Jan M. Jasiewicz

CALONIS: An Artificial Companion Within a Smart Home for the Care of Cognitively Impaired Patients

The paper describes a prototype Embodied Conversational Agent or Companion, called CALONIS, for a brain-injured Veteran with severe cognitive impairment. The CALONIS project is a sub-project of the larger Tampa VA SmartHome implementation initiative. CALONIS is intended to provide increased engagement, diversion and assistance beyond the usual mechanisms of providing assistance through text based prompting and interactions. We hope to eventually integrate CALONIS fully into the next generation of the Tampa VA SmartHome in which the SmartHome itself becomes a fully interactive and intelligent electronic caregiver. The project began with a Wizard-of-Oz version of CALONIS but even at this early stage we appear to have achieved high levels of patient engagement as well as in relation to the caregiver. The full CALONIS prototype is based on the Senior Companion project, originally developed as part of a large-scale EU project [1].

Decreased Movement Path Tortuosity Is Associated With Improved Functional Status in Patients With Traumatic Brain Injury.

Objective:To determine if movement path tortuosity in everyday ambulation decreases in Veterans being treated in a residential setting for traumatic brain injury. Elevated path tortuosity is observed in assisted living facility residents with cognitive impairment and at risk for falls, and tortuosity may decrease over the course of cognitive rehabilitation received by the Veterans. If observed, decreased tortuosity may be linked to improved clinical outcomes. Design:Longitudinal observational study without random assignment. Setting:Veterans Affairs Medical Center inpatient residential polytrauma treatment facility. Patients:Twenty-two Veterans enrolled in a postacute predischarge residential polytrauma treatment facility. Interventions:None, observation-only. Main Outcome Measure:Mayo-Portland Adaptability Index-4, and movement path tortuosity measured by Fractal Dimension (Fractal D). Fractal D was obtained continuously from an indoor movement tracking system primarily used to provide machine-generated prompts and reminders to facilitate activities of daily living. Patients were deemed “responders” (N = 10) if a significant linear decline in Fractal D occurred over the course of treatment, or nonresponders (N = 12) if no significant decline was observed. Results:Responders had lower discharge Mayo-Portland Adaptability Inventory scores (mean = 32.6, SD = 9.53) than non-responders (mean = 39.5, SD = 6.02) (F = 2.07, df = 20, P = .05). Responders and nonresponders did not differ on initial injury severity or other demographic measures. Conclusions:Fractal D, a relatively simple measure of movement path tortuosity can be linked to functional recovery from traumatic brain injury.

Movement Path Tortuosity Predicts Compliance With Therapeutic Behavioral Prompts in Patients With Traumatic Brain Injury

Objective:Rehabilitation of patients with traumatic brain injury typically includes therapeutic prompts for keeping appointments and adhering to medication regimens. Level of cognitive impairment may significantly affect a traumatic brain injury victims ability to benefit from text-based prompting. We tested the hypothesis that spatial disorientation as measured by movement path tortuosity during ambulation would be associated with poorer compliance with automated prompts by veterans actively being treated for traumatic brain injury. Setting:Clinical polytrauma center. Participants:Ten (1 female) veteran patients mean age = 35.4 (SD = 12.4) years. Design:Small group correlational study without random assignment. Main Measures:Fractal Dimension, a measure of movement path tortuosity derived from a GPS logging device used to record casual outdoor ambulation at the start of the study. Compliance with smart home machine-generated therapeutic prompts received during rehabilitation at the James A. Haley Veterans Administration Hospital Polytrauma Transitional Rehabilitation Program. A patient was compliant with a prompt if they transited from where the prompt was presented to the prescribed destination (both within the Polytrauma Transitional Rehabilitation Program) within 30 minutes. Noncompliance was failure to appear at the destination within the allotted time. Results:Fractal dimension was significantly inversely related to overall prompt compliance (r = −0.603, n = 10, P = .032; 1-tailed). Conclusions:The findings support the hypothesis that increased spatial disorientation adversely impacts compliance with automated prompts throughout therapy. The results are consistent with previous studies linking elevated path tortuosity to cognitive impairment and increased risk for falls in assisted living facility residents.

Quantification of equine sacral and iliac motion during application of manual forces and comparison between motion capture with skin-mounted and bone-fixated sensors

&NA; Diagnosis of sacroiliac dysfunction in horses includes manual motion palpation of the equine ilium and sacrum. Motion of the ilium and sacrum during manual force application to the equine pelvis has been measured previously in vitro. The aim of this study was to measure the amount and direction of motion in vivo, including comparison of bone‐fixated and skin‐mounted inertial sensors. Sensors were skin‐mounted over tuber sacrale (TS) and third sacral spinous process of six Thoroughbred horses and later attached via Steinmann pins inserted into the same bony landmarks. Orientations of each TS and sacrum were recorded by one investigator during six trials of manual force applied to the pelvis, inducing cranial, caudal, and oblique rotations. Mean values were reported in Euler angles for the three orthogonal planes lateral bending, flexion–extension (FE), and axial rotation (AR). Differences between skin‐ and bone‐fixated markers were determined with significance set at P < .05. The largest mean values recorded during rotations applied to the pelvises were for FE, (2.08° ± 0.35°) with bone‐fixated sensors. AR gave the largest values recorded with skin mountings (1.70° ± 0.48°). There was a poor correlation between skin‐mounted and bone‐fixated markers with AR being the orthogonal plane in which results from skin mounting were closest to results from bone‐fixated sensors Bony kinematics during external movement applied to the pelvis cannot be predicted from skin‐mounted sensors, due to differences between skin‐ and bone‐mounted sensors.

VA SmartHome for Veterans with TBI: Implementation in Community Settings

Individuals with traumatic brain injury (TBI) are at risk for reduced levels of independence, safety issues, falls, and institutionalization. VA SmartHome (SH) technology, developed for Veterans with TBI, uses an accurate indoor tracking technology capable of following numerous individuals simultaneously and resolving their location to approximately 15 cm in an open environment. In addition, SH technologies provide time- and location-dependent prompts to promote independence of the participant by providing reminders for the management of daily activities such as medication, meal planning, and other necessary tasks. SH tech-nology was initially developed for clinical rehabilitation settings, however, was recently expanded to private homes of Veterans with TBI. Current features available in the SH and the process of implementation are presented.