Judith T. Matthews

A robotic walker that provides guidance

This paper describes a robotic walker designed as an assistive device for frail elderly people with cognitive impairment. Locomotion is most often the primary form of exercise for the elderly, and devices that provide mobility assistance are critical for the health and well being of such individuals. Previous work on walkers focused primarily on safety but offered little or no assistance with navigation and global orientation. Our system provides these features in addition to the stability and support provided by conventional walkers. A software suite of robot localization and navigation combined with a shared-control haptic interface achieves this capability. The system has been tested in a retirement facility near Pittsburgh, PA, USA.

Disability, Age, and Informational Privacy Attitudes in Quality of Life Technology Applications: Results from a National Web Survey

Technology aimed at enhancing function and enabling independent living among older and disabled adults is a growing field of research. Privacy concerns are a potential barrier to adoption of such technology. Using data from a national Web survey (n=1,518), we focus on perceived acceptability of sharing information about toileting, taking medications, moving about the home, cognitive ability, driving behavior, and vital signs with five targets: family, healthcare providers, insurance companies, researchers, and government. We also examine acceptability of recording the behaviors using three methods: video with sound, video without sound, and sensors. Results show that sharing or recording information about toileting behavior; sharing information with the government and insurance companies; and recording the information using video were least acceptable. Respondents who reported current disability were significantly more accepting of sharing and recording of information than nondisabled adults, controlling for demographic variables, general technology attitudes, and assistive device use. Results for age were less consistent, although older respondents tended to be more accepting than younger respondents. The study provides empirical evidence from a large national sample of the implicit trade-offs between privacy and the potential for improved health among older and disabled adults in quality of life technology applications.

Effect of adherence to self-monitoring of diet and physical activity on weight loss in a technology-supported behavioral intervention

Background Examination of mediating behavioral factors could explain how an intervention works and thus provide guidance to optimize behavioral weight-loss programs. This study examined the mediating role of adherence to self-monitoring of diet and physical activity on weight loss in a behavioral weight-loss trial testing the use of personal digital assistants (PDA) for self-monitoring. Methods Mediation analysis was conducted to examine the possible mediating role of adherence to self-monitoring of diet and physical activity between treatments using varying self-monitoring methods (paper record, PDA, and PDA with daily tailored feedback messages) and weight loss. Findings The sample (N = 210) was predominantly white (78%) and female (85%). Compared to a paper record, using a PDA for self-monitoring diet (P = 0.027) and physical activity (P = 0.014) had significant direct effects on weight loss at 12 months, as well as a significant indirect effect on outcomes through improved adherence to self-monitoring (PS < 0.001). Receiving an automated daily feedback message via PDA only had a significant indirect effect on weight through self-monitoring adherence to diet (P = 0.004) and physical activity (P = 0.002). Conclusions Adherence to self-monitoring of diet and physical activity is important as the underlying mechanism in this technology-supported behavioral weight-loss intervention.

An integrative review of factors associated with falls during post-stroke rehabilitation.

Purpose: Our aims were to evaluate evidence of risk factors for falls among patients in stroke rehabilitation and to offer recommendations for clinical practice and future research. Method: We conducted an integrative review of the literature published from 1990 to 2009 that describes empirical investigations of risk factors for post-stroke falls during inpatient rehabilitation. We searched Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Embase databases, using the search terms “accidental falls,”“fall risk,”“risk factors,”“risk assessment,”“stroke,” and “cerebrovascular disorders.” We extracted information regarding study design, sample, potential risk factors, analytic methods, findings, and limitations from the 14 articles that met our inclusion criteria, and we rated the level of evidence for each study. Findings: Available empirical evidence points to impaired balance, visuospatial hemineglect, and impaired performance of activities of daily living as risk factors for falls during inpatient rehabilitation for stroke. Associations between falls and cognitive function, incontinence, visual field deficits, and stroke type were less clear, while relationships between falls and age, gender, stroke location, and impaired vision and hearing were not supported. Conclusions: The relatively sparse literature pertaining to risk factors for falls among stroke rehabilitation inpatients indicates that deficits affecting balance, perception, and self-care significantly increase the likelihood of falls. Particularly intriguing is the less well established role of post-stroke cognition in falls in this population. A conceptual model is needed to guide scientific inquiry and clinical practice in this area. Clinical Relevance: When clinicians in the inpatient stroke rehabilitation setting evaluate which patients are at greatest risk to fall, stroke-specific risk factors such as impaired balance, visuospatial hemineglect, and self-care deficits may be better predictors than more general risk factors such as age, incontinence, and sensory impairments. Patients with these stroke-specific deficits may benefit from the use of aggressive fall prevention interventions.

iWalker: Toward a Rollator-Mounted Wayfinding System for the Elderly

Research on intelligent walkers aims at helping elderly individuals to maintain their independence in familiar and unfamiliar environments. Several walkers have been developed by researchers at Carnegie Mellon University and the University of Pittsburgh. This article contributes to this research venue by describing the design and initial evaluations of iWalker, a multi-sensor rollator-mounted wayfinding system for the elderly. The primary difference of the proposed navigation aid from other intelligent walkers is that iWalker is assumed to operate in a smart world (SW), a physical space equipped with embedded sensors. By integrating inexpensive sensors into the environment, the cost and complexity of the walker can be reduced.

Preventive health practices: comparison of family caregivers 50 and older.

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

Self-Monitoring of Blood Glucose Is Associated With Problem-Solving Skills in Hyperglycemia and Hypoglycemia

Purpose The purpose of this study was to examine the association between self-monitoring of blood glucose (SMBG) and problem-solving skills in response to detected hyperglycemia and hypoglycemia among patients with type 2 diabetes. Methods Data were obtained from the American Association of Diabetes Educators Outcome System, implemented in 8 diabetes self-management education programs in western Pennsylvania. SMBG was measured by asking patients how often they checked, missed checking, or checked blood glucose later than planned. Problem-solving skill was measured by asking how often they modified their behaviors after detecting high or low blood glucose. Results Most patients checked their blood glucose at least once per day. However, when blood glucose was high or low, many of them reported doing nothing, and only some of them resolved the problem. There were significant associations between self-monitoring of blood glucose and problem-solving skills for hyperglycemia and hypoglycemia, after controlling for age, gender, ethnicity, education, and time since diagnosis. Conclusions Patients reported poor problem-solving skills when detecting hyperglycemia and hypoglycemia via SMBG. Patients need to learn problem-solving skills along with SMBG training to achieve glycemic control.

Designing and Evaluating Quality of Life Technologies: An Interdisciplinary Approach

Developing quality of life technologies (QoLT) poses unique challenges to engineers and computer scientists. This paper provides a roadmap for design, development, and evaluation. We begin with a definition of quality of life and identify key attributes of QoLT. This is followed by a discussion of methods for identifying target populations and needs. Next, we describe the process of user-centered iterative design and development and conclude with evaluation strategies to assess the impact of QoLT. A central theme of the paper is that successful technology development in this arena is highly dependent on collaborative interdisciplinary teams involving social scientists, clinicians, engineers, and computer scientists.

Usability of a Wearable Camera System for Dementia Family Caregivers

Health care providers typically rely on family caregivers (CG) of persons with dementia (PWD) to describe difficult behaviors manifested by their underlying disease. Although invaluable, such reports may be selective or biased during brief medical encounters. Our team explored the usability of a wearable camera system with 9 caregiving dyads (CGs: 3 males, 6 females, 67.00 ± 14.95 years; PWDs: 2 males, 7 females, 80.00 ± 3.81 years, MMSE 17.33 ± 8.86) who recorded 79 salient events over a combined total of 140 hours of data capture, from 3 to 7 days of wear per CG. Prior to using the system, CGs assessed its benefits to be worth the invasion of privacy; post-wear privacy concerns did not differ significantly. CGs rated the system easy to learn to use, although cumbersome and obtrusive. Few negative reactions by PWDs were reported or evident in resulting video. Our findings suggest that CGs can and will wear a camera system to reveal their daily caregiving challenges to health care providers.

Demographic profile of older adults using wheeled mobility devices

The purpose of this study was to determine whether the use of wheeled mobility devices differed with respect to age, gender, residential setting, and health-related factors among older adults. A total of 723 adults ageing 60 and older are representing three cohorts, from nursing homes, the Center for Assistive Technology, and the wheelchair registry from the Human Engineering Research Laboratories. Wheeled mobility devices were classified into three main groups: manual wheelchairs, power wheelchairs, and scooters. Our results found factors including age, gender, diagnosis, and living settings to be associated with differences in use of manual versus powered mobility devices. Differences in use were also noted for subtypes of manual (depot, standard, and customized) and powered (scooter, standard, and customized) mobility devices, on demographic, living arrangements, and health-related factors. Consideration of demographic, health-related, and environmental factors during the prescription process may help clinicians identify the most appropriate mobility device for the user.