IT applications that support aging in place:

• 1. IT applications that support aging in place:seven categories of needMike RosenOutgoing DirectorRehabilitation Engineering LabsNational Rehabilitation HospitalDisclaimer: This talk is about meeting theneeds of elders by using technology.Therefore it will focus on technology. It is,however, the position of the speaker, hiscolleagues and family that IT must be appliedin the context of an integrated consumer-centered system of health care and supportfor independent living.

2. Seven killer apps that support life and living Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoringNote: first three are about Health maintenance service delivery; last three areassistive; fourth one can be Cognitive support in ADLs either depending on onesmodel of health care. Enhanced communication with the outside Access to information and stimulation 3. First application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication with the outside Access to information and stimulation Talking Lights 4. For example: Critical medical events (e.g. stroke, coronary, diabetic coma) incapacitatedNote 1: Engineering challenges some capacities intact vary dramatically across these Fallsexamples; e.g. sensor integrationand knowledge-based processing conscious but immobile for automated fall detection. at homeNote 2: Automated solutions must awaytake into account the costs of false unconsciouspositives and false negatives. at home away Wandering (secondary to dementia) aware unaware 5. Second application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication with the outside Access to information and stimulation 6. Note 1: This kind ofFor example: instrumented monitoring may befelt as lessintrusive than Detection, timing, counting ofvideo. environmental use, e.g.Note 2: Wireless bed, chair, bathroom use solutions arenearly essential. to sample elders energy and engagementNote 3: Either to note indications of depression modular retro- fittable senor to track the progress of rehab or disease products (like X10) state or smart home integrated In situ motion analysissystems*. Crude cumulative accelerometry for overall (Actigraphs)*MIT, GA Tech, Targeted processing of wearable sensor Intel, GE, signals to detect/measure particular Rochester symptoms, e.g. tremor, spasticity, o.c.d. 7. Third application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication with the outside Access to information and stimulation 8. the premise Unobtrusive monitoring of selected ADLs in the home is technically feasible and practical. Performance of ADLs is the most direct and ecologically valid indicator of functional status (and rehab outcome). ADL event time records can be processed to return meaningful estimates of global functional status for display to OTs and other remote service providers without video 9. NRH project design First: develop and demonstratea prototypesensor packageand data- acquisition hardware and software for installation in akitchen: done Wired Independence Square at NRH 10. micro-switch unobtrusivesensors: sofar justIs theswitchesstove on?in-lineflow switch magneticproximityswitch Is thefaucetIs therunning?cabinetopen? 11. project design Then: formulate and validate estimators Hypothesize performance metrics (PMs) based on timing and counting Regress linear combinations of PMs against AMPS sub-scores (as the validated standard measure) across subjects Test the hypothesis: look for correlations between PMs and AMPS scores; i.e. show that our objective automated sampling of selected task performance can estimate overall function 12. possible performance metrics Durations, e.g. event-to-event Counts, e.g. # times refrigerator was opened Categorical: yes/no Spatial distance moved Rates, events per time Normalized by optimal or norm or contract with therapist 13. status Sensor package in place in Independence Square at NRH with funding from NIDRR via the RERC on Telerehab, and from the U.S. Army Medical Research and Materiel Command OT research partner, trained in AMPS (Assessment of Motor and Process Skills), has tested five subjects with left CVA In-home validation studies proposed, both cross-subject and longitudinal 14. development plan Bring to market the CARE package (Collection of Adls for Remote Evaluation): Wireless switch package Data logging and transfer box (H.323 protocol) Hub-site data capture and processing software Interactive display software for OTs and other service providers 15. Fourth application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication with the outside Access to information and stimulation 16. For example: *MIT MANUS, Greg Burdeas hand and foot systems, Dave Sensing of medication use and prescribedReinkensmeyers JavaTherapy therapeutic activities to monitor compliance Home health technology for regular sampling of physiological signals and video visits integrated into home environment, e.g. the smart toilet special purpose table-top wearableNote 1: an engineering implanted challenge is the processingof instrumentation signals Telerehab, e.g.to yield clinician-friendly speech pathology results; OR educate psychological counseling clinicians to be neuropsych evaluationinstrumentation-friendly wound management Note 2: always-on assistive technology assessmentstreaming videomonitoring may be viewed follow-up post-dischargeas Big Brother by some, web-enabled video-enhanced robotic PT* Guardian Angel by others. 17. Fifth application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication with the outside Access to information and stimulation 18. Note: this need is not limited to elders. For example:This is universal assistive technology. Application of mass-market technologies such as PDAs and GPS Purpose-designed software and human interfaces* for prompting during home-based ADLs, e.g. cooking: cognitive orthoses Integrated smart home solutions, e.g. networking contents-monitoring refrigerator with shopping service; or digital voice prompts about safety *Elliot Cole, issues such as door locking or Institute forCognitive remembering to shut off the stove Prosthetics 19. Sixth application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication with the outside Access to information and stimulation 20. For example: Phone Email, instant messaging, Cell-phone-based short text message service Televisits with remote family (via H.324 videophones; H.323 Internet-based standard; or coming 3G video cell phones) Special-interest chat rooms, blogs, On-line photo albums Web-based advocacy Note: Evidence is convincing thatold age itself is not a barrier to use and politics of sophisticated IT. The habits,expectations, experience and Amazon.com etc.attitudes of this particulargeneration of elders can be. 21. Seventh application Emergency detection and response-cuing Activity tracking for status monitoring Task sampling for status monitoring Health maintenance Cognitive support in ADLs Enhanced communication to the outside Access to information and stimulationARMCHAIR TRAVEL.COM 22. For example: Unlimited access to all interest areas via specialty Web sites Virtual travel On-line news and other publications Health information Web sites Internet-based music browsing and downloading 23. More notes: The majority of the products noted here are sold to the mass market. Elders are themselves a huge and growing market; but many of these IT apps or their core technologies suit virtually the entire population. In telehealth, communication and cognitive support, mass-market convergence products can become specialty tools -- 3G video smart phones, for example, for telehealth. 24. New Yorker Cartoon by Gregory Swissmemory USB by Victorinox