seniors. A two-layer architecture based on the Fuzzy Cognitive Maps (FCMs) methodology is considered as the main tool to encode medical knowledge and reason about the health status of seniors. This is the initial step, since outputs of several discrete FCM models are then combined to form the input concepts for an upper level schema (the health status of the senior) of upper-level concepts and relationships, so as to infer about recommended individualized therapies and interventions that would help therapists to prevent risky situations and enhance the independence and quality of life of the seniors. A modeling sample of the depression assessment is presented at the first level of the proposed architecture, while am integration schema of the proposed approach provides a view of our future extended model.

Emotion Recognition in the Wild: Results and Limitations from Active and Healthy Ageing Cases in a Living Lab

The work presented in this paper relies on the recognition of emotions during pilot trials with elderly people in an ecologically valid living lab. The emotion recognition is processed by cloud based service and the photos for processing are captured from Kinect based on the skeleton presence and information. The Kinect publishes its information to a channel where the clients subscribe efficiently either to the skeleton or the RGM images channel.

Thessaloniki Active and Healthy Ageing Living Lab: the roadmap from a specific project to a living lab towards openness

This paper exhibits the roadmap of the Thessaloniki Active and Healthy Ageing Living Lab (Thess-AHALL) from the demand of a specific project to openness, fostering collaborations with other researchers. It presents how carefully and intensive efforts of a multidisciplinary team turned a need for trials pertaining to a specific project to the establishment of Thess-AHALL fostering openness and collaborations with any type of stakeholder (research, education, commercial, etc.). Thess-AHALL is, located in the Lab of Medical Physics in the Aristotle University of Thessaloniki in Greece. A detailed presentation of the roadmap, the studies and research conducted in Thess-AHALL are presented.