Helios De Rosario

ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial

BackgroundFalls are very common, especially in adults aged 65 years and older. Within the current international European Commission’s Seventh Framework Program (FP7) project ‘iStoppFalls’ an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people.Methods/DesignThis international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars.DiscussionWe hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home.Trial registrationAustralian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651.International Standard Randomised Controlled Trial Number: ISRCTN15932647.

The design of a purpose-built exergame for fall prediction and prevention for older people

BackgroundFalls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system.MethodsThe system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components.ResultsThe iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people.ConclusionsThe iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.

Analysis of effects and usage indicators for a ICT-based fall prevention system in community dwelling older adults

Falls are a serious problem in aging societies. A sedentary life style and low levels of physical activity are major factors aggravating older adults’ fall risk. Information and communication technology (ICT)-based fall prevention interventions are a promising approach to counteract the fall risk of this target group. For some time now, fall prevention interventions have put emphasize to video game based solutions, as video games have become more popular and accepted among older adults. Studies show that such ICT-based fall prevention interventions significantly reduce fall risk in older adults. Nevertheless, the population of older adults is fairly heterogeneous, and factors like gender, age, fitness, sociability, and so on may influence the use of such systems. Therefore, the analysis of subgroups is a common procedure to investigate the affects of various factors on the effectiveness of ICT-based systems. Many of these studies analyze the effectiveness of the system with quantitative measures only. However, the effectiveness of ICT-based fall prevention systems always depends on the sustainable system use by the target group. Qualitative analyses is generally the prime selection to identify determining usage indicators for system usage. Therefore, it seems likely that combined quantitative and qualitative investigations will generate detailed information about system effectiveness and relevant usage indicators for respective target groups. Here, we analyze the ICT-based fall prevention system, iStoppFalls, incorporating exergames and a mobility monitor as well, targeting three aims, (1) is the system effective for different subgroups of older adults, (2) what are the factors influencing fall risk reduction in older adults using the system and are there combined effects of exergaming and activity monitoring on fall risk reduction, and (3) which usage indicators explain the usage of such a system by older adults. This paper will provide a better understanding of the effectiveness of ICT-based fall prevention for different subgroups and the indicators that determine the use of such technologies by older adults.

Analytical study of the effects of soft tissue artefacts on functional techniques to define axes of rotation

The accurate location of the main axes of rotation (AoR) is a crucial step in many applications of human movement analysis. There are different formal methods to determine the direction and position of the AoR, whose performance varies across studies, depending on the pose and the source of errors. Most methods are based on minimizing squared differences between observed and modelled marker positions or rigid motion parameters, implicitly assuming independent and uncorrelated errors, but the largest error usually results from soft tissue artefacts (STA), which do not have such statistical properties and are not effectively cancelled out by such methods. However, with adequate methods it is possible to assume that STA only account for a small fraction of the observed motion and to obtain explicit formulas through differential analysis that relate STA components to the resulting errors in AoR parameters. In this paper such formulas are derived for three different functional calibration techniques (Geometric Fitting, mean Finite Helical Axis, and SARA), to explain why each technique behaves differently from the others, and to propose strategies to compensate for those errors. These techniques were tested with published data from a sit-to-stand activity, where the true axis was defined using bi-planar fluoroscopy. All the methods were able to estimate the direction of the AoR with an error of less than 5°, whereas there were errors in the location of the axis of 30-40mm. Such location errors could be reduced to less than 17mm by the methods based on equations that use rigid motion parameters (mean Finite Helical Axis, SARA) when the translation component was calculated using the three markers nearest to the axis.

Point of optimal kinematic error: Improvement of the instantaneous helical pivot method for locating centers of rotation

This paper proposes a variation of the instantaneous helical pivot technique for locating centers of rotation. The point of optimal kinematic error (POKE), which minimizes the velocity at the center of rotation, may be obtained by just adding a weighting factor equal to the square of angular velocity in Woltring׳s equation of the pivot of instantaneous helical axes (PIHA). Calculations are simplified with respect to the original method, since it is not necessary to make explicit calculations of the helical axis, and the effect of accidental errors is reduced. The improved performance of this method was validated by simulations based on a functional calibration task for the gleno-humeral joint center. Noisy data caused a systematic dislocation of the calculated center of rotation towards the center of the arm marker cluster. This error in PIHA could even exceed the effect of soft tissue artifacts associated to small and medium deformations, but it was successfully reduced by the POKE estimation.

Relationship between neck motion and self-reported pain in patients with whiplash associated disorders during the acute phase

BACKGROUND Biomechanical measures quantify motor control and functional deficits in Whiplash Associated Disorders (WAD), but few studies relate those measures to the clinical scales that are routinely used to assess patients. Most studies are limited to chronic neck pain, and report poor to moderate correlations. OBJECTIVE To define a statistical model that relates measures of neck kinematics with clinical scales of neck pain, in WAD patients during the rehabilitation process in the acute phase (less than 3 months since the accident). METHODS 96 WAD patients self-assessed their pain using VAS and NPQ, and passed neck motion tests as part of their rehabilitation program. Four regression models were fitted to analyze the effects of the measured kinematic parameters and subject-specific characteristics on VAS and NPQ. Model errors were compared to minimal clinically significant differences. RESULTS Multiple correlation coefficients of the models were between 0.74 and 0.90. More than 66% of that correlation was accounted for by subject-specific factors, and most of the other half by the measured kinematic parameters. Range of motion of flexion-extension and axial rotation, and harmonicity of flexion-extension, where the variables most consistently related to the decrease of pain. The error of the models was within the MCSD in more than 50% of the observations. CONCLUSIONS Part of the individual progression of pain and pain-related disability in acute WAD patients, as rated by NPQ and VAS, can be mapped to objective kinematic parameters of neck mobility tests, like ranges of motion, velocities, repeatability and harmonicity of movements.

The My Active and Healthy Aging (My-AHA) ICT platform to detect and prevent frailty in older adults: Randomized control trial design and protocol

Frailty increases the risk of poor health outcomes, disability, hospitalization, and death in older adults and affects 7%–12% of the aging population. Secondary impacts of frailty on psychological health and socialization are significant negative contributors to poor outcomes for frail older adults.