Abstract — The International Classification of Functioning, Disability and Health (ICF) provides an internationally established conceptual framework to describe and assess functions and disabilities of a person in several health domains. It will guide the technical design of the system functionalities of the I-Support bath robot system. Based on the ICF we describe a comprehensive model of impairments, limitations and user requirements, which are the basis for the definition of use case scenarios from a clinical perspective. At the end, we present a brief description of technical specifications used for the I-Support bath robot system and also provide information on hardware configurations and their feasibility.

I. INTRODUCTION

Health care in old age is becoming increasingly important due to the current socio-demographic changes as well as the development in health policy. The primary aim in health care is to ensure that peoples’ lives are as healthy and independent as possible while maintaining the highest possible quality of life. Furthermore, the quality of medical and nursing care as well as an adequate and safe home environment is of high relevance.

Technical innovations, e.g. Ambient Assisted Living (AAL) systems, offer increasing opportunities for an independent and self-determined way of life for older people living at home and in care facilities. The majority of potential AAL users are chronically ill and frail older persons. Thus, knowledge about their needs and medical prepositions is crucial for the collaboration of scientists and technicians. What is the situation of older people? How are their health conditions? Which kind of requirements and needs does this target group have? Which kinds of health problems limit the use of AAL-systems in daily living?

A clinical model of user requirements for the AAL project development will need a strong conceptual basis. Functionalities of the I-Support bath robot system will support impaired functions of potential users. Thus, we have chosen an internationally well-established classification and assessment system to describe these geriatric impairments. The International Classification of Functioning, Disability and Health (ICF) represents an efficient tool to assess peoples´ current functional health status (functioning) in daily life (1). As such, the ICF constitutes a comprehensive concept for health care planning including multiple dimensions from body functions and body structures to personal activities, societal

* This project has received funding from the European Union‘s Horizon 2020 Research and Innovation Framework Programme, Societal Challenge 1 (DG CONNECT/H) under grant agreement No 643666, Activity PHC-19-2014, ICT-Supported Bath Robots.

participation and environmental factors (1). It provides the potential framework for transition along the continuum of care (2) and recent design studies of AAL tools, primarily based on analysis of activities of daily living (3, 4).

The loss of function typically begins with those activities, which are most complex and least basic. Shower and bathing represent most complex activities of daily living (ADL), and thus are among the first to be lost within the ageing process and the last to be regained after acute trauma or medical interventions such as surgery. Therefore, in the next chapter we give a brief overview of the epidemiology of functional loss and bathing disabilities.

II. EPIDEMIOLOGY OF BATHING DISABILITIES

A. Activities of Daily Living Activities of daily living (ADLs) comprise people's basic

daily self-care activities (5), including mobility (ability to walk, get in and out of bed, sit on and raise from a chair), bathing and showering (washing the body)1, dressing, self-feeding, personal hygiene and grooming (including brushing/ combing/styling hair), and toilet hygiene (getting to the toilet, cleaning oneself, and getting back up). The concept of basic ADLs was extended to more complex activities (Instrumental Activities of daily Living, IADLs), which require a higher level of planning and executive functions partly also a higher motor-functional performance (6). IADLs include among others housework, preparing meals, taking medications as prescribed, managing money, shopping, use of telephone, and transportation (6).

B. Bathing Disability In community-living older persons aged 65 years and

older, the prevalence of bathing disability, defined as help of another person, ranges from 4.6% to 6.9% (7). In a community-dwelling population of 5151 persons aged 70 years and older 12.7% reported bathing difficulties (8). 21% of community-living persons aged 85 and older received help performing bathing (9). In an institutionalized elderly population over 90% of residents received help with bathing (7).

Gill et al. (10) analyzed data of a prospective cohort study with community-living older persons aged 70 years and older (N=754) and published incidence rates of bathing disability. Within 6 years 58.4% of the participants (N=440) had at least

1 The ADL item „bathing“ includes the use of a bath tub or a shower as well as taking a complete sponge bath. In the literature, there is no differentiation between bathing and showering activities.

Design of a Bath Robot System – User Definition and User Requirements Based on International Classification of Functioning,

Disability and Health (ICF)* Jochen Werle and Klaus Hauer, Non-Member, IEEE

25th IEEE International Symposium onRobot and Human Interactive Communication (RO-MAN)August 26-31, 2016. Columbia University, NY, USA

978-1-5090-3929-6/16/$31.00 ©2016 IEEE 459

one episode of bathing disability, and 34.0% (N=266) had multiple episodes, with the duration of each episode averaging about 6 months. The prevalence of bathing disability is higher in women than in men and increases with age and physical frailty. The occurrence of bathing disability was strongly associated with the risk of long-term nursing home admission (11) and the receipt of home care services (12).

Several studies have assessed the extent to which loss of function across ADLs progresses hierarchically. The hierarchy within ADLs was first identified in studies of illness in the aged. The Index of ADL (5) was developed based on observations of a large number of activities performed by a group of patients (N = 1001) with hip fracture. The authors developed a hierarchy for the observed functions: bathing, dressing, toileting (going to the toilet), transferring, maintaining continence, and feeding. Bathing represents the first ADL to be lost and the first function requiring assistance. In the following years a number of cross-sectional studies have evaluated and confirmed the Katz hierarchy. This hierarchy is representative for older adults in the community, in acute care settings and in the inpatient rehabilitation setting (8,13,14,15).

Dunlop et al. (16) referred to data from the Longitudinal Study of Aging (LSOA). The LSOA is a prospective survey of 5151 community-dwelling persons aged 70 years and older who were initially interviewed in the 1984 National Health Interview Survey, Supplement on Aging and re-interviewed every two years ending in 1990. The main result of this longitudinal study was to define the incidence of disability of ADL (see Table I).

TABLE I. INCIDENCE OF DISABILITIES OF ADL (16)

Function Total incidence of disability (in %)

Women (N = 1837)

Men (N = 3255)

Walking 38.2 33.5

Bathing 29.9 25.0

Transferring 23.0 18.8

Dressing 14.1 12.7

Toileting 11.5 9.1

Feeding 8.2 6.3

a. Change in disability over six years (1984 to 1990) among elderly without baseline (1984) disabilities in ADL (n = 2777)

Women consistently experienced higher disability incidence rates than men for all six activities. For example, over the 6-year period, the incidence rate for bathing disability was 29.9% for women and 25.0% for men. The higher incidence rate, compared to other cross-sectional studies was esxplained with methodological issues. In the LSOA study, disability for a specific activity was defined as having difficulty performing that function. Other studies have used different definitions of disability, such as inability to perform an ADL or requiring assistance in order to perform an ADL.

Njegovan et al. (17) studied the hierarchy of functional loss associated with cognitive decline in older persons (N=5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II). This is the first prospective study using a large representative cohort of elderly

persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks. Dependency in IADLs occured at higher cognitive scores compared to basic ADLs with an overlap. Bathing as basic ADL is comparable to more complex IADL, e.g. shopping, transportation or meal preparation (17).

For the I-Support project this is a remarkable result. Bathing, especially with an ICT-supported bath robot system, is as complex as other IADLs with a high impact of cognitive functions. In future times, ICT-supported bathing may be part of the IADL.

III. USER DEFINITION

The user definition for the design of the I-Support bath robot system will be based on internationally established, valid and reliable clinical assessment strategies with focus on ADL deficits and cognitive impairment with established cut-off values available for the staging of impairment levels.

A. Bathing disability Dependency in the comprehensive bathing activities

represents the first inclusion criterion for the definition of the I-Support user group. According to the Index of ADL (5) we use the Barthel definition of scoring for the item “bathing” to give a clear dichotomous decision between “independent” and “dependent”. The BADL item “bathing” of the Barthel Index (18) will be used as a clear defining criterion for the user group in the I-Support project.

• Independent: Patient may use a bath tub, a shower, or take a complete sponge bath. He must be able to do all the steps involved in whichever method is employed without another person being involved.

• Dependent: Patient may use a bath tub, a shower, or take a complete sponge bath only with help of another person.

B. Cognitive status For screening of cognitive functions we chose the Mini

Mental State Examination (MMSE) (19), an internationally well-established screening test for cognitive impairment that allows comparability to other studies including cognitive criteria. The test has proven high validity, reliability, feasibility to be used as a screening instrument (19,20). The time to administer is about 10-15 minutes requesting only limited personell resources for assessment. For a screening tool, the MMSE allows a rather comprehensive documentation of cognitive sub-performances including memory (early-late recall, working memory), executive- and semantic performances, orientation in time and locus.

For the I-Support user definition we will use established cut-offs (19) with 24-30 scores to define persons without cognitive impairment and scores ranging from 18-23 to define persons with moderate impairment.

As we start with the development of a new service robot we suggest not including persons with advanced or severe cognitive impairment levels (MMSE <18), as those will be overtaxed by managing the assistance of the I-Support bath robot system or may need a far more complex handling support.

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For the I-Support validation studies we will include people with a dependency in bathing and showering activities. Within this population persons with severe cognitive impairments (MMSE < 18) are excluded.

IV. MODELING OF USER REQUIREMENTS AND USE CASE SCENARIOS

The World Health Organization (WHO) has developed two reference classification systems to describe the health status of a person at a particular point in time. Diseases and other health-related concerns are recorded with the International Classification of Diseases (ICD-10). ICD-10 is the standard diagnostic tool for epidemiology, health management and clinical purposes. It is used to monitor the incidence and prevalence of diseases and other health-related problems (21). Medical therapies in acute events such as stroke, heart attack or fractures, request strictly disease-related therapy pathways.

A. International Classification of Functioning, Disability and Health (ICF) as framework for modeling user needs In contrast, the International Classification of Function,

Disability and Health (ICF) comprises health domains and contemplates individual health conditions with its effects on daily life. The ICF represents a holistic, integrated bio-psycho-social model of human functioning and disability (1).

In terms of ICF a person is (functionally) healthy, if her/his entire background (concept of context factors)

• her/his body functions and body structures correspond to generally accepted (statistical) standards (concept of body functions and body structures),

• she/he is able to do all the things, which are expected from people without health problems (concept of activities), and

• she/he can unfold her/his entity in all areas of life in a way it is expected from non-disabled people (concept of participation in areas of life).

Within the ICF, the term “disability” denotes the negative aspects of the interaction between a person’s health condition(s) and the individual’s contextual factors. Thus, disability is used as an umbrella term for body impairments, activity limitations and participation restrictions (1).

Diseases as well as changes due to the ageing process are associated with disabilities resulting in persisting or temporary somatic changes of body functions and structures (concept of impairments) as well as psycho-social changes affecting activities (concept of limitations) or societal participation (concept of restrictions). Contextual factors may affect functional health/disability in a positive (facilitators) or negative way (barriers).

The ICF model of disability and the relationships of its health domains are represented in Figure 1.

Figure 1. The ICF model of disability (according to WHO, 2002)

In summary, functional health/disability of a person represents the result of the interaction between the persons´ health conditions (ICD) and her/his perceived contextual factors. Contextual factors represent the complete background of an individual’s life and living. They include two components: environmental factors and personal factors.

Environmental factors comprise the physical, social and attitudinal environment in which people live and conduct their lives. Personal factors include, among others, gender, race, age, other health conditions, fitness, lifestyle, habits, coping styles, social background, education, profession, past and current experience (past life events and concurrent events), overall behavior pattern and character style, individual psychological assets and other characteristics (1).

It is the changes of body functions and structures (impairments), which are specifically targeted in a rehabilitation process and it is these changes that trigger the design of the I-Support bath robot system. Therefore, in the next section we give a short overview of the ICF strategies to assess functions and disabilities.

B. Assessment of functions and disabilities – ICF Core Sets The ICF provides the comprehensive framework to

describe and assess functions and disabilities of a person in several health domains. ICF codes utilize an alphanumeric system to describe health and health-related domains, with the following letter codes: b=body functions, s=body structures, d=activities and participation, e=environmental factors.

The letters are followed by a numeric code that starts with a one digit chapter number followed by a second level denoted by two-digits, and third and fourth levels represented by one digit each. (1).

Comprising over 1400 second-level categories, the entire volume of the ICF cannot be applied by the clinicians to all their patients. In order to enhance the applicability of the ICF in clinical practice and research as well as to overcome practical concerns relating to the high number of categories provided within the ICF, the development of ICF Core Sets was recently initiated by the ICF Core Set projects (22). Those comprehensive ICF Core Sets were created to provide standards for a multi-professional comprehensive patient assessment, and to include the typical spectrum of problems in functioning encountered in different patient populations (23).

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The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients (2). The brief ICF Core Set for geriatric patients in early-post-acute rehabilitation represents a practical alternative to the lengthy comprehensive sets for our target group. It provides a minimal standard for measuring and communicating patients’ functioning in a therapeutic context (24).

For the design of the I-Support bath robot system the ICF Core Sets have to be adapted to define user requirements and describe use case scenarios from a clinical perspective. Therefore, in the next chapter we give a description of frequent geriatric impairments, which have to be considered in the design process of the I-Support bath robot system.

C. Description of frequent geriatric impairments In a geriatric population, using the ICF Core Set, most

prevalent disabilities were found in the health domain “Activities”, primarily moving around (80%), walking (79%), washing oneself (75%), caring for body parts (74%) or dressing (73%). They are closely linked with frequent impairments in associated categories of “body functions”, such as gait pattern functions (73%), muscle power functions (73%), mobility of joint functions (59%) and sensation of pain (57%) (23).

As mentioned above, bathing/showering disability may have different causes, cognitive as well as motor and sensorial impairments. Therefore, we selected the most relevant second-level categories concerning bathing/showering limitations from the comprehensive ICF Core Set for geriatric patients.

Figure 2. Potential impairments of body functions affecting

bathing/showering activities

As displayed in Figure 2, we identified six main categories of functional impairments that affect bathing/showering: mental functions, sensory functions/pain, movement-related functions, skin functions, and urination/defecation functions.

D. Modeling of user requirements and use case scenarios The technical requirements for an innovative bath robot

system are very complex. From a clinical perspective, we focus on needs of potential users, based on frequent impairments of body functions and associated limitations of activities. The bathing/showering process consists of many different activities which users have to perform, starting from entering the shower until leaving it again. The shower process itself is the core process, but transfer and transition process are of similar importance.

Figure 3. I-Support: Model of impairments, limitations and user

requirements

In the previous section, we described frequent geriatric impairments which are clinically relevant for the overall bathing/showering process. In figure 3, these impairments are listed as second-level codes in the left column. Those impairments are often followed by limitations of activities. As listed in the middle column of figure 3, limitations concerning bathing/showering activities are more complex than expected. For the design of an innovative bath robot system it is not sufficient to focus on self-care functions alone. It is also

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essential to provide functionalities for limitations, concerning transfer and transition to the shower room as well as communication with the system. In our model, user requirements can directly be derived from specific impairments and limitations. In the right column of figure 3, impairment-related user requirements for the I-Support bath robot system are shown.

The following paragraph gives detailed information on the user requirements defined in figure 3 (right column). This will be the basis for the use case scenarios which are based on clinical expertise.

Cognitive assistance As mentioned before, bathing represents a complex ADL/IADL with a high impact of cognitive functions, especially in the context of an ICT-supported, sophisticated bath robot system. Therefore, cognitive status was identified as main inclusion criterion for the I-Support user definition. Persons with advanced impairment levels (MMSE <18) will be excluded from the project. People with no or moderate cognitive impairment might have limitations using communication and technical devices (d360) properly, particularly when they are lacking technical experience which is associated with a feeling of helplessness and fear avoidance strategies. Within the I-Support development process, this issue has to be considered in the design of all system functionalities. Ease of use, safety, and automation are requested standards for the complete sequence of the I-Support shower process. Furthermore, the I-Support bath robot system may have to provide strategies and functionalities

• to adjust base settings, • to provide clear and safe operating instructions, • to navigate older persons through the transfer and

shower process, for example with verbal instructions to avoid fears and a feeling of helplessness,

• to support subsequent modifications of base settings, • to provide emergency strategies (e.g. fall detection), • to include gesture/speech recognition.

Shower assistance Showering represents the core process of the I-Support bath robot system. The entire shower process consists of pouring water, soaping, scrubbing, wiping, and drying with a towel) specific body parts. From a clinical perspective, it is essential to maintain the user´s independence in parts of her/his activities as long as possible. The I-Support system will provide as much technical support as needed, depending on the user´s abilities and preferences, leaving remaining abilities to be still trained and used in the showering process. For this reason, we defined four use case scenarios, based on user abilities and impairments: Core region, distal region, back region and posterior region. The core region includes body parts, where the user is able to wash herself/himself in a seated position, with low risk exposure or little effort. The core region includes abdomen, chest, arms, front of thighs and genitals. Performing intimate

hygiene independently is very important for the elderly. For washing this sensitive body part, the soft arms of the I-Support system may only have assistive functions - as passive water hose and as robotic arm - to give the user washing tools or drying towels. The distal region comprises the lower thighs from knee joints on downwards to the feet. For washing these body parts, the user has to bend forward with a high risk of losing postural control. The I-Support bath robot system has to perform the distal region shower process automatically. The back region is expanding from the cervical spine to the tailbone. Due to limitations in reaching this body part, the I-Support bath robot system may has to provide a functionality for a fully automatic back region shower process. The posterior region includes the back of the thighs and the backside (buttock). Urinary and/or fecal incontinence (see figure 3) are serious problems for many older persons, and intimate care is indispensable. It is not possible to wash the back of thighs and the backside comprehensively while seated. For this reason, a use case scenario “Posterior region shower process” may have to provide functionalities for sit-to-stand and stand-to-sit transfer as well as postural control while standing. The development of such technical assistive technologies for bathing procedures has a long tradition on which the I-Support project may draw from. At the 1970 World Expo in Osaka, a Japanese Electronics Group, introduced a first concept of a washing machine for humans, officially named Ultrasonic Bath, which found no access to the market. Due to lack of demand, the production of a descendant of the Ultrasonic Bath concept (2004) called the HIRB ("Human In Roll-lo Bathing") system was also stopped. More recent design studies deal with mechatronic systems for bathing assistance of bedridden elderly people (25,26) and the development of a head care robot (27). In addition, some rehabilitation robots have functionalities to support activities of daily living, including grooming, shaving and bathing (28, 29).

Motion control of the soft arm Bathing/showering with an ICT-supported bath robot

system is not only cognitively demanding. It also requires well-trained motor control capabilities. For older persons the fine hand use as well as the hand and arm use is limited. Modeling the user´s intention and movements in complex motions of the soft arms is a prior challenge in the design process of the I-Support bath robot system. The I-Support bath robot system may have to provide functionalities to assist the user in showering (based on learned motion primitives), and to control the soft arm motions.

Transfer, transition and posture assistance A loss of muscle strength, postural control and gait

abnormalities caused by an age-related loss of muscle mass and a decline of vestibular and proprioceptive functions represent intrinsic risk factors for falling. Due to the high prevalence of falls in the bathing environment (30), it is essential to give the potential user a secure feeling, in particular while entering and leaving the shower cabin, during

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stand-to-sit and sit-to-stand transfers and maintaining a secure sitting position during the shower procedure. The hardware of the I-Support bath robot system may have to provide functionalities for stand-to-sit/ sit-to-stand transfer, transition into/out of the shower area, and postural control.

Sensorial Assistance Perceptual impairments did not seem to impact older adults’ ability to perform ADLs and IADLs as much as motor impairments (31). However, for the design and operation of an assistive bath robot system, perceptual impairments represent a serious problem. When using the shower, persons usually do not wear eye glasses or hearing aids. It is essential that people with poor vision are able to operate the I-Support bath robot system correctly. High safety standards should ensure that operator errors do not result in increased numbers of accidents and injury due to sensory deficits, e.g. the adjustment of water temperature. Hearing impairment in older persons requires additional system adaptations for the human-robot-communication tools of the I-Support system. It has to be considered, that the I-Support bath robot system provides sufficient font sizes and brightness as well as voice control functions for persons with visual impairments. In addition, it is important to adjust signals or alerts with respect to persons with hearing impairments. It has to be considered that annoying signals and alarms promote confusion in older and/or cognitively impaired persons.

Base settings and system adjustment Older persons have a reduced thermal sensitivity, especially during cooling and a decreased thermogenesis (32). For this reason, they start freezing very quickly. In addition, heat exposure may extend cardiac sensations. These issues may have to be considered in the adjustment of the base settings, e.g. air and water temperature, pressure of the water jet, and length of the shower process. Deviations may cause short-term risks for the health of old and frail users. The recognition of the user´s behavior during the shower process is essential. Appropriate functionalities of the I-Support bath robot system are user perception, gesture and voice recognition, and interpretation.

Transition to potential use case scenarios In the comprehensive model above (Figure 3), we described

user requirements, based on frequent geriatric impairments and associated limitations of activities. These user requirements serve as a basis for the definition of use case scenarios from a clinical perspective. In the following table (see Table II) we summarize impairments and associated potential use case scenarios for the I-Support project.

The preliminary use case scenarios will be amended by the identification of user behaviors and attitudes from a qualitative perspective as identified by qualitative interviews and quantitative data collection (Frankfurt University of Applied Sciences). Final use cases will be described in cooperation with technical partners including their technical perspective and identification of functionalities.

TABLE II. PRELIMINARY USE CASE SCENARIOS AND SYSTEM FUNCTIONALITIES FROM A CLINICAL PERSPECTIVE

User requirements System functionalities

Use case scenarios

Cognitive assistance To adjust base settings

Operation and control of system functionalities

To provide clear and safe g instructions

To navigate persons through the transfer and shower process

To support subsequent modifications of base settings

Subsequent modification of base settings

To provide emergency strategies

Emergency procedures

Shower assistance To assist the user to shower

Core region shower process

To assist the user to dry herself/himself

Distal region shower process

To control the motion of the soft arm(s)

Back region shower process

Posterior region shower process

Transfer, transition and posture assistance

To provide physical assistance during stand-to-sit/sit-to-stand transfer

Stand-to-sit/Sit-to-stand transfer

To assist the user during transition into/out of the shower area

Transition into/out of the shower area

To provide postural control

To provide emergency strategies

Emergency procedures

Sensorial assistance To support user with visual impairment

Visual control

To provide adequate communication tools for user with hearing impairment

Human-Robot communication

V. DESCRIPTION OF THE TECHNICAL SET-UP OF THE I-SUPPORT BATH ROBOT SYSTEM

The I-Support bath robot system consists of two main hardware components:

• A motorized shower chair mounted on the wall with three degrees of freedom (vertical, horizontal, rotational) providing support for stand-to-sit and sit-to-stand transfer and for the transition from dry areas outside into the shower space and back.

• A robotic shower with two identical soft-arm, lightweight, robotic manipulators mounted on the wall and aimed at the provision of pouring water,

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soaping, scrubbing, wiping and drying. Different tools for wiping and scrubbing can be automatically attached/de-attached in a quick and secure way, based on small magnets.

The consortium has selected the Pressalit commercially available motorized chair. Currently the Pressalit chair has one motorized DOF (along the vertical axis). The adaptations done by partner ROBOTNIK will add two additional DOFs: one translational (along the horizontal axis) and one rotational (about the vertical axis), in order to position the user in an optimal way with respect to the two soft-robot arms. Hence, during the validation studies the motorized chair will have overall three DOFs.

The two arms are identical: one soft arm will serve the lower extremities; the other arm will serve the back, the torso and the upper extremities, offering the following functionalities:

• Pouring water, soaping and rinsing. These tasks do not involve human interaction. The robotic arm will act as a robotic hose which pours water and/or soap. The control unit will provide the possibility to select only water, only soap or water/soap simultaneously.

• Scrubbing, wiping and drying. These tasks involve human interaction. The end-effector for performing these contact-tasks is removable and equipped with quick release mechanism so that

Figure 4. Latest version of soft robot arm with end effectors and their quick release mechanism (Source: The BioRobotics Institute - Scuola

Superiore Sant' Anna, Italy)

Additionally, a set of force, shape, motion-tracking and context awareness sensors are installed in the shower environment in order to enable audio/gestural and telemanipulation human-robot interaction, context awareness of the shower environment and sensing of the robot state. Figure 5 depicts the complete I-Support system in CAD design.

Figure 5. Overall system showing the configuration of the I-Support bath

robot system (Source: Robotnik Automation, Spain)

The RGB-D vision system is responsible for human pose estimation, robot pose estimation and gesture recognition. The final design of the vision system was done by INRIA and comprises three KINECT V2 sensors. Their position/ orientation in the shower space has been finalized and has been validated by conducting calibration experiments and data collection experiments at KIT premises.

Audio sensors enable the verbal human-robot-interaction. The proposed audio sensing setup is designed to provide sufficient spatio-temporal sampling of the targeted acoustic scenes in the I-SUPPORT bathroom environment and consists of eight condenser omni-directional microphones distributed on the walls and ceiling of the room.

The force sensor measures the forces imparted by the soft-arm end-effector on the user and provide feedback for force control. Partner SSSA has selected an ATI force sensor (model: Nano17). As context awareness sensors SSSA proposes the CubeSensors and/or Amphiro.

A hand-held motion tracker is used as an intuitive soft-arm tele-manipulator. The elderly will tele-manipulate the soft-arm end-effector motion. OMEGA is currently developing the custom made motion tracker for telemanipulation, and will evaluate its functionality and compare its performance prior to the validation studies.

At the moment, data collection experiments take place in order to adapt the hardware configuration to the specific requirements of the I-Support bath robot system. Technical data are not yet available.

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VI. CONCLUSION Based on the International Classification of Functioning,

Disability and Health (ICF) as an internationally established conceptual framework we described a comprehensive model of impairments, limitations and user requirements, which may represent the basis for the definition of use case scenarios from a clinical perspective.

ACKNOWLEDGMENT This project has received funding from the European

Union‘s Horizon 2020 Research and Innovation Framework Program, Societal Challenge 1 (DG CONNECT/H) under grant agreement No 643666, Activity PHC-19-2014, ICT-Supported Bath Robots. The I-Support Consortium: Karlsruhe Institute of Technology (KIT), Germany; Robotnik Automation, Spain; Institute of Communication and Computer Systems (ICCS), Greece; Scuola Superiore Sant´Anna – The BioRobotics Institute (SSSA), Italy; Institut Nationale de Recherche en Informatique et en Automatique (INRIA), France; T. Alexandridis & CO Omega Technology (Omega), Greece; Fondazione Santa Lucia (FSL), Italy; Frankfurt University of Applied Sciences (FRA-UAS), Germany; Agaplesion Bethanien Hospital/Geriatric Centre at Heidelberg University (Bethanien), Germany.

REFERENCES [1] World Health Organization: ‘Towards a Common Language for

Functioning, Disability and Health - ICF’, Genova, 2002 [2] Grill, E., Muller, M., Quittan, M., Strobl, R., Kostanjsek, N., and Stucki,

G.: ‘Brief ICF Core Set for patients in geriatric post-acute rehabilitation facilities’, J Rehabil Med, 2011, 43, (2), pp. 139-144

[3] Matsumoto, Y., Nishida, Y., Motomura, Y., and Okawa, Y.: ‘A concept of needs-oriented design and evaluation of assistive robots based on ICF’, IEEE International Conference on Rehabilitation Robotics Rehab Week Zurich, ETH Zurich Science City, Switzerland, June 29 - July 1, pp. 1-6

[4] Tanaka, H., Yoshikawa, M., Oyama, E., Wakita, Y., and Matsumoto, Y.: ‘Development of Assistive Robots Using International Classification of Functioning, Disability, and Health: Concept, Applications, and Issues’, Journal of Robotics, 2013

[5] Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., and Jaffe, M.W.: ‘Studies of Illness in the Aged. The Index of ADL: A standardized measure of biological and psychosocial function’, JAMA, 1963, 185, pp. 914-919

[6] Lawton, M.P., and Brody, E.M.: ‘Assessment of older people: self-maintaining and instrumental activities of daily living’, Gerontologist, 1969, 9, (3), pp. 179-186

[7] Wiener, J.M., Hanley, R.J., Clark, R., and Van Nostrand, J.F.: ‘Measuring the activities of daily living: comparisons across national surveys’, J Gerontol, 1990, 45, (6), pp. S229-237

[8] Lazaridis, E.N., Rudberg, M.A., Furner, S.E., and Cassel, C.K.: ‘Do activities of daily living have a hierarchical structure? An analysis using the longitudinal study of aging’, J Gerontol, 1994, 49, (2), pp. M47-51

[9] Dawson, D., Hendershot, G., and Fulton, J.: ‘Aging in the Eighties: Functional Limitations of Individuals Age 65 Years and Over’, nchs - advance data, 133

[10] Gill, T.M., Guo, Z., and Allore, H.G.: ‘The epidemiology of bathing disability in older persons’, J Am Geriatr Soc, 2006, 54, (10), pp. 1524-1530

[11] Gill, T.M., Allore, H.G., and Han, L.: ‘Bathing disability and the risk of long-term admission to a nursing home’, J Gerontol A Biol Sci Med Sci, 2006, 61, (8), pp. 821-825

[12] LaPlante, M.P.: ‘The classic measure of disability in activities of daily living is biased by age but an expanded IADL/ADL measure is not’, J Gerontol B Psychol Sci Soc Sci, 2010, 65, (6), pp. 720-732

[13] Siu, A.L., Reuben, D.B., and Hays, R.D.: ‘Hierarchical measures of physical function in ambulatory geriatrics’, J Am Geriatr Soc, 1990, 38, (10), pp. 1113-1119

[14] Travis, S.S., and McAuley, W.J.: ‘Simple counts of the number of basic ADL dependencies for long-term care research and practice’, Health Serv Res, 1990, 25, (2), pp. 349-360

[15] Gerrard, P.: ‘The hierarchy of the activities of daily living in the Katz index in residents of skilled nursing facilities’, J Geriatr Phys Ther, 2013, 36, (2), pp. 87-91

[16] Dunlop, D.D., Hughes, S.L., and Manheim, L.M.: ‘Disability in activities of daily living: patterns of change and a hierarchy of disability’, Am J Public Health, 1997, 87, (3), pp. 378-383

[17] Njegovan, V., Hing, M.M., Mitchell, S.L., and Molnar, F.J.: ‘The hierarchy of functional loss associated with cognitive decline in older persons’, J Gerontol A Biol Sci Med Sci, 2001, 56, (10), pp. M638-643

[18] Mahoney, F.I., and Barthel, D.W.: ‘Functional Evaluation: The Barthel Index’, Md State Med J, 1965, 14, pp. 61-65

[19] Folstein, M.F., Folstein, S.E., and McHugh, P.R.: ‘"Mini-mental state". A practical method for grading the cognitive state of patients for the clinician’, J Psychiatr Res, 1975, 12, (3), pp. 189-198

[20] Tombaugh, T.N., and McIntyre, N.J.: ‘The mini-mental state examination: a comprehensive review’, J Am Geriatr Soc, 1992, 40, (9), pp. 922-935

[21] World Health Organization: ‘International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Volume 2 Instruction manual 2010 Edition’, Genova, 2011

[22] Bickenbach, J., Cieza, A., Rauch, A., and Stucki, G.: ‘ICF Core Sets. Manual for clinical practice’, Hogrefe, Göttingen, 2012

[23] Stier-Jarmer, M., Grill, E., Muller, M., Strobl, R., Quittan, M., and Stucki, G.: ‘Validation of the comprehensive ICF Core Set for patients in geriatric post-acute rehabilitation facilities’, J Rehabil Med, 2011, 43, (2), pp. 102-112

[24] Haglund, L., and Henriksson, C.: ‘Concepts in occupational therapy in relation to the ICF’, Occup Ther Int, 2003, 10, (4), pp. 253-268

[25] Bezerra, K., Machado, J.M., Silva, B., Carvalho, V., Soares, F., and Matos, D.: ‘Mechatronic system for assistance on bath of bedridden elderly people’, in Editor (Ed.)^(Eds.): ‘Book Mechatronic system for assistance on bath of bedridden elderly people’ (2015, edn.), pp. 1-4

[26] Yukawa, T., Nakata, N., Obinata, G., and Makino, T.: ‘Assistance system for bedridden patients to reduce the burden of nursing care (first report 2014; Development of a multifunctional electric wheelchair, portable bath, lift, and mobile robot with portable toilet)’, in Editor (Ed.)^(Eds.): ‘Book Assistance system for bedridden patients to reduce the burden of nursing care (first report &#x2014; Development of a multifunctional electric wheelchair, portable bath, lift, and mobile robot with portable toilet)’ (2010, edn.), pp. 132-139

[27] Hirose, T., Ando, T., Fujioka, S., and Mizuno, O.: ‘Development of head care robot using five-bar closed link mechanism with enhanced head shape following capability’, in Editor (Ed.)^(Eds.): ‘Book Development of head care robot using five-bar closed link mechanism with enhanced head shape following capability’ (2013, edn.), pp. 5530-5536

[28] Balaguer, C., Gimenez, A., Jardon, A., Cabas, R., and Correal, R.: ‘Live experimentation of the service robot applications for elderly people care in home environments’, in Editor (Ed.)^(Eds.): ‘Book Live experimentation of the service robot applications for elderly people care in home environments’ (2005, edn.), pp. 2345-2350

[29] Smarr, C.-A., Fausset, C.B., and Rogers, W.A.: ‘Understanding the Potential for Robot Assistance for Older Adults in the Home Environment’, Technical Report HFA-TR-1102, 2010

[30] Stefanacci, R.G., and Haimowitz, D.: ‘Bathroom assistances’, Geriatr Nurs, 2014, 35, (2), pp. 151-153

[31] Seidel, D., Crilly, N., Matthews, F.E., Jagger, C., Brayne, C., and Clarkson, P.J.: ‘Patterns of functional loss among older people: a prospective analysis’, Hum Factors, 2009, 51, (5), pp. 669-680

[32] Vogelaere, P., and Pereira, C.: ‘Thermoregulation and aging’, Rev Port Cardiol, 2005, 24, (5), pp. 747-761

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