María Teresa Arredondo Waldmeyer

A succinct overview of virtual reality technology use in Alzheimer's disease.

We provide a brief review and appraisal of recent and current virtual reality (VR) technology for Alzheimer’s disease (AD) applications. We categorize them according to their intended purpose (e.g., diagnosis, patient cognitive training, caregivers’ education, etc.), focus feature (e.g., spatial impairment, memory deficit, etc.), methodology employed (e.g., tasks, games, etc.), immersion level, and passive or active interaction. Critical assessment indicates that most of them do not yet take full advantage of virtual environments with high levels of immersion and interaction. Many still rely on conventional 2D graphic displays to create non-immersive or semi-immersive VR scenarios. Important improvements are needed to make VR a better and more versatile assessment and training tool for AD. The use of the latest display technologies available, such as emerging head-mounted displays and 3D smart TV technologies, together with realistic multi-sensorial interaction devices, and neuro-physiological feedback capacity, are some of the most beneficial improvements this mini-review suggests. Additionally, it would be desirable that such VR applications for AD be easily and affordably transferable to in-home and nursing home environments.

Using the Analytic Hierarchy Process (AHP) to understand the most important factors to design and evaluate a telehealth system for Parkinson's disease

BackgroundThe assessment of a new health technology is a multidisciplinary and multidimensional process, which requires a complex analysis and the convergence of different stakeholders into a common decision. This task is even more delicate when the assessment is carried out in early stage of development processes, when the maturity of the technology prevents conducting a large scale trials to evaluate the cost effectiveness through classic health economics methods. This lack of information may limit the future development and deployment in the clinical practice. This work aims to 1) identify the most relevant user needs of a new medical technology for managing and monitoring Parkinsons Disease (PD) patients and to 2) use these user needs for a preliminary assessment of a specific system called PERFORM, as a case study.MethodsAnalytic Hierarchy Process (AHP) was used to design a hierarchy of 17 needs, grouped into 5 categories. A total of 16 experts, 6 of them with a clinical background and the remaining 10 with a technical background, were asked to rank these needs and categories.ResultsOn/Off fluctuations detection, Increase wearability acceptance, and Increase self-management support have been identified as the most relevant user needs. No significant differences were found between the clinician and technical groups. These results have been used to evaluate the PERFORM system and to identify future areas of improvement.ConclusionsFirst of all, the AHP contributed to the elaboration of a unified hierarchy, integrating the needs of a variety of stakeholders, promoting the discussion and the agreement into a common framework of evaluation. Moreover, the AHP effectively supported the user need elicitation as well as the assignment of different weights and priorities to each need and, consequently, it helped to define a framework for the assessment of telehealth systems for PD management and monitoring. This framework can be used to support the decision-making process for the adoption of new technologies in PD.

A wearable system for long-term ubiquitous monitoring of common motor symptoms in patients with Parkinson's disease

PERFORM is a system for the monitoring, assessment and management of patient with Parkinsons disease (PD). It comprises of three subsystems: (i) Multi-Sensor Monitoring Unit, (ii) the Local Base Unit, and (iii) the Centralized Hospital unit. The wearable, multi-sensor monitoring unit (WMSMU) of the PERFORM system is presented in this work. This unit plays an essential role in the overall PERFORM system since it is responsible to record and pre-process accelerometer and gyroscope signals that are later used by the various components of the Local Base Unit in order to classify and quantify the symptoms and motor status of the PD patients. The WMSMU was evaluated in a large set of pilot studies in PD patients.

Exploring the Frequency Domain of Continuous Glucose Monitoring Signals to Improve Characterization of Glucose Variability and of Diabetic Profiles

Background: Continuous glucose monitoring (CGM) devices measure interstitial glucose concentrations (normally every 5 minutes), allowing observation of glucose variability (GV) patterns during the whole day. This information could be used to improve prescription of treatments and of insulin dosages for people suffering diabetes. Previous efforts have been focused on proposing indices of GV either in time or glucose domains, while the frequency domain has been explored only partially. The aim of this work is to explore the CGM signal in the frequency domain to understand if new indexes or features could be identified and contribute to a better characterization of glucose variability. Methods: The direct fast Fourier transform (FFT) and the Welch method were used to analyze CGM signals from three different profiles: people at risk of developing type 2 diabetes (P@R), T2D patients, and type 1 diabetes (T1D) patients. Results: The results suggests that features extracted from the FFT (ie, the localization and power of the maximum peak of the power spectrum and the bandwidth at 3 dB) are able to provide a characterization for all the three populations under study compared with the Welch approach. Conclusions: Such preliminary results can represent a good insight for futures investigations with the possibility of building and using new indexes of glucose variability based on the frequency features.

An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise:

Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping “desired behaviours” into specific system’s specifications, borrowing concepts from Fogg’s Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.

Mobile Systems as a Challenge for Neurological Diseases Management – The Case of Parkinson's Disease

Nowadays the importance of bio-medical engineering and mobile applications for healthcare is amazingly growing. During the last decades many devices and technological solutions have become available on the market and the interest in applying those technologies to the treatment of several kinds of pathologies has consequently increased. This chapter addresses the problem of continuous monitoring of patients affected by Parkinson’s Disease (PD) and proposes a set of technologies to improve the following and management of such subjects. PD is a neurodegenerative disorder of the central nervous system that affects motor skills and speech (Tolosa, 1998). The primary biochemical abnormality in PD is a deficiency of dopamine due to degeneration of neurons in the substantia nigra pars compact (D. G. Standaert & Young, 2001). The characteristic motor features of the disease include bradykinesia (i.e. slowness of movement), tremor, rigidity (i.e. resistance to externally imposed movements), flexed posture, postural instability and freezing of gait. Furthermore, PD is usually characterised by the loss of normal prosody of the speech (Darkins et al., 1988). According to the World Health Organisation [WHO], 2002), there are more than six million people worldwide affected by PD. The syndrome typically appears around the age of 60. It affects Europeans and North Americans more often than Asians or Africans and it is more common in men than in women. PD affects about 2% of the population over the age of 65 years, figure that is expected to double by 2020 (de Lau & Breteler, 2006). For those reasons, PD poses a significant public health burden, which is likely to increase in the coming years. Annual medical care, including doctors’ visits, physical therapies and treatment for cooccurring illnesses -such as depressionis estimated at

Developing an augmentative mobile communication system

2,000 to

Personalized e-Health for Elderly Self-care and Empowerment

7,000 for people in early stages of the disease, and it is probably much higher for advanced stages. Surgical treatments for PD can cost

Corrigendum: A succinct overview of virtual reality technology use in Alzheimer’s disease

25,000 or more. As the disease progresses, institutional care at an assisted-living facility or nursing home may be required, and the related costs can exceed

User interface framework for ambient intelligence platforms

100,000, per person annually. Technology in general and specifically ICT might be an affordable alternative for PD’s patients’ treatment and management. The development of platforms for remote health