Cliodhna Ní Scanaill

Quantitative Falls Risk Assessment Using the Timed Up and Go Test

Falls are a major problem in older adults worldwide with an estimated 30% of elderly adults over 65 years of age falling each year. The direct and indirect societal costs associated with falls are enormous. A system that could provide an accurate automated assessment of falls risk prior to falling would allow timely intervention and ease the burden on overstretched healthcare systems worldwide. An objective method for assessing falls risk using body-worn kinematic sensors is reported. The gait and balance of 349 community-dwelling elderly adults was assessed using body-worn sensors while each patient performed the “timed up and go” (TUG) test. Patients were also evaluated using the Berg balance scale (BBS). Of the 44 reported parameters derived from body-worn kinematic sensors, 29 provided significant discrimination between patients with a history of falls and those without. Cross-validated estimates of retrospective falls prediction performance using logistic regression models yielded a mean sensitivity of 77.3% and a mean specificity of 75.9%. This compares favorably to the cross-validated performance of logistic regression models based on the time taken to complete the TUG test (manually timed TUG) and the Berg balance score. These models yielded mean sensitivities of 58.0% and 57.8%, respectively, and mean specificities of 64.8% and 64.2%, respectively. Results suggest that this method offers an improvement over two standard falls risk assessments (TUG and BBS) and may have potential for use in supervised assessment of falls risk as part of a longitudinal monitoring protocol.

BASE - An interactive technology solution to deliver balance and strength exercises to older adults

There is a high prevalence of falls in older adults. It has been recognised that a highly challenging balance and strength retraining program can reduce the incidence of falls significantly. This paper describes the design and initial evaluation of a home-based interactive technology solution to deliver a personalised, physiotherapist prescribed exercise program to older adults. We adopted a user centred design process to ensure such technology is easy to use, acting as a facilitator to completing the exercise program, rather than an inhibitor. Initial usability findings, in addition to participant attitudes towards such a system, are outlined.

Lessons learned in deploying independent living technologies to older adults' homes

Independent living technologies are fast gaining interest within both academia and industry, amid the realization that the world’s population is ageing. Technology can increase the quality of life of older people, allowing them to age-in-place and helping them to remain physically, cognitively and socially engaged with their environment. However, little research in this area is applied. The paper argues for the necessity of moving such technology out of the research laboratory and into the home, where its real impact on the lives of older adults can be assessed. Moreover, a series of recommendations are outlined, encompassing the life cycle of independent living technologies, from ethnographic assessment, through to design, deployment and evaluation. This work is based on lessons learned in deploying such technologies to older people in over 200 homes. This paper can act as a guide for other researchers interested in developing technologies with older people.

Technology Innovation Enabling Falls Risk Assessment in a Community Setting.

Approximately one in three people over the age of 65 will fall each year, resulting in significant financial, physical, and emotional cost on the individual, their family, and society. Currently, falls are managed using on-body sensors and alarm pendants to notify others when a falls event occurs. However these technologies do not prevent a fall from occurring. There is now a growing focus on falls risk assessment and preventative interventions. Falls risk is currently assessed in a clinical setting by expert physiotherapists, geriatricians, or occupational therapists following the occurrence of an injurious fall. As the population ages, this reactive model of care will become increasingly unsatisfactory, and a proactive community-based prevention strategy will be required. Recent advances in technology can support this new model of care by enabling community-based practitioners to perform tests that previously required expensive technology or expert interpretation. Gait and balance impairment is one of the most common risk factors for falls. This paper reviews the current technical and non-technical gait and balance assessments, discusses how low-cost technology can be applied to objectively administer and interpret these tests in the community, and reports on recent research where body-worn sensors have been utilized. It also discusses the barriers to adoption in the community and proposes ethnographic research as a method to investigate solutions to these barriers.

Wellness, Fitness, and Lifestyle Sensing Applications

Physical fitness is not only one of the most important keys to a healthy body; it is the basis of dynamic and creative intellectual activity.

Activity level classification algorithm using SHIMMER™ wearable sensors for individuals with rheumatoid arthritis

In rheumatoid arthritis (RA) it is believed that symptoms associated with the progression of the disease result in a reduction in the physical activity level of the patient. One of the key flaws of the research surrounding this hypothesis to date is the use of non-validated physical activity outcomes measures. In this study, an algorithm to estimate physical activity levels in patients as they perform a simulated protocol of typical activities of daily living using SHIMMER kinematic sensors, incorporating tri-axial gyroscopes and accelerometers, is proposed. The results are validated against simultaneously recorded energy expenditure data and the defined activity protocol and demonstrate that SHIMMER can be used to accurately estimate physical activity levels in RA populations.

Objective real-time assessment of walking and turning in elderly adults

Recent research suggests that falls are the most common cause of injury and disability in older persons. Invasive systems or body worn sensors can be employed in controlled clinical and laboratory settings to determine clinical measures of gait and stability. This study by contrast aims to explore how video technology, can be employed to unobtrusively determine the same measures. Data from 63 elderly subjects, recruited through a research clinic was analyzed. The derived parameters include: the walk time, the number of steps of the TUG test and stability out of the turn. The results show that video analysis can be used to automate current clinical measures of gait and stability as well as to inform future automated interventions.

Older adults, falls and technologies for independent living: a life space approach

ABSTRACT This paper draws attention to the need for further understanding of the fine details of routine and taken-for-granted daily activities and mobility. It argues that such understanding is critical if technologies designed to mitigate the negative impacts of falls and fear-of-falling are to provide unobtrusive support for independent living. The reported research was part of a large, multidisciplinary, multi-site research programme into responses to population ageing in Ireland, Technologies for Independent Living (TRIL). A small, exploratory, qualitative life-space diary study was conducted. Working with eight community-dwelling older adults with different experiences of falls or of fear-of-falls, data were collected through weekly life-space diaries, daily-activity logs, two-dimensional house plans and a pedometer. For some participants, self-recording of their daily activities and movements revealed routine, potentially risky behaviour about which they had been unaware, which may have implications for falls-prevention advice. The findings are presented and discussed around four key themes: ‘being pragmatic’, ‘not just a faller’, ‘heightened awareness and blind spots’ and ‘working with technology’. The findings suggest a need to think creatively about how technological and other solutions best fit with peoples everyday challenges and needs and of critical importance, that their installation does not reduce an older adult to ‘just a faller’ or a person with a fear-of-falls.

Sensing and Sensor Fundamentals

Sensors utilize a wide spectrum of transducer and signal transformation approaches with corresponding variations in technical complexity. These range from relatively simple temperature measurement based on a bimetallic thermocouple, to the detection of specific bacteria species using sophisticated optical systems. Within the healthcare, wellness, and environmental domains, there are a variety of sensing approaches, including microelectromechanical systems (MEMS), optical, mechanical, electrochemical, semiconductor, and biosensing. As outlined in Chapter 1, the proliferation of sensor-based applications is growing across a range of sensing targets such as air, water, bacteria, movement, and physiology. As with any form of technology, sensors have both strengths and weaknesses. Operational performance may be a function of the transduction method, the deployment environment, or the system components. In this chapter, we review the common sensing mechanisms that are used in the application domains of interest within the scope of this book, along with their respective strengths and weaknesses. Finally, we describe the process of selecting and specifying sensors for an application.

Clinical gait assessment of older adults using open platform tools

Gait impairment is associated with increased falls risk. The gait of 321 community dwelling elderly adults was assessed using the TRIL Gait Analysis Platform (GAP), which was specially designed for ease of use in a research clinic setting by non-experts. The GAP featured body-worn kinematic sensors, a pressure sensitive electronic walkway, and two orthogonally mounted web cameras, and was developed using open platform tools. This flexible platform was applied to objectively measure gait parameters in different gait assessments. The results from the 6 meter walk assessment are presented here. In this assessment, participants were categorized by clinical falls history as ‘fallers’ or ‘non-fallers’. Temporal and spatial gait parameters were examined. Significant differences in spatial parameters were observed when fallers and non-fallers were compared. Temporal parameters were found to differ, though not significantly.