Mohanraj Karunanithi

Review of Accelerometry for Determining Daily Activity Among Elderly Patients

OBJECTIVES To review studies that used accelerometers to classify human movements and to appraise their potential to determine the activities of older patients in hospital settings. DATA SOURCES MEDLINE, CINAHL, and Web of Science electronic databases. A search constraint of articles published in English language between January 1980 and March 2010 was applied. STUDY SELECTION All studies that validated the use of accelerometers to classify human postural movements and mobility were included. Studies included participants from any age group. All types of accelerometers were included. Outcome measures criteria explored within the studies were comparisons of derived classifications of postural movements and mobility against those made by using observations. Based on these criteria, 54 studies were selected for detailed review from 526 initially identified studies. DATA EXTRACTION Data were extracted by the first author and included characteristics of study participants, accelerometers used, body positions of device attachment, study setting, duration, methods, results, and limitations of the validation studies. DATA SYNTHESIS The accelerometer-based monitoring technique was investigated predominantly on a small sample of healthy adult participants in a laboratory setting. Most studies applied multiple accelerometers on the sternum, wrists, thighs, and shanks of participants. Most studies collected validation data while participants performed a predefined standardized activity protocol. CONCLUSIONS Accelerometer devices have the potential to monitor human movements continuously to determine postural movements and mobility for the assessment of functional ability. Future studies should focus on long-term monitoring of free daily activity of a large sample of mobility-impaired or older hospitalized patients, who are at risk for functional decline. Use of a single waist-mounted triaxial accelerometer would be the most practical and useful option.

Wavelet based approach for posture transition estimation using a waist worn accelerometer

The ability to rise from a chair is considered to be important to achieve functional independence and quality of life. This sit-to-stand task is also a good indicator to assess condition of patients with chronic diseases. We developed a wavelet based algorithm for detecting and calculating the durations of sit-to-stand and stand-to-sit transitions from the signal vector magnitude of the measured acceleration signal. The algorithm was tested on waist worn accelerometer data collected from young subjects as well as geriatric patients. The test demonstrates that both transitions can be detected by using wavelet transformation applied to signal magnitude vector. Wavelet analysis produces an estimate of the transition pattern that can be used to calculate the transition duration that further gives clinically significant information on the patients condition. The method can be applied in a real life ambulatory monitoring system for assessing the condition of a patient living at home.

Detecting walking activity in cardiac rehabilitation by using accelerometer

This study is part of the ongoing care assessment platform project, which involves monitoring vital signs and daily activity profile information of chronic disease patients undergoing cardiac rehabilitation. In this study, we have focussed on detecting walking activity from a cardiac rehab session which includes many other high intensity activities such as biking and rowing, using waist worn accelerometers. Walking is an important measure useful to assess the mobility of elderly people. Various methods have been proposed in the literature to identify walking from waist worn accelerometer signals based on wavelet, frequency and computational intelligence methods. Wavelet based approach, due to its feasibility to be implemented in real time with low computational complexity, good accuracies and also the ability to provide good time frequency resolution, has been the most desirable approach. In this study, we have evaluated and compared six wavelet decomposition based measures to detect walk from other high intensity activities. The different measures were derived using anterior-posterior, vertical, medio-lateral and signal vector magnitude (SVM) acceleration signals. The results show that all these measures can discriminate walking from other high intensity activities and the SVM based measure was the most efficient (89.14% sensitivity and 89.97 % specificity).

What Kinds of Website and Mobile Phone–Delivered Physical Activity and Nutrition Interventions Do Middle-Aged Men Want?

Within a health context, men in Western societies are a hard-to-reach population who experience higher rates of chronic disease compared with women. Innovative technology-based interventions that specifically target men are needed; however, little is known about how these should be developed for this group. This study aimed to examine opinions and perceptions regarding the use of Internet and mobile phones to improve physical activity and nutrition behaviors for middle-aged men. The authors conducted 6 focus groups (n = 30) in Queensland, Australia. Their analyses identified 6 themes: (a) Internet experience, (b) website characteristics, (c) Web 2.0 applications, (d) website features, (e) self-monitoring, and (f) mobile phones as delivery method. The outcomes indicate that men support the use of the Internet to improve and self-monitor physical activity and dietary behaviors on the condition that the website-delivered interventions are quick and easy to use, because commitment levels to engage in online tasks are low. Participants also indicated that they were reluctant to use normal mobile phones to change health behaviors, although smartphones were perceived to be more acceptable. This pilot study suggests that there are viable avenues to engage middle-aged men in Internet- or in mobile-delivered health interventions. This study also suggests that to be successful, these interventions need to be tailor-made especially for men, with an emphasis on usability and convenience. A wider quantitative study would bring further support to these findings.

Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews

Background Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone–based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone–based monitoring and videoconferencing, require further investigation.

A review of the nature and effectiveness of nutrition interventions in adult males – a guide for intervention strategies

BackgroundEnergy excess, low fruit and vegetable intake and other suboptimal dietary habits contribute to an increased poor health and the burden of disease in males. However the best way to engage males into nutrition programs remains unclear. This review provides a critical evaluation of the nature and effectiveness of nutrition interventions that target the adult male population.MethodsA search for full-text publications was conducted using The Cochrane Library; Web of Science; SCOPUS; MEDLINE and CINAHL. Studies were included if 1) published from January 1990 to August 2011 and 2) male only studies (≥18 years) or 3) where males contributed to >90% of the active cohort. A study must have described, (i) a significant change (p<0.05) over time in an objective measure of body weight, expressed in kilograms (kg) OR Body Mass Index (BMI) OR (ii) at least one significant change (p<0.05) in a dietary intake measure to qualify as effective. To identify emerging patterns within the research a descriptive process was used.ResultsNine studies were included. Sample sizes ranged from 53 to 5042 male participants, with study durations ranging from 12 weeks to 24 months. Overlap was seen with eight of the nine studies including a weight management component whilst six studies focused on achieving changes in dietary intake patterns relating to modifications of fruit, vegetable, dairy and total fat intakes and three studies primarily focused on achieving weight loss through caloric restriction. Intervention effectiveness was identified for seven of the nine studies. Five studies reported significant positive changes in weight (kg) and/or BMI (kg/m2) changes (p≤0.05). Four studies had effective interventions (p<0.05) targeting determinants of dietary intake and dietary behaviours and/or nutritional intake.Intervention features, which appeared to be associated with better outcomes, include the delivery of quantitative information on diet and the use of self-monitoring and tailored feedback.ConclusionUncertainty remains as to the features of successful nutrition interventions for males due to limited details provided for nutrition intervention protocols, variability in mode of delivery and comparisons between delivery modes as well as content of information provided to participants between studies. This review offers knowledge to guide researchers in making informed decisions on how to best utilise resources in interventions to engage adult males while highlighting the need for improved reporting of intervention protocols.

Monitoring technology for the elderly patient

In view of the current demographic change in the aging population and its impact on changing the health system towards community care, this review focuses on monitoring technology for elderly patients. In particular, the focus is on wearable monitoring technology and its integration into telehealth systems. In review of the available commercial wearable monitoring technologies, their form factor, sensing methods and application for the purpose of monitoring elderly patients for ongoing care are discussed. At the same time, advances in research regarding how to overcome the limitations of commercial wearable monitoring devices are reviewed. Issues of usability, functionality, human interaction and social factors, and ethical considerations in the application of wearable monitoring and telehealth technologies for elderly patients are outlined. Some of the initiatives taken to address these issues are also discussed and some suggestions are made. Finally, the review looks at the anticipated benefits of the application of wearable monitoring and telehealth technologies from an elderly patient, clinician or carer and healthcare system point of view. Expert opinion of what strategies need to be used to enhance the use and uptake of these technologies and what future directions are anticipated are expressed. In conclusion, available wearable monitoring technologies and its integration into teleheath systems are currently limited for application on elderly patients. There are many issues of standardization, design and ethical considerations that need to be addressed before advances can be made with these technologies so that these patients can be remotely monitored and provided with a better quality of care.

BLUESOUND: A New Resident Identification Sensor—Using Ultrasound Array and BLE Technology for Smart Home Platform

Activity recognition through ambient sensors in a smart home can efficiently monitor residents’ abnormal behaviors in daily life, while not adding extra burdens caused by wearable sensors. Monitoring and separating the activities of a specific individual in a multi-residential home is still, however, a significant challenge for these smart home applications. This paper proposes a new human identification sensor, which can efficiently differentiate multiple residents in a home environment to detect their height as a unique bio-feature. This sensor includes three sensing/communication modules: pyroelectric infrared (PIR) occupancy, ultrasound array, and bluetooth low energy (BLE) communication modules. The PIR occupancy module is used to detect the moving direction, while the ultrasound array module detects the moving residents’ height. The combination of these two sensing technologies can be used to then detect the moving velocity. The BLE advertising mode is then used to communicate these data to the data server. A new embedded algorithm increased the energy efficiency of this identification technology. A comprehensive modeling and experiments are done to assess the performance of this sensor and the results are provided.

Information and communication technology-based cardiac rehabilitation homecare programs

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Smart Homecare Technology and TeleHealth 2015:3 69–79 Smart Homecare Technology and TeleHealth Dovepress

Gait velocity estimation using time-interleaved between consecutive passive IR sensor activations

Gait velocity has been consistently shown to be an important indicator and predictor of health status, especially in older adults. It is often assessed clinically, but the assessments occur infrequently and do not allow optimal detection of key health changes when they occur. In this paper, we show that the time gap between activations of a pair of passive infrared motion sensors in the consecutively visited room-pair carry rich latent information about a persons gait velocity. We name this time gap transition time and modeling the relationship between transition time and gait velocity, and using a support vector regression approach, we show that gait velocity can be estimated with an average error of <;2.5 cm/s. Our method is simple and cost effective and has advantages over competing approaches such as: obtaining 20-100 times more gait velocity measurements per day. It also provides a pervasive in-home method for context-aware gait velocity sensing that allows for monitoring of gait trajectories in space and time.