Ebook: Recent Advances in Ambient Assisted Living – Bridging Assistive Technologies, e-Health and Personalized Health Care

Introduction

Recent advances on Ambient Assistive Living addresses integration of assistive technologies, e-Health and personalized health care, which covers the topics on smart healthcare, healing environments, and intelligent environments supporting healthcare and wellbeing. The aim is for empowering people for more comfortable care and social connection, enabling people to achieve better recovery results and helping medical staff to achieve better training. The goal of all healing environments is to support people with physical, emotional, and spiritual healing by eliminating environmental stressors and putting people in contact with nature and comfortable settings.

This book focuses on ambient assistive living systems and services for health care, which is multidisciplinary encompassing areas like electrical engineering, computer science, user centered design and medical science. People benefit from assistive technologies, e-Health and personalized health care range from neonates to elderly persons.

Overall Objectives and Mission

The objectives and mission of the book are as follows:

• Provide an overview on the state-of-the-art ambient assistive technologies, e-Health and personalized health care

• Discuss the challenges of ambient assistive technologies, e-Health and personalized health care

• Discuss cutting edge ambient assistive technologies

• Present the new development on medical data processing and interpretation

• Demonstrate novel design for e-health and personalized health care

• Present design process for user centered design solutions

• Discuss the technological, clinical and social impact

• Encourage multi-disciplinary corporation

• Inspire other healthcare applications for people of any age at home, in hospital and during work

The book presents a unique integration of knowledge from multidisciplinary fields of electrical engineering, computer science, industrial design and medical science for smart healthcare. The process, design and the technologies will have impacts clinically, technologically as well as on families and society. The process, design and the technologies can be transferred to other applications in a broader scope or market.

Topics of Interests

The book targets researchers and practitioners from different domains interested in the area of Ambient Assistive Technologies, e-Health and Personalized Health Care. It invites researchers, engineers, medical professionals, and students to present their ideas and recent work including sensor systems, wearable technologies, patient monitoring, home monitoring, personalized healthcare, user centered design, ethical challenges, clinical and lab evaluations.

Relevant topics include the following:

– Technologies and intelligent systems for Smart Healthcare and Healing Environments

– Sensor and feedback systems for Smart Healthcare and Healing Environments

– Smart Healthcare and Healing Environments applications, ranging from neonates to elderly

– Patient monitoring

– Home monitoring

– Smart systems for sleep

– Stress monitoring and management

– Case studies, lab studies, clinical studies of Smart Healthcare and Healing Environments

– Evaluations of Smart Healthcare and Healing Environments

– Ethical challenges of Smart Healthcare and Healing Environments

Prospective Audience

The proposed book is expected to have a wide spectrum of audiences, for example:

• Engineers

– They will be refreshed by the cutting edge technologies and system implementation. The technologies presented in the book encompass ambient assistive technologies, non-invasive sensing, wearable sensors, feedback actuators, sensor fusion, clinical signal correlation, etc.

• Medical staff

– They benefit from the book the new developments on e-health and personalized healthcare and new designs for improve the patient care experience.

• Industrial designers

– They can learn from the design process, the way to conduct user research and clinical validation, the approach to integrate technology. And they will be inspired to design for health care applications and other user centered applications.

• Health care industries and manufacturers

– They will be inspired by the opportunities of producing new materials, devices, and systems.

Organization of the book

This book contains 10 chapters. Among the authors, many are international renowned professors and researchers in the area of ambient assistive living and enabling technologies. We also welcome a set of younger authors contributing to this work who demonstrate a promising potential for future research and development. The 10 chapters in the book represent a comprehensive knowledge of the state-of-the-art developments on ambient assistive living with integration of assistive technologies, e-Health and personalized health care that addresses several aspects of this evolutionary field. In this book, three thematic parts are presented:

Part 1: Personalized Healthcare Monitoring Technologies

The advance of monitoring technologies are enabling personalized healthcare. The four chapters in this part present new wearable monitoring technologies and data analysis for applications like Freezing of Gait detection in Parkinson's disease patients, Seizure characterization, Cardiac monitoring, and assessment of obstructive respiratory diseases.

Chapter 1 Posture detection based on a waist-worn accelerometer: an application to improve Freezing of Gait detection in Parkinson's disease patients starts with introducing the Freezing of Gait (FoG) symptom in Parkinson's disease (PD) and a review of the current wearable inertial system based algorithms for FoG detection. And then the chapter presents the evaluation of 20 PD patients in their homes and the inclusion of a posture algorithm in order to contextualize FoG detection. The evaluation results show that the algorithm improves the optimal FoG detection algorithm specificity.

Chapter 2 EMG data analysis of Seizures presents quantitative analysis of surface electromyography (EMG) signals to characterize the pathophysiology of convulsive seizures. Specific EMG features were found for convulsive seizures, and quantitative characteristics distinguishing generalized tonic and generalized tonic-clonic seizures (GTCS). A neurophysiological biomarker for GTCS was developed based on these EMG features. This proved to be accurate in distinguishing between GTCS and convulsive psychogenic non-epileptic seizures. In consequence, an algorithm was created which detected GTCS with a high sensitivity and specificity. In this chapter, a synopsis of the findings on quantitative analysis of surface EMG during epileptic seizures was described with focus on clinical and biomedical applications.

Chapter 3 Wearable Solutions Using Bioimpedance for Cardiac Monitoring discusses the basics of bioimpedance measurements and provides insight into the technical and design challenges relevant for the development of system components. The chapter addresses the importance of monitoring of a patient's vital signs in their home using wearable technologies and reviews the state-of-the-art developments on tele-monitoring of physiological signals.

Chapter 4 Impedance pneumography for ambulatory assessment of obstructive respiratory diseases addresses obstructive respiratory diseases such as asthma feature time-variation in presence of symptoms. The fundamental variation has been difficult to quantify, especially in young children and infants due to methodological limitations of current lung function measurement methods. This chapter presents a recently proposed wearable lung function assessment method based on impedance pneumography which enables assessing lung function in a continuous real-life setting. The chapter discusses the physiological and technical theoretical background, and technical advancements and clinical studies.

Part 2: ICT for Ambient Assistive Living

Information and communication technology (ICT) plays an important role for ambient assistive living. The three chapters in this part discuss ambient intelligent systems, mHealth, challenges on user interaction, ICT-enabled Tailored Diet Solutions for self-management of health.

Chapter 5 Embodied ambient intelligent systems presents the concept of ambient intelligent systems and the challenges regarding user interaction. The information and communication technology (ICT) we interact with in daily life is more and more distributed in the environment. In the meanwhile, interaction with such ambient intelligent systems gets more and more complex. Research projects are currently investigating the possibility of users interacting with avatars. The user is interacting in a natural dialogue with a system which has a personality, cognitive and effective capabilities, human like memory structures as well as perception and awareness. The chapter shows how the interaction of such systems can be improved by the embodiment of an ambient distributed system. The concept is explained and first results are presented based on three current research projects working with avatars.

Chapter 6 mHealth: Challenges and impact on new healthcare supply gives an overview of mHealth, its definition and challenges to ensure high quality treatment and discuss a state of the art about challenges focusing on medical apps as medical device and the pervasiveness of data sensing and analysis resulting in information overload. The authors address the regulatory situation for medical devices regarding apps within the European Union and analogies to the United States. Furthermore the chapter discusses perspectives to fulfill data processing along users demand. At last case study results are shown for the Obesity Companion, beHealthy, iHerz and the iNephro project gathered by scientists of the University Hospital Essen, Gelderland Clinic and Fraunhofer ISST.

Chapter 7 ICT-enabled Tailored Diet Solutions for Health Promotion and Chronic Diseases Management addresses Geriatric health care especially the dietary problem. Three solutions are presented in this chapter, including 1) tailored healthy diet coaching system, 2) multi-purposes meal planning support system, and 3) central kitchen automatic dietary inspection system. They contribute to the creation of an ICT enabled food service ecosystem to cover the whole spectrum of dietary needs for care of elderly people and individuals with chronic illnesses.

Part 3: Healing Environments

Healing environments aim at eliminating environmental stressors and creating spaces for patients in contact with nature and comfortable settings. The three chapters in this part address alarm management at neonatal intensive care units, a smart dosing proposal and healing environments for stroke patients.

Chapter 8 Alarm management in single-patient room intensive care units discusses challenges for managing alarms. Additional technology is necessary for single room care in order to distribute alarms from the source to the healthcare worker's location such as a distributed alarming system. The authors presented an example of alarm management in a single-patient intensive care situation along with the prevalent rates of different alarms for an adult and a neonatal ICU (NICU) in a general teaching hospital. In this chapter, methods are proposed towards improving the alarm chain and reducing alarm pressure.

Chapter 9 Smart Dosing: A mobile application for tracking the medication tray-filling and dispensation processes in hospital wards addresses automating the process of dispensing medications. The chapter presents the Smart Dosing application which helps nurses in performing the filling and dispensing of the medicine tray more efficiently and allows nurses to keep history of the medication distributed and dispensed to patients. The application makes the whole process smoother by improving the patient safety. The usability of the application prototype was studied by a survey conducted among nurses.

Chapter 10 Experiences of stroke patients, family and caregivers of in-patient care environments – an exploratory study investigates the aspects of the healing process supported by environments. To capture the experience, the role of researcher was extended from just an observer to a participatory approach whereby caregivers become co-creators of the research data. The methods including shadowing, observation and interviewing were used. In this chapter, specific environmental needs were identified, including dosing stimulus load, having social support, having access to single patient rooms, balancing clinical and personal environments, having a clear structure of the day, undisturbed sleeping and the need for information.

Expectations

This book offers a broad coverage on the recent development of ambient assistive living technologies, e-health and personalized health care, providing medical professionals, scholars, designers, industrial companies, and family members of patients with some of the most advanced research, developments and innovations.

We sincerely expect that this work will stimulate further research in the area of ambient assistive living. Furthermore, the technologies and new developments presented in this book will make a remarkable contribution to the research and application areas of emerging assistive technologies, unobtrusive sensing and wearable technologies, advanced data processing, and personalized health care.

The Editors

Wei Chen, Juan Augusto, Fernando Seoane, Fedor Lehocki, Klaus-Hendrik Wolf, Johan Arends, Constantin Ungureanu, Reiner Wichert

Sept. 2015

Freezing of Gait (FoG) is one of the most disabling symptoms in Parkinson's disease (PD). Current algorithms to detect FoG are based on wearable inertial systems which relies on the frequency response given by the inertial signal. However, these algorithms have only been evaluated under laboratory conditions causing that, in real life, they present false positives, reducing the reliability of the algorithm. This paper presents the evaluation of 20 PD patients in their homes and the inclusion of a posture algorithm in order to contextualize FoG detection. This algorithm improves the optimal FoG detection algorithm specificity from 74.5% to 79% (4.3%) while in average improves specificity from 69.9% to a 74.6% (4.7%) preserving the sensitivity. In some patients, those who performed more false positive tests, specificity could increase up to 11.95% keeping the sensitivity.

The neuromuscular junction connects the motor nervous system with the muscles. Thus, measuring the electric signals in the muscles provides information about the function of the motor cortex. We used quantitative analysis of surface electromyography (EMG) signals to characterize the pathophysiology of convulsive seizures. We found specific EMG features for convulsive seizures, and quantitative characteristics distinguishing generalized tonic and generalized tonic-clonic seizures (GTCS). Based on these EMG features we developed a neurophysiological biomarker for GTCS. This proved to be accurate in distinguishing between GTCS and convulsive psychogenic non-epileptic seizures. In consequence, an algorithm was created which detected GTCS with a high sensitivity and specificity. In this chapter we give a synopsis of our findings on quantitative analysis of surface EMG during epileptic seizures, with focus on clinical and biomedical applications.

Monitoring of a patient's vital signs in their home using some form of wearable technology is of increasing importance and interest. Preferably, patients should be able to operate the system and perform the measurements themselves in a comfortable, easy and reliable way. Until now, only heart rate and rhythm measurements, e.g. obtained from the electrocardiogram or photoplethysmogram, have been realized in a home care scenario. Particularly interesting for telemonitoring applications are the hemodynamic measures such as stroke volume, systolic heart phases, or the development of edemas. The relatively simple bioimpedance technique has a long research history and has proven useful to detect changes in these latter measures. In addition, the technique can be implemented in wearables, such as functional textiles. This chapter discusses the basics of bioimpedance measurements and provides insight into the technical and design challenges relevant for the development of system components based on our experience to date.

Obstructive respiratory diseases such as asthma feature time-variation in presence of symptoms. For example in asthma there is typically a decline in lung function during night. Due to methodological limitations of current lung function measurement methods this fundamental variation has been difficult to quantify, especially in young children and infants. In this chapter, a recently proposed wearable lung function assessment method based on impedance pneumography is presented. The physiological and technical theoretical background, and technical advancements and clinical studies are discussed. In light of current clinical information, the proposed solution may have clinical value for assessment of obstructive respiratory diseases, especially because it enables assessing lung function in a continuous real-life setting.

The information and communication technology (ICT) we interact with in daily life is more and more distributed in the environment (the so called intelligent space). Most of these devices have increasing calculation capacity and therefore the potential to contribute to an overall distributed calculation power and therefor a processing intelligence. These so called intelligent nodes can for example provide context information (sensors) or act as an interface through which we interact with the whole system. At the same time interaction with such ambient intelligent systems gets more and more complex. The interaction with the system is not any more human to single machine, like we were used in the interaction with the personal computer (PC) or personal device, it's an interaction with a system which is around us and ubiquitously distributed in our surroundings.Research projects are currently investigating the possibility of users interacting with avatars. The advantage of avatars is, that the systems gets an embodiment and a personality. The complexity of the underlying distributed system is hidden from the user. The user is interacting in a natural dialogue with a system which has a personality, cognitive and effective capabilities, human like memory structures as well as perception and awareness. The paper presents the concept of ambient intelligent systems and the challenges regarding user interaction. It shows how the interaction of such systems can be improved by the embodiment of an ambient distributed system. Based on three current research projects working with avatars this concept is explained and first results are presented.

Technologies enabling pervasive sensing and analysis within the healthcare sector are fast increasing. Especially the usage of mobile devices enables the development of new therapy concepts and business models to ensure patient centered treatment. Within this paper we'll give an overview of mHealth, its definition and challenges to ensure high quality treatment. Later on, a state of the art discussion about challenges will focus on medical apps as medical device and the pervasiveness of data sensing and analysis resulting in information overload. The paper will contribute by discussing the regulatory situation for medical devices regarding apps within the European Union and analogies to the United States. Furthermore we'll show perspectives to fulfill data processing along users demand. At last the paper will show case study results of the Obesity Companion, beHealthy, iHerz and the iNephro project gathered by scientist of the University Hospital Essen, Gelderland Clinic and Fraunhofer ISST.

Geriatric health care has become a pressing task, and the first confronting issue is dietary problem inseparable from life as the risks of various illnesses grow progressively with aging evidently. Three solutions, including 1) tailored healthy diet coaching system, 2) multi-purposes meal planning support system, and 3) central kitchen automatic dietary inspection system, have been introduced in this chapter. They were designed and developed to build an ICT-enabled food service ecosystem to cover the whole spectrum of dietary needs for care of elderly people and individuals with chronic illnesses. The outcomes of the pilot study of the tailored healthy diet coaching system showed that early nutrition intervention could be easily conducted by using the developed system. The multi-purposes meal planning support system not only saved manpower by providing the automatic planning to decrease complexity of the process; it also enhanced the efficiency of process by two-phase design to save the operation time. For the central kitchen automatic dietary inspection system, the experimental results showed the inspection accuracy had reached around 89%. Moreover, the efficiency had reached 1.2 second, and the quantity accuracy was as high as 90%. By saving inspection time, the proposed system has been concluded to increase the capacity of meal supply by over 50%. These outcomes indicated that this ICT-enabled food service ecosystem may assist the health slef-management of both senior citizens and people with chronic illnesses that required nutrition attention.

An international trend in intensive care is the shift from open, bay area intensive care units towards single-patient room care, since this is considered optimal for patient healing and family privacy. However, in the intensive care setting, an increasing number of devices and parameters are being used to treat and monitor the patient. This leads to an increase in the number of alarms that are needed to notify caretakers. In single room care, additional technology is also necessary in order to distribute alarms from the source to the healthcare worker's location such as a distributed alarming system. While single-room care creates a better environment for healing, it poses challenges for managing alarms. This book chapter discusses alarm management in detail. An example of alarm management in a single-patient intensive care situation along with the prevalent rates of different alarms for an adult and a neonatal ICU (NICU) in a general teaching hospital are also discussed. Finally, methods towards improving the alarm chain and reducing alarm pressure are proposed.

Traditionally in hospitals the task of dispensing medications to patients can be strenuous for the hospital staff, as many variables have to be considered, such as searching for a particular medicine in shelves, finding alternative active components and possible interactions, verifying the amount or dosage of the medicine, keeping in mind the intake timings and other meticulous details. In addition to that, the dispensation process is the combination of many manual and computerized steps which do not function together. In this work, we have gone a step forward towards automating the whole process by combining information from different sources and providing it on a single centralized rich internet application. The application Smart Dosing helps nurses in performing the filling and dispensing of the medicine tray more efficiently. The application allows nurses to keep history of the medication distributed and dispensed to patients, as well as it makes the whole process smoother by improving the patient safety. A survey was conducted among nurses to validate the application prototype usability.

The aim of this study is to thoroughly understand neurology patients, family and caregivers experiences of in-patient care environments and to investigate the aspects of the healing process that can be supported by the environment. Our goal is to identify the role the environment plays during the process of being treated for and recovering from a stroke. Detailed stroke patients descriptions of experiences during hospitalization will help researchers, medical professionals and architects in adjusting the environment according to their specific needs. A set of research methods was used to capture the experience, expanding the role of researcher from just observer to a participatory approach whereby caregivers become co-creators of the research data [1,2].These methods included: shadowing, observation and interviewing, allowing nurses to describe their experiences and to obtain a voice in decision making. We built insights from healing environment literature combined with own field studies. Specific environmental needs identified include: dosing stimulus load, having social support, having access to single patient rooms, balancing clinical and personal environments, having a clear structure of the day, undisturbed sleeping and the need for information.