Ebook: Everyday Technology for Independence and Care

On behalf of the Association for the Advancement of Assistive Technology in Europe we are proud to publish the proceedings of the 11^th bi-annual AAATE conference. With the 11^th conference once again being held in the Netherlands, this traveling conference returns to its first venue in Maastricht. Since 1990, the conference has been organized in Sweden, Greece, Portugal, Germany, Slovenia, Ireland, France, Spain and Italy. The proceedings of the 11^th conference add to the sharing and dissemination of research based knowledge on the development and application of Assistive Technology in general, and more specifically in Europe.

The Association for the Advancement of Assistive Technology in Europe (http://www.aaate.net) is the interdisciplinary pan-European association devoted to all aspects of Assistive Technology: use, research, development, manufacture, supply, service, delivery and the development of policy. Its mission is to stimulate the advancement of Assistive Technology for the benefit of people with disabilities, including the elderly, through the following main areas of action:

• the raising of awareness of assistive technology

• the promotion of research and development of assistive technology

• the facilitation of an exchange of knowledge within the field

• the dissemination of information regarding assistive technology and related issues.

Assistive Technology encompasses a whole range of technological applications. Traditional Assistive Technology devices have remained an important topic throughout past AAATE conferences. AT devices are becoming increasingly relevant in society, due to the demographic changes in many European countries. In future, those with disabilities and older citizens will want to remain living independently in their own homes, but human care support is becoming more costly and difficult to find. Traditional assistive technology devices will continue to be important in supporting this independent living, but assistive environments are increasingly providing a powerful support solution. Advances in technology also pave the way for technological innovations such as robotics and ICT sensor applications.

As the number of users increase, the potential of accessible consumer products also increases. However, to make this potential a reality, design for all and accessibility principles must be implemented.

A final area of applied technology that is becoming ever more interrelated with Assistive Technology is Care Technology. Technological care support is traditionally intended to support care staff, but is gradually also becoming more important for informal care givers and clients. Applications such as monitoring systems and tele-care are expanding and clients are more and more involved as the users of such systems.

The content of these proceedings reflects the range of current technologies. Chapter 1 provides examples of research and development of care systems intended to support people in their daily life. Perspectives on a range of traditional Assistive Technology issues are presented in chapters 2 to 7. Chapter 8 focuses on design for all and accessibility. Chapter 9 approaches the development and use of technology in general from a user perspective. Chapter 10 investigates the circumstances and approaches taken to make Assistive Technology available to individual users.

We hope this substantial volume will support the further advancement of Assistive Technology for the citizens of our countries and we would like to take this opportunity to thank all the contributing authors for sharing their excellent work with us.

Gert Jan Gelderblom

Thijs Soede

Objective: Use of technology to structure and support the daily activities of the residents in a small scale group accommodation (SSGA) for dementia is a new innovation in the Netherlands. This paper presents: a) the process of development of this new way of structuring activities by describing the making of digital planning boards, b) the findings of a pilot study looking at the experiences of using this device in people with dementia living in a small-scale group accommodation as well as experiences of informal carers and members of staff and c) the process of organizing day structure using this device from the user's perspectives.

Main content of paper: To develop the memory aid a user centred development process was used. After the first development cycle was completed the resulting digital planning boards were placed in the living room of a small scale living group for people with dementia and in private rooms of the residents. The main task of the aid is to support the memory of the residents by structuring the daily activities during the day. This paper provides the experiences of the users including the residents, informal carers and members of staff, issues around implementation and further development.

Method & findings: A qualitative method was chosen, data was collected using semi structured individual interviews with the residents (n=6) and focus groups interviews with informal carers (n=5) and members of staff (n=6). The framework analysis by Ritchie & Spencer (1994) was used to analyse the data. This resulted in the description of the findings based on the following three general themes; the state of affairs regarding the implementation, the needs for further development and the learning experiences acquired during the development.

The occurrence of installation errors, inefficient use, limited ease of use and a lack of knowledge regarding the function and use of the memory aid are highlighted as the most important issues that prevented a successful implementation. However, the majority of the residents were happy with the use and function of the memory aid when it worked. The informal carers were not very positive but indicated opportunities for improvement. This was echoed by the staff, although they saw an added value for the current use of the device. The findings highlighted shared views about ways of improving through adaptation of the software programme and additional technological applications such as Internet connectivity, improving its accessibility by using a remote control, adding videos and photos.

Conclusions: A number of lessons are learned about the use and transferability of this innovation in general health care setting as well as in people with dementia. The process of user centred design and development will be followed to obtain solutions that can be effectively implemented in their living environment.

Objective: To collaborate with relevant stakeholders and end-users to develop an innovative and feasible system that monitors physical functioning and provides tailored feedback and advice to community-dwelling elderly people.

Main content of paper: Technological innovations can contribute to bridging the gap between demand and supply of care in frail elderly people. The progression of physical functioning in elderly people can be monitored using technology and via the same technology, functioning-related feedback and advice can be provided to the elderly user and care providers. This may support self-management. However, when developing and introducing new technology, it is important that relevant stakeholders and end-users accept the technology and are able to use it. Therefore, a feedback and advisory system was developed in close collaboration with elderly people, engineers, researchers, geriatricians, physiotherapists, and other health care professionals. All these stakeholders provided input during interviews and expert-meetings on issues such as: which physical indicators should be measured, how (often) should they be measured, how should feedback and advice be provided, and how to embed the technology in daily living and in health care? During this iterative process, aspects of the system were adjusted based on the input of all stakeholders.

Results: The technological system that was developed consists of three devices; a bathroom scale monitoring weight and balance, a Grip-ball monitoring grip strength and a mobile phone with a built-in accelerometer monitoring physical activity and gait. The information about these physical indicators is sent to the mobile phone via blue-tooth. The users will receive feedback and advice regarding their own physical functioning on the screen of the mobile phone using text messages and/or spoken messages. The tailored advices relate to individually relevant and realistic goals that aim to maintain or improve physical functioning. The mobile phone also sends the information to an online database that is accessible for care professionals.

Conclusion: In collaboration with different stakeholders and end-users, an innovative feedback and advisory system was developed for community-dwelling elderly people. The system can also be used by health care professionals to monitor the progression of physical functioning of their clients. By ensuring that all relevant stakeholders and end-users were able to provide their input during the development process, the feasibility and acceptability of the current system have been optimized. This resulted in a unique system that might relief part of the burden that frailty places on elderly people and on health care systems.

Objective: The purpose of this project was to develop a toolkit with comfort products, low-tech assistive devices and information, based on the needs and demands of an elderly population living independently, aiming at maintaining independence and autonomy.

Main content: An increasing part of the Dutch population is aging. Elderly people wish to continue living in their own environment as long as possible, living independently and experiencing a high quality of living. Will the use of simple, low-tech products, comfort products and assistive devices contribute to this endeavour? First, a study was conducted to find out which difficulties the elderly encounter. Secondly, a team of experts identified comfort products and assistive devices that could offer solutions to the difficulties mentioned, a manual was added for each product, and decision trees (guidelines) were developed for the five foremost difficulties identified in the research mentioned above. For the evaluation, one hundred participants received the toolkit and were interviewed. All the participants were over 65 years old and living independently.

Results: The participants were very positive about the idea of receiving the toolkit when getting older. Almost all the participants used most of the products from the toolkit and continued using them after a few months. The products in the toolkit and the information were generally judged positively. The participants stated that the toolkit enabled them to live their life more independently, with less effort or pain. The impression arises that using the toolkit increases the participants' awareness of possible difficulties in aging, as well as their knowledge of products offering a solution for these difficulties, and their problem solving skills.

Conclusion: From the perspective of elderly users, a toolkit with comfort products, low technology devices and information helps them to live their life more independently and autonomously and to continue doing so in the future.

Continence problems are extremely common in the adult population and prevalence increases with age. Urinary system function can decline with age and concomitant diseases (congestive heart failure, Parkinson's Alzheimer's etc) and mobility problems are more prevalent. Any limitation in mobility is likely to cause difficulties with continence simply because the person finds it difficult to reach the toilet in time or transfer onto it when they get there. The most common method of managing ongoing continence problems is with the use of continence pads. Pads provide a hygienic and socially acceptable solution to incontinence but they are associated with problems that affect both physical and psychological well-being.

The objective of this part of our project was to develop underwear that would alert the wearer to a leak from the continence pad. The purpose of this product is to assist the wearer to avoid leakage spreading to outer clothing and the seating surface. This would in turn help prevent the embarrassment of visible leakage and reduce the associated additional cleaning of clothes and soft furnishings.

Content: This paper outlines the user-focused design process employed in creating the underwear and describes the technical development of the signaling system. The system comprises a wetness sensor and an electronic signaling unit. The sensor consists of tracks of conductive yarn that are stitched into the underwear. They are used to detect overspills of urine from the pad to the underwear. The signaling unit is a microcontroller-based unit that operates in deep sleep mode and is awoken by electrical contact between the conductive tracks. When triggered, the signaling unit responds by vibrating, alerting to the wearer to a pad leakage event. The paper also discusses user evaluation of the underwear.

Results: The results of the technical development and the clinical evaluation are reported. Pilot user evaluation data indicates that prototype product function is acceptable and that the underwear has a role in aiding management of continence problems.

Conclusion. The product will be a welcome addition to continence aids in the continence market.

Objective. Physical exercise may be used to improve mental cognition, physical strength and overall dexterity within the older population. This can enhance health and wellbeing. Walking is cited as the best exercise for persons over 60. We outline the development of a smart garment that allows the wearer to monitor their wellbeing whilst harnessing technology to provide additional safety measures and functionality.

Main Content. In order to ascertain the user needs, questionnaires were designed and distributed to a target cohort of 50 hikers (aged 60 or over). These questionnaires elicited user opinions and experiences with walking activities, clothing attire and technology; in addition to examining what users sought from a smart garment. A number of workshops were organized to offer users hands-on experience with appropriate fabrics, textiles and technology. From the feedback received a technology mapping exercise was performed in which viable technologies were mapped onto the requirements elicited.

Results. From this user interaction phase, themes were established: safety enhancement, additional functionality, support for monitoring health indicators and increased social interaction. The technology mapping exercise facilitated the development of an initial prototype that used a Smartphone and inbuilt sensors (accelerometer, GPS) to collect and record: location and walking attributes (such as speed, distance and altitude) all of which were fed back on an interactive map. A step count was implemented using the onboard accelerometer, to provide an indication of overall activity level. Further development will harness expertise in clothing manufacturing to create a layering system with the capability of integrating sensors to create a Body Area Network, to monitor and record requested information such as heart rate and (peripheral) body temperature. All this information must be assimilated in a useful and meaningful way. Hence the user interface and interaction methods will be designed appropriate to the age and experience of the target cohort, with elements of personalisation.

Conclusion. Feedback from users on the development of a smart garment has influenced the initial prototype. Further technical development will be based on user evaluation of the wearable system. Feedback from these evaluations will be used to add, amend or remove functionality.

Caregivers are among those professionals who experience the highest incidence of low back pain and low back injuries, and one of the most frequently described reasons for this is person transfers. This paper reports on a controlled intervention study in two Danish municipalities with perceived strain during person transfer, self reported low back pain and low back injuries as main outcomes. The intervention was implemented in one municipality consisting of maximum use of assistive devices for person transfer combined with organizational changes. The other municipality served as control group. The study population consisted of all permanently employed caregivers in the two municipalities, and data was collected by means of a questionnaire at baseline and after 10 months of follow-up. At follow-up the caregivers in the intervention group reported lower perceived strain during person transfer and fewer low back injuries compared to the control group. However, no differences were found in terms of intensity and duration of low back pain. Reasons for the differences are discussed.

Objective. People use pedometers and sport watches to measure calorie use and training performance. Knowing “how you move” is often more important than knowing “how much you move”. Measuring “how you move” and feedback to the user is the objective of the BioSensing project. Patients with osteoarthritis of the knee and patients with acute knee injury are the intended user groups.

Main content of paper. A sensor system was developed that quantifies simultaneously body acceleration, knee angle, foot pressure and repetitive loading patterns of the knee joint during activities of daily living. Patients get feedback if they move too much, too little, or move in the wrong way. The sensor system consists of a smart knee brace that measures the knee angle (developed by TNO), a combined angular velocity and acceleration sensor (McRoberts), a foot sensor (Zephyr/TNO), a data acquisition system (IDEE), and a wireless communication system (IDEE/Neways). Data is uploaded to a webserver and presented via a web application. Demonstrators were created for the medical specialist (diagnostics), for the physiotherapist (training), and patients at home (training, monitoring).

Results. Demonstrators were successfully shown at the BioSensing Symposium (Maastricht, Dec 2010). Experiments were conducted at Maastricht UMC+ to validate the knee brace sensors. Software was developed that automatically detects different daily activities by analysis of movement data: walking, climbing stairs, descending stairs, running (MOBILAB). An application of the DynaPort Hybrid was developed for knee loading measurement during daily activities (McRoberts).

Conclusion. BioSensing movement sensors give patients the opportunity to be more involved in their own rehabilitation, using direct feedback as a guideline.

Objective: The objective of the ACube (Ambient Aware Assistance) project is the development and testing of an advanced monitoring system to support professional caregivers in nursing home and residential care facilities. The goal of the system is the detection of events potentially dangerous for the guest of nursing homes, or interesting for the health care professionals, and the development of an appropriate response.

Design: The prototype developed during the project relies on distributed sensor networks connected to an automatic reasoning system. Sensing technologies used for collecting environmental data include video cameras, RFID antennas, microphones, and wireless sensor networks. Wearable sensors for detecting biosignals (such as electrocardiogram, actigrafy and breath) are also used. The data acquired from the sensors are analyzed by the automatic reasoning system that identifies potentially dangerous situations and alerts the caregiver.

Results: The developed prototype has been deployed into two test site: one in Trento, and the other in Milan (within the smart home facility of the DAT service). Several scenarios have been tested where the ACube prototype proved to be able to identify relevant events such as a repetitive walking pattern, the proximity to dangerous areas (e.g. an open window), health problems (e.g. tachycardia), etc.

Conclusions: By supporting the professional caregivers the ACube system could contribute to the improvement of the quality of services provided by nursing homes and residential care facilities while reducing the costs. In the future, the system could also be exported to different application domains, such as the intelligent monitoring and surveillance of public spaces (museums, schools, stations).

Objective and research questions. Dementia is a growing challenge in our aging society. Often, persons close to older people at some point in time sense that ‘something is wrong’ (long) before dementia is actually diagnosed, but do not know how to act upon it. This may lead to situations where dementia progresses unnoticed, until it escalates, and people need sudden admission to a hospital or nursing home. Therefore the aim of this project was to develop the outlines of an ICT system to effectively register and interpret signs of potential dementia, in order to give proper care long before things get out of hand. Besides relatives, close friends and health care workers, also other persons or organizations that are involved with older persons could play a role in the early detection of dementia. Individual signs often do not elicit a call to action. The combination of signals from several sources into a central digital system might generate a more complete view of an individual's situation. This yielded the following research questions: 1. Who are the important social contacts in the network of older persons that might detect early signs of problems? 2. How do social contacts currently experience and process possible signs of dementia? 3. How do older persons and their social contacts perceive a solution like the one we are envisioning (a kind of ‘digital central signaling system’)?

Methods. The social network of 12 older persons was studied with semi-structured interviews. Furthermore, 12 formal carers, 12 informal carers and eight family carers of persons with dementia were interviewed, in order to map experiences and processing of early signs of dementia. In addition, the attitude toward the envisioned system was studied. In an expert panel of 18 participants the results of the interviews were transformed into recommendations. These were subsequently tested in two focus group sessions with older persons.

Results. Family plays a central role, both in the social network of older persons as well as in the early signaling of dementia. All persons involved in this study valued the idea of a dementia signaling system. There is some skepticism with respect to privacy matters among carers. Apart from signaling, there is also a great demand for tailor made information in the pre-diagnostic stage. All involved persons indicate the need for support, but they experience high barriers in taking the first steps and finding the right aid and information.

Conclusion. An adaptive information system that also offers signaling possibilities will be more appropriate than an exclusive signaling system. Such a system needs to prevent stigmatization, should be demand driven, focused on empowerment rather than care, and managed by the user. An approach from the welfare perspective might be more successful than a disease-oriented approach.

Objective. Elderly people, who occupy nursing homes with dementia or legs getting weak, are on the increase. The nursing homes are requested to keep wandering, fall or other incidents of residents from going to fatal accidents. We propose a new hazardous behavior detector with face recognition technology in nursing home corridors.

Main content. This system consists of some multi-camera gates to acquire corridor passer events and a processor for face recognition and behavior detection or estimation. Each camera gate is composed of network cameras, including front cameras, side cameras, and top cameras. We place these gates to corridor areas outside private rooms in the nursing home. The faces of the passing residents, care staffs or visitors are detected and identified with the front cameras or side cameras. The face recognition leads to the acquisition of 3-D passing position, passing speed, and passing time of the residents. From these transfer information, we assemble a state transition diagram of each resident for the gates and estimate who is in danger of wandering indoors or going out of the facilities without notice. We also detect the tumbles or the crouches around each gate with if-then rules from passing information.

Results. We assembled a prototype of the multi-camera gate equipment and conducted on-the-spot experiments at a nursing home in Japan. Eight incidents of wandering at daytime or late night that care staffs recorded, were all successfully located over 582 hour period and came down to a care staff post using a computer network. In the time period, 13 incidents of wandering whose documents did not exist, were also located. This out-of-record number leads work load reduction of care staffs.

Conclusion. We have proposed a hazardous behavior detector of residents with multi-camera gates in nursing home corridors and confirmed its performance with on-the-spot experiments. This system is useful when the care staffs are not abundant at late night or they are in shifts.

Objective. Handling of emergency calls is an essential task for an environmental control system, when aimed at assistive applications. Often, though, voluntary activation of an emergency call (by pressing a help button, or activating any kind of AT communication device) can be quite demanding for people with debilitating diseases or severe motion impairments (besides, of course, depending on patient's consciousness). Modern ICTs can provide much help, enabling automatic recognition of help needs and management of emergency calls. Although very different in nature, this task has many technical similarities with environmental safety and security control carried out by an Ambient-Assisted Living system, which, in turn, can be also quite useful in allowing bedridden patients to control the home environment. Hence, embedding health-monitoring features within a general-purpose AAL framework may result in a more flexible, reliable and cost-effective solution. This work aims at describing design and implementation of such a solution in a “live” context: the CARDEA AAL system was deployed at ‘Casa Scarzara’, a sheltered house for people with multiple sclerosis in Parma, embedding wireless sensors for vital-sign monitoring.

Main Content. A wireless wearable sensor has been used, which allows for acquiring 3 physiological parameters (2-channel ECG, temperature, and breathing). The sensor is worn at patient's chest, and wirelessly communicates with a PC (base-station), through a Bluetooth connection. The base-station then processes the incoming data stream, extracting the hearth and breathing rates; if such rates (or body temperature) exceed given ranges, the processor issue a request to CARDEA, through a standard LAN connection. From this phase on, CARDEA manages the emergency call, warning a human attendant, by means of visual or acoustic signals, or activating a local pager. If no one takes care of the alert within a few minutes, emergency phone calls and SMS are generated automatically by the CARDEA system.

Results. Before deployment, the system has undergone extensive testing at TAU labs, with positive results. Field-testing at ‘Casa Scarzara’ is starting (February 2011). We expect the proposed solution can help to increase protection of a bedridden person, by providing continuous local and possibly remote supervision.

Objective: Currently, capturing and quantifying subjective health relevant data, such as pain, pain-profiles, well-being, etc., is routinely done by visual analog scales, i.e., the patient rates by associating the considered parameter with a numerical value, e.g., between 0 and 10. In most cases this is still done, on a paper-pencil basis, requiring wasteful (manual) post-processing and at the same time being susceptible to errors. In order to overcome these problems, an analog scale integrated into a smart NFC transponder has been developed.

Methods: The developed NFC analog scale (Austrian patent application A504/2010, PCT application pending) can be realized with dimensions of typically 2.5 cm (width) x 12 cm (length) and less than 0.3 mm thickness. It consists of the following elements: a 13.56 MHz resonant coil antenna and an ISO 14443 transponder chip, extended by an electronic circuit for A/D conversion of two analog voltages Us (sensor voltage) and Uc (compensation voltage) provided by two corresponding coils, also realized in the smart transponder. The sensor coil is distributed along the longer axis of the transponder in a special way in order to provide the voltage Us induced by an external reader device (mobile phone with NFC interface and corresponding software application) and at the same time Us being a measure for the position of the reader device along the longer axis of the transponder. The reference coil runs along the outer boundaries of the sensor coil and produces the voltage Uc, required to compensate for the reader device's magnetic field strength variations. From the voltages Us and Uc the position of the reader device in relation to the longer axis of the transponder can be determined and via the ISO 14443 transponder chip the position can be wirelessly transmitted to the reader device. The whole system can be realized purely passive, i.e., all the electronic circuits inside the NFC analog scale can be powered solely by the reader device's magnetic field and no additional power supply is required.

Results/Conclusion: The NFC analog scale described above enables an easy-to-use, comfortable and robust way for capturing and quantifying subjective health relevant parameters, such as pain, pain-profiles, well-being, etc. Equipped with such a device, a patient needs not more than a mobile phone with NFC interface and corresponding software application, to be able to rate the considered health parameter anywhere, at any time, by just placing the mobile phone at the corresponding position above the NFC analog scale. Real time feedback about the current position on the mobile phone's display ensures accurate data capturing and the acquired data can easily be forwarded wirelessly to a telemonitoring, therapy or compliance management centre. Especially for home-monitoring of patients with chronic pain, this passive NFC analog scale could be a big improvement for monitoring the efficacy of different therapy methods and medications.

Objective: With the increase in life expectancy and growth in the number of frail elderly, the demand for complex care will increase. In 2035, about 54% of the Dutch population will be over 65 years of age. Loneliness will be a problem in an estimated 30–40% of these elderly. Most elderly prefer care at home and in most cases this is less expensive than institutionalised care. Both client and care provider could benefit from systems using advanced technology to support people at home. CareTV is a technological solution, which allows users to interact with carers, family and friends from their home. In prior research users mentioned that CareTV expanded their social contacts, but it had not been measured if feelings of loneliness as a consequence have decreased. This paper reports on research whether CareTV is a valid instrument for elderly to engage in meaningful social contacts by a video connection to avoid loneliness.

Main content of the paper: 130 clients of home care organisation Proteion Thuis participated in this study and were connected to CareTV. Participants included men and women with an average age of 73,8 years. 45 clients terminated their participation during the trial period and were excluded. The CareTV duplex video/voice network allowed clients to communicate 24 hours, 7 days a week with a nurse practitioner. Applications of CareTV are (1) Alarm Service (2) Care Service (3) Good morning/good evening service (4) Welfare and housing and (5) Family Contact. During the one year trial period, feelings of loneliness and safety have been measured using a questionnaire. Social and emotional feelings of loneliness were measured with the validated 11-item loneliness-scale from de Jong-Gierveld. Safety has been measured with a not-validated 9-item scale. In addition, clients' experiences were evaluated in open questions in the survey.

Results: The results show that the average feeling of loneliness at group level significantly (p<0,001) decreased from 5,97 to 4,02 (sd 3,91) between start and end of the study on a scale from 0 till 11. Social loneliness (5-items) as well as emotional loneliness (6-items) showed significant decreases. To evaluate safety, no sum score could be calculated, but on item level: for 5 out of 9 items, most clients felt less safe after one year. For one item most clients had improved feelings of safety and for three items, most clients had an equal score.

Conclusion: Feelings of loneliness significantly decreased within one year. As loneliness is a problem in an estimated 30-40% of the elderly, CareTV seems to be a suitable instrument for elderly, to live longer at home with less feelings of loneliness. Feelings of safety on item level did not seem to improve, this might be due to the fact that no validated scale was used. On the other hand, comments of individual clients with respect to safety were: ‘CareTV makes me feel safe’. In future a study with a validated safety scale should be performed in order to clarify the effect of CareTV on feelings of safety.

Objective. The field of ambient assisted living (AAL) is attracting increasing attention from policymakers, industry and the general public. The reason is the growing number of elderly persons and the opportunities provided by new technological advances. The objective of MonAMI (Mainstreaming on Ambient Intelligence) is to demonstrate that accessible and useful services for elderly and disabled persons at home can be delivered on a mainstream, open-standard, flexible platform. A number of issues related to the market, exploitation, policies and business opportunities are also being addressed.

Main content. The technology base for delivering the MonAMI services is the MonAMI platform developed from mainstream, open-source components in an OSGi framework with a touch screen computer as the central element. Other parts are a Universal Control Hub as the user interfaces server, wireless sensor networks and a remote service management function. The total is a platform flexible enough to deliver a wide range of different services and facilitate future development and addition of services in a cost-effective manner. The services developed have been grouped into five packages: AMiSURE for safety and security, AMiCASA for home control, AMiVUE for home status information, AMiPAL for time management and AMiPLAY for games. The technology and the services have been installed and evaluated in the homes of 62 users in Slovakia, Spain and Sweden.

Results. The field trial ran for three months ending in March 2011. The evaluation covers the benefit to the users as well as operational parameters, reliability and scalability.

Conclusions. MonAMI has provided a proof of concept of the benefit and feasibility of AAL services over a home platform. The challenge now is to create a mainstream market for AAL applications, i.e. an ecosystem that provides economic opportunities while addressing the social necessity of our ageing society. MonAMI has identified a three-phase roadmap to that end.

The purpose of this study is to develop a new methodology for the comprehensive clinical evaluation of novel assistive technologies. The proposed methodology involves four steps: evaluation by rehabilitation professionals, evaluation by potential users in a simple setting, evaluation by users in an experimental environment, and evaluation by users in a real-life environment. In this paper, details of the first step of the methodology are provided. The aim of the first step of our evaluation is to identify the target users and ensure effective use of the novel assistive technology. This evaluation is mainly based on qualitative research intended for rehabilitation professionals. The effectiveness of this methodology has been demonstrated by using it for the clinical evaluation of “Robotic Bed” developed by Panasonic Corporation. On the basis of the results, three target potential users are identified, and the manner in which “Robotic Bed” can be put to effective use was confirmed. The findings of this study can be used to set the experimental conditions for the second step of the proposed methodology, i.e., evaluation by the envisioned users.

In this study a web service for the interactions between home carers and their clients was developed. The aim was to provide a system for the exchange of messages and topics of conversation relating to the clients' interests. The system had two unique characteristics: firstly the use of digital pens so that the carers did not have to change their usual working practices of keeping records on paper and secondly the carers received client related notifications and conversation topics via their mobile phones.

Digital pens collected the written information that made up the home carers' reports. The data was uploaded automatically to the server over the networks when the pens were placed in their cradles connected to relaying computers at home and/or care stations. The server was loaded with optical character recognition software that analyzed the character stroke or written data. There was also a home care database that handled the information on clients, home carers plus care and visiting schedules. The server based software automatically extracted the message part from a previous visit and emailed its recognised text to the mobile phone of the next carer, 30 min before their visit

The server also added conversation topics to the notification email. The topics were composed using open Internet services that included local news and information on recipes, weather, what happened on that day. This function was designed to automatically refine topic content according to its frequency and recency of the carers' access

The prototype was evaluated with over four hundred carers working in the field. The result showed that the notification email not only acted as a reminder about an impending visit, but also provided the carer with a chance to think a little more carefully about their conversation with their client, which in turn tended to result in improved rapport.

Objective. Injuries caused by falls of elderly people are a common worldwide problem and ageing of population will even further increase related burdens and costs. In this paper we present a monitoring system that detects dangerous actions of elderly and raises an alarm when necessary. Such a system would improve the quality of life for elderly and reduce costs in healthcare in general. The main requirements in its design are that the system can perform in real time with a high detection rate using realistic data, and to make it affordable so that it can be used as a healthcare monitoring system.

Main content. Our system is equipped with a single wide angle camera mounted on the ceiling of an elderly home. This gives a topview image of the environment resulting in a clear map of household objects without any occlusions. The main idea is to monitor the motion information of elderly and to model actions as change of motion or poses in time that lead to a specific action. After background subtraction, the motion information is extracted using the Motion History Images method and analyzed to detect important actions. We propose to model actions as the shape deformations of the motion history image in time. Every action is defined with the specific shape parameters taken at several moments in time. Shape models are extracted in offline analysis and used for comparison in room monitoring. For testing, we used a real elderly home environment in which we monitored in various environmental conditions a total of three different actions that are dangerous for elderly people: “Walking”, “Bending” and “Getting Up”.

Results. The obtained results from observing real elderly household show that our system can detect dangerous actions in a real time with high recognition rates. It can separate Walking, Bending and Standing Up actions with detection rates up to 94%.

Conclusion. Our system is able to detect multiple actions by analyzing the size and shape information of the motion history image. Because of the high recognition rates we can conclude that the presented method has a large potential to be further implemented in a real healthcare monitoring system which will increase the safety of elderly and improve their quality of life. We are now gathering data from various elderly homes to test our system, further improve detection rates and get a better understanding of actions that are happening. The presented system performed both training and testing on data obtained form a same household environment. We are now working on a design of a more advanced algorithm that will be able to transfer models learned in one environment to other households, which will allow a wider applicability of our system.

Objective. A symptom often associated with early stage dementia is the misunderstanding of context. This may be inability to match activities of daily living to time of day and can manifest by wandering behaviour, at dusk or during nighttime. This behaviour is certainly inconvenient to the carer, but can be dangerous should the person trip, misuse a domestic appliance (e.g. cooker) or leave the dwelling. Technology has been used to assist people with dementia. Commercial systems deploy sensors that can raise an alarm and allow a remote carer to intervene via an intercom, for example. In this work we seek to extend the technology to provide reassurance and guidance to the client. In this case the client can be the person with dementia, but the beneficiary may also be their carer.

Main Content. A person may engage with wandering behaviour, possibly because they forget their intended goal. This is of course exacerbated by early stage dementia. Sensors such as movement detectors can trigger actuators to provide lighting guidance, for example. Reasoning systems use rules and utilize context to decide whether the recorded behaviour is intended and legitimate or unintended and potentially dangerous. The rules can be preset and supported by collected data. The decision on when and how to intervene in a particular situation is complex. In this case the reasoning system may need to utilize context to provide a reasonable result, and hence compensate for the misunderstanding by the individual.

Results. In this study, which has been undertaken in the Nocturnal project, we discuss the use of software agents, which monitor ‘restlessness’ and ‘wandering’ to determine the rules for subsequent intervention. The intervention should be initially advisory, e.g. using lighting to guide a wandering person back to the bedroom during the hours of darkness. However there should be an in-built safety procedure, which alerts a carer, should the person ignore advice and potentially put himself or herself in a harmful situation. The guidance technology supports the carer, and seeks to assist the cared for person, in a beneficial manner.

Conclusion. The technology to implement sensing and guidance is available. In order to utilize this technology for assistance with early stage dementia requires the development of supporting software (agents) and rules of engagement. In any case the necessity of back up assistance, a human carer, is still a requirement.

Objective: Detecting changes in activity performance by persons living at home may provide to be a powerful tool to support them to live independently. To this end a new care arrangement had to be developed in which commercial available technology is used by a homecare organization and informal carers. The objective of this study is a) to organize the conditions needed to deliver care support to people living independently and b) to investigate the effectiveness thereof.

Main Content of paper: A commercial available technology was identified by which activities of seniors performed in their own home can be monitored. A combination ofInfra Red motion sensors is installed in the house by which data are collected. Data analysis results in information to healthcare professionals as an urgent alert (by voicemail) or as a non-urgent alert( through a web-interface). The communication infrastructure was organized on a 2417 basis. Careworkers of a homecare organization identified clients that could benefit of this supporting service. A care arrangement was agreed between the client and the care organization. In this the actual use of the infrastructure was specified. The conditions are first piloted on a small scale project; thereafter an implementation study is started. During this implementation study an increasing number of clients are supported by this arrangement. Also the number of formal and informal careworkers increased.

Results: During the project the conditions needed to implement this arrangement as a regular service to support independent living elderly are investigated. These comprised of establishing standard operation protocols at the technology and at the service level, protocols to introduce new clients and (informal) careworkers in using the infrastructure, protocols for data management as well as the financial conditions involved. Based on the effects obtained during the project the conditions needed to organize continuation of this service as part of routine procedures of a home-care organization are analyzed as well. A societal business case was developed. In this the following elements are described 1) the business model consisting of: a) indentification of the preferred user groups ( frail elderly living independently; informal carers, professional carers) b) the technical and organizational conditions c) the costs and revenues of service delivery, and 2) the societal case consisting of a) revenues at the care level, b) revenues at the wellbeing level. Taken together the societal business case was used as a negotiating paper used to organize the conditions required for the continuation of this service. At time of completion of this paper the negotiations are closed. It is concluded that the care organization is enabled to continue this service until the end of 2012.

Conclusions: The use of technology to support people living independently may be incorporate in a service arrangement to deliver care at a distance. Implementation research demonstrates the effectiveness thereof. Organizing structural conditions requires a change in the perception of both clients, careworkers and care organizations.

Objective: The purpose of this study was to undertake process evaluation of the implementation of tele-care in a large care-providing organization in the Netherlands.

Method: The study was executed as a satellite study of the actual implementation of the Quiet Care tele-care system within the Proteion Care group in the south of the Netherlands. Data on the process of implementation was gathered through extensive document analysis, semi-structured interviews and participant observation. Based on these data the implementation performance and the caregivers' implementation, evaluated by the caregivers/staff/professionals, were investigated, guided by the framework for implementation from Grol and Wensing (2006).

Results: The implementation was started with an introduction to some of the stakeholders at the home-care organization. After several months of practice, there were some misconceptions on the use of the facility, i.e. the fit thereof into daily care practice. Therefore, a restart of the implementation was organized with a customized training programme focusing on the relationship between innovation and professional behaviour as the subject matter. The implementation process involved professional training conveying the (evidence-based) added value of the implemented system. This training was positively evaluated by most of the participants. After the completion of the course the care providers enrolled more new clients for the Quiet Care system and used the outcome from the data to improve daily care and adjust the nursing care plan. The outcome of this changed approach was that the innovation was more accepted by caregivers. Analysis of the implementation process revealed the lack of a formal approach: there was no underlying implementation model resulting in the lack of coherence/commitment/sense of importance from an organizational viewpoint. Caregivers in the organization found the guidance by the staff of the implementation programme very supportive to their learning needs. But such a strongly imbedded ethos in the implementation staff introduced some reluctance in other management staff involved in the programme in taking over the ownership of the implemented innovation and thereby guaranteeing a continuous improvement of the innovation over time.

Conclusion: The impact of the implementation of Quiet Care on the business processes could not previously be fully overseen. Ad hoc decisions had to be made to guarantee a continuous roll-out throughout the organization. The training participants perceived the training to be valuable because it was a) supportive in the use of the technology and b) supportive in their daily professional performances. This outcome supports the aim of the training to provide a meaningful learning environment in which the transfer of the experimental approach to daily practice could occur. The training was well evaluated and turned out to be a key element for success. The absence of a pre-formulated implementation plan proved to be a barrier for acceptance of the system at management level and hindered the uptake of the approach as part of the standard care provision. It is concluded that an implementation plan and evidencebased training programme have to be included as part of a strategy to implement health care technology in professional practice. This should be accompanied by an applied research path to observe the performance.

Objective. The provision and financing of assistive devices (AD) in Germany is regulated by social legislation. Depending on the rehabilitation goal and the personal situation of the person needing an AD, different agencies are responsible. The term assistive device is not clearly defined and a variety of regulations apply for reimbursement. Statutory health insurance and long term care insurance finance a major part of aids for medical rehabilitation and care. Other agencies are the social welfare office, statutory accident insurance, pension insurance, employment office and integration office. Experts and persons concerned often have problems clarifying whether entitlement of an AD exists and which agency is responsible. Another problem is choosing the appropriate product. The large German assistive device market offers a wide range of products, it is however non-transparent and fragmented.

Main content. Overview of the assistive devices (AD) provision system in Germany and the role of the REHADAT information platform. REHADAT has developed into the central digital information platform for assistive devices in Germany. Detailed, comparable and up-to-date product descriptions are published in a database which covers products on the German market. The product descriptions are supplemented with additional information. Assistive products at the workplace are linked to practical examples. A variety of search possibilities are available for the user, enabling a rapid overview and a direct search. REHADAT is well known by end users, experts and the AD industry.

Results. Independent and comparable information is urgently required in order to enable an optimal provision of AD.

Context. With the support of assistive technology a person with a disability can do a lot of activities that were impossible otherwise. Knowing which devices exist and which device provides the best solution in an individual situation is a major problem. The Flemish government acknowledged this problem already in the late 1980's. It gave the organization Vlicht the task to develop and maintain a database on assistive technology. That database grew to a public service delivery system where people with a disability can find information about devices and are helped to choose and obtain the most suited device. Currently the system is maintained and supported by the Knowledge Center Assistive Technology (KOC) of the Flemish Agency for Disabled Persons (VAPH).

The information system. Vlibank is an Internet database with information about assistive devices, their manufacturers and their Flemish distributors. Vlibank has textual and visual information. Vlibank contains digital versions of the product brochures provided by the manufacturers. The products in the database are classified in a proprietary classification based on ICF activities. Vlibank provides answers to questions like: “I have a problem with eating, which assistive devices exists?”

Impact. Vlibank is used by AT advisors, end-users, the Flemish reimbursement organization and policy makers. Vlibank contains about 9000 products and is daily questioned by 150 different users. Vlibank is only one part of the Flemish information delivery services for persons with a disability. Besides Vlibank, KOC also distributes information folders for advisors and end-users and gives educational courses about AT. In these additional services is explained how to use assistive technology, how to compare products and how to choose the best solution.