Ilkka Winblad

Comparison of low-complexity fall detection algorithms for body attached accelerometers.

The elderly population is growing rapidly. Fall related injuries are a central problem for this population. Elderly people desire to live at home, and thus, new technologies, such as automated fall detectors, are needed to support their independence and security. The aim of this study was to evaluate different low-complexity fall detection algorithms, using triaxial accelerometers attached at the waist, wrist, and head. The fall data were obtained from standardized types of intentional falls (forward, backward, and lateral) in three middle-aged subjects. Data from activities of daily living were used as reference. Three different detection algorithms with increasing complexity were investigated using two or more of the following phases of a fall event: beginning of the fall, falling velocity, fall impact, and posture after the fall. The results indicated that fall detection using a triaxial accelerometer worn at the waist or head is efficient, even with quite simple threshold-based algorithms, with a sensitivity of 97-98% and specificity of 100%. The most sensitive acceleration parameters in these algorithms appeared to be the resultant signal with no high-pass filtering, and the calculated vertical acceleration. In this study, the wrist did not appear to be an applicable site for fall detection. Since a head worn device includes limitations concerning usability and acceptance, a waist worn accelerometer, using an algorithm that recognizes the impact and the posture after the fall, might be optimal for fall detection.

Determination of simple thresholds for accelerometry-based parameters for fall detection

The increasing population of elderly people is mainly living in a home-dwelling environment and needs applications to support their independency and safety. Falls are one of the major health risks that affect the quality of life among older adults. Body attached accelerometers have been used to detect falls. The placement of the accelerometric sensor as well as the fall detection algorithms are still under investigation. The aim of the present pilot study was to determine acceleration thresholds for fall detection, using triaxial accelerometric measurements at the waist, wrist, and head. Intentional falls (forward, backward, and lateral) and activities of daily living (ADL) were performed by two voluntary subjects. The results showed that measurements from the waist and head have potential to distinguish between falls and ADL. Especially, when the simple threshold-based detection was combined with posture detection after the fall, the sensitivity and specificity of fall detection were up to 100 %. On the contrary, the wrist did not appear to be an optimal site for fall detection.

DANCE AND MOVEMENT THERAPEUTIC METHODS IN MANAGEMENT OF DEMENTIA: A RANDOMIZED, CONTROLLED STUDY

To the Editor: Behavioral and cognitive problems in dementia can be addressed using various nonpharmacological interventions such as neuropsychological rehabilitation and Reality Orientation therapy, but alternative methods still need to be sought for. Creative activities, stimulation of sensomotor system, and music therapy have been found to be potentially beneficial. We previously demonstrated the applicability of dance and movement therapy (DMT) in dementia, and this letter evaluates whether it would improve patients’ cognitive level or behavior. The DMT intervention consisted of nine sessions with 1-week intervals lasting for 30 to 45 minutes each (see for the description); the control group spent the same amount of time together in regular nursing home activities. The intervention study was conducted in compliance with Declaration of Helsinki ethical standards. The patients and their spouses signed an informed consent, and the municipal board of Health Centre of Nivala, acting as a disciplinary committee, approved the study. Assessments made 1 week before and immediately before the beginning of the DMT (double-baseline, the mean used in statistical comparisons), at Weeks 5 and 9 of the intervention, and at Week 13 (follow-up 4 weeks post-intervention) included the Mini-Mental State Examination (MMSE); the Word List savings score (percentage of the delayed recall compared with the third learning trial) and the Clock Drawing Test (maximum score 6) from the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery; the Cookie Theft picture description task from Boston Diagnostic Aphasia Test, along with other pictures used alternatively, scored for the number of Information Units; and the Nurses’ Observation Scale for Geriatric Patients (NOSGER), for which, in each subscale, a higher score indicates greater impairment. Means and standard deviations are given; an independent-samples t-test, a multivariate analysis of variance (MANOVA) for repeated measures, and a paired-samples t-test from SPSS for Windows (Release 13.0.1. 2004. SPSS Inc., Chicago, IL) were used.

Prevalence of disability in three birth cohorts at old age over time spans of 10 and 20 years

The prevalence of disability at the age of 75+ measured by the Katz Index of Activities of Daily Living (ADL) was compared among three birth cohorts: those born < or = 1903 (n = 348), those born < or = 1913 (n = 586), and those born < or = 1923 (n = 758). Significant risk factors for disability were female sex and age; the cohort effect was not significant. The prevalence rates of disability were 29.0% (95% CI 24.2-33.8), 34.8% (30.9-38.7), and 28.8% (25.5-32.0) for the first, second, and third cohorts. In the age group 75-79 years the rates were 20.1% (95% CI 13.8-26.4), 25.5% (20.2-30.7), and 14.4% (10.6-18.1). The change was due to the declining disability of women. The distributions in the three cohorts based on the numbers of ADL limitations did not differ. As far as the whole aged populations were concerned, longer life was not accompanied by improving health.

The feasibility of telemedicine for orthopaedic outpatient clinicsa randomized controlled trial

We investigated the use of videoconferencing in the examination of orthopaedic outpatients. A consecutive sample of orthopaedic outpatients was randomized to examination either via videoconferencing (n = 76) while attending a primary-care unit or at a conventional hospital outpatient clinic 160 km away (n = 69). Videoconferencing was found to be feasible and the equipment functioned well technically. There were somewhat more problems in examining the telemedicine patients than the clinic patients. The two patient groups were equally satisfied with the specialist service. The telemedicine patients were more willing to have their next visit by videoconferencing than the conventional patients. Videoconferencing between primary and secondary care can be used in the examination of orthopaedic patients whenever no demanding imaging technology is needed.

A Cost-Minimization Analysis of Orthopaedic Consultations Using Videoconferencing in Comparison with Conventional Consulting

We compared the costs of conventional outpatient visits to the surgical department of the University Hospital of Oulu with those of videoconferencing between the primary care centre in Pyhäjärvi and the University Hospital (separated by 160 km). The cost data were obtained from a randomized controlled trial that included 145 first-admission and follow-up orthopaedic patients. In the telemedicine group the annual fixed costs were 6074 in the hospital and 3910 in the primary care centre. The additional variable costs were 2 in the hospital and 19 in primary care. At a workload of 100 patients, the total cost, including travel and indirect costs, was 87.8 per patient in the telemedicine group and 114.0 per patient in the conventional group (i.e. a total cost saving from the use of teleconsultation of 2620). A cost-minimization analysis showed that telemedicine was less costly for society than conventional care at a workload of more than 80 patients per year. If the distance to specialist care were reduced from 160 km to 80 km, the break-even point increased to about 200 patients per year. Wider utilization of the videoconferencing equipment for other purposes, or the use of less expensive videoconferencing equipment, would make services cost saving even at relatively short distances. The study showed that orthopaedic outpatient telecare can be cost minimizing.

Dance/Movement Therapeutic Methods In Management Of Dementia

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The Pyhäjärvi Cataract Study. I. Study design, baseline characteristics and the demand for cataract surgery

Purpose:  The Pyhäjärvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland.

Transnational Comparison: A Retrospective Study on e-Health in Sparsely Populated Areas of the Northern Periphery

Healthcare delivery in the northern periphery of Europe is challenged by dispersed populations, geographical complexities (including mountainous terrain and inhabited islands), ageing populations, and rising patient expectations. It is challenged further by variations in transport networks and information communication technology infrastructure. This article provides an overview of e-health development across the northern periphery areas of four northern European countries (Finland, Sweden, Norway, and Scotland) by summarizing the outcomes of a mixed methods e-health mapping exercise and subsequently identifying service needs and gaps. A total of 148 applications, with a range of applied e-health solutions, were identified and the findings have promoted the sharing and transfer of e-health innovation across the four countries. The supporting telecommunications infrastructure and development of innovative telemedicine appear slower in sparsely populated areas of Scotland in comparison to its northern peripheral counterparts. All four countries have, however, demonstrated a clear commitment to the development of e-health within their remote and rural regions.

The use of videoconferencing for mental health services in Finland

The utilization of telemental health (TMH) services in Finland was surveyed in 2006. In total, 135 health-care units provided responses. Eighty-four responses were received from primary care units (health-care centres and clinics) and eight from other clinics, in all hospital districts. The overall rate of TMH consultations was 4 per 100,000 population. The highest TMH consultation per population ratio, 22 per 100,000, was in northern Finland. Most of the sites used telepsychiatry services for less than 10% of clinical outpatient services. The sites with over 20% utilization of clinical TMH services from all psychiatric consultations were all rural health centres. Compared with Finland, the utilization rates of TMH were higher in Canada; that might be due to differences between the countries in the organization of mental health services in primary and specialized care. In Finland TMH consultations made up only a very small proportion of all mental health services. The use of TMH was particularly common in remote areas; however, there were many rural centres that did not utilize clinical TMH. TMH was widely utilized for continuing and medical education.