unobtrusive sensing of ADL unobtrusive sensing of ADL performance for estimation of performance for estimation of functional statusfunctional status

Michael Rosen, Ph.D. Justin Carter, M.S.

Linsey Barker, B.S.

the premise…the premise…

Unobtrusive monitoring of ADLs in hospital and home settings is technically feasible and practical.Performance of ADLs is the most direct and ecologically valid indicator of functional status (and rehab outcome).Processed data from ADL-sensing can return valid predictive estimates of global functional status for display to on-site or remote clinicians.

context: means and motivation for context: means and motivation for monitoring older adults monitoring older adults in situ …in situ …

Video-audio conversational interaction for assessment, visualization of sensor readouts, followup to in-patient, counseling, support, some therapy.

Automatic transmission of data from room-fixed sensors, either s&f or live, for health tracking.

Context: means and motivation for Context: means and motivation for monitoring older adults monitoring older adults in situ …in situ …

Always-on xmission from wearable sensors for immediate detection of anomolous events, or continuous data acquisition.

Automatic and user-activated emergency call systems.

project design …project design …1- develop and demonstrate a prototype sensor package and data-acquisition hardware and software installed at NRH in Independence Square.

unobtrusiveunobtrusivesensorssensors

Is the sink on?

Is the cabinet open?

Is the stove on?

in-lineflow switch

micro-switch

magnetic contactswitch

project design …project design …

2- develop valid estimatorsHypothesize performance metrics (PMs) based on timing and countingRegress PMs against AMPS sub-scores (gold standard)Test the hypothesis that cheap, simple, readily-retrofitted sensors can supply automated objective task-performance data from which measures of functional status can be calculated in clinically meaningful terms

AMPSAMPS“The Assessment of Motor and Process Skills … standardised observational assessment … therapist is able to evaluate a person's overall ability to perform domestic activities of daily living and the quality of a person's motor and process skills. An AMPS observation involves … person perform two tasks (e.g., pouring a glass of juice; making a bed; preparing eggs, toast, and coffee) that the person has had prior experience performing. The person is rated on 16 motor skill items and 20 process skill items.

possible performance metrics …possible performance metrics …Durations, e.g. event-to-eventCounts, e.g. # times refrigerator was openedCategorical: yes/noSpatial distance moved Rates, events per timeNormalized by optimal or norm or “contract” with therapistMost likely correlations may be with AMPS “process skills”, e.g. “sequences”, “searches”, “accommodates”, …

project design …project design …

3- validation:across subjects by correlation with AMPS scoreslongitudinal (the punch line) within-subject against AMPS scores longitudinal within-subject against other clinical and practical metrics

status …status …

Sensor package installed and demonstrated in Independence Square at NRH …with funding from NIDRR via the RERC on Telerehab and the U.S. Army MRMCIn-hospital validation study approved and underwayIn-home validation studies proposed for funding

development plan …development plan …

Bring to market the CARE package (Collection of Adls for Remote Evaluation):

Wireless switch packageData logging and transfer box (H.323 protocol)Hub-site data capture and processing softwareInteractive display software for OTs and other service providers