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ORCATECH The Internet of Everything – Pervasive Computing for Health
Jeffrey KayeLayton Professor of Neurology & Biomedical EngineeringOregon Center for Aging & TechnologyLayton Aging & Alzheimer's Disease Center [email protected]
Carl Richards
OREGON CONNECTIONS TELECOMMUNICATIONS CONFERENCE - “Broadband: The Pulse of the Future”
October 23-24, 2013, Hood River, Oregon
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Current Assessmentis Limited
Cardinal features of health change - slow decline punctuated with acute events - are challenging to assess with current tools and methods.
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Assessment LimitationsInclude…
• Rely on sparsely spaced, brief queries – questionnaires, phone or in-person exams.
• Performed at the convenience of the assessor. • Depend on recall of events or brief snap-shots of
function.• Use artificial or non-real world tests; not fun• Assumes observations recorded during the exam
represent typical function• Challenged to track across the course of illness.• High inter-rater or test-to-test variability• Limited knowledge of other events that can significantly
effect outcomes (e.g., sleep, socialization, physical activity)
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Early detection
The Greatest Challenge: Detecting Meaningful Change
BaselineBaseline 3 years3 years 6 years6 years
Mea
sure
Symptoms Reported
Functional range
Change
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Path Forward: Change the Paradigm
New Discovery New & Transformed Businesses
New Discovery New & Transformed Businesses
OPTIMAL HEALTHOPTIMAL HEALTH
Pervasive Computing Wireless Technologies
“Big Data” Analytics
Pervasive Computing Wireless Technologies
“Big Data” Analytics
• Real-time• Continuous• Home-
based• Unobtrusive• Ambient
• Real-time• Continuous• Home-
based• Unobtrusive• Ambient
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To Facilitate this Change…
• Target key functions most related to QoL and highest costs that can be unobtrusively detected to change over time (e.g., cognition, gait, mood, pain, sleep, socialization).
• Build upon advances in remote sensing, pervasive computing, telehealth, activity and behavior modeling creating an ambient, multi-domain home-based assessment system.
• Minimize need to wear, carry or tend to devices, and especially to disrupt the person’s usual daily routine.
• Increase sensitivity by continuous, multi-domain assessment.
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Doorsensors
Walking sensors
Activity sensors
Cell phone as prompting device and for location
tracking
Localization sensors
Actigraphy devices
Bed Sensors
Medication tracking device
Phone sensors
Physiological sensors
Pervasive Computing Platform Elements
7
PC/Kiosk/Etc.: Experience sampling; cognitive testing; social engagement; coaching
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What you get: Continuous, Holistic Assessment “A Day in the Life”
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Embedded Ambient Assessment Technologies
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SecureInternet
SecureInternet
Activity Time & Location Gait
Speed
Doors Opening/Closing
Computer/KioskActivity
PhoneActivity
MedTrackerBody
Composition
Together: A Community-wide Home-Based Assessment Platform
Kaye et al. Journals of Gerontology: Psychological Sciences, 2011 10
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Identifying change using remote assessment methods: Evidence Examples
Room Transitions during a Norovirus Epidemic
Intact MCI
Daily Activity &
Cognitive Decline
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Total Activity: Life Space & EventAnalysis
Spiral plot: The plot is a 24 hour clock representing here 8 weeks of continuous data. At the top of the clock is midnight; at the bottom is noon. Each concentric blue circle outward represents 2 weeks of time. The colors of the dots represent firings of sensors by location
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Norovirus Epidemic: All ill patients identified by decreased room transition events without self report
-34%-34%
-24%-24%
-40%-40%
Campbell, 2011
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Walks: From 2 to 7000 per year
Photo: NYT, 2009
Hayes, 2009; Hagler, 2010; Kaye, 2012
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Variability in walking speed and total activity differentiates MCI from cognitively normal people
MCI
NL
• Mean age = 88 years• Mean in-home motion-activity
sensing 315 ± 82 days
Hayes et al. Alzheimer's & Dementia, 2008; 4(6): 395-405.Hayes et al. Alzheimer’s & Dementia, 2008
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Routine home PC use over time (without formal tests or queries) detects change in those with MCI
• Mean 1.5 hours on computer/per day at baseline month
• Over time:– Less use days
per month – Less use time
when in session– More variable in
use pattern over time
Kaye, et al. 2011 Kaye, et al. Alzheimer & Dementia, 2013
Intact MCI
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Continuous, multi-domain assessment over timevia pervasive computing – the future norm…
DataFusion
Improved Assessment & Outcomes
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Acknowledgements: The ORCATECH Village
Research Collaborators
Diverse Companies Funding Sponsors
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Additional Material
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Hayes et al., Proceedings : Engineering in Medicine and Biology Soc, 2006; Leen T, et al., Technology and Aging, 2007 ; Hayes T et al. .Journal of Aging Health, 2009; Hayes T et al.Telemedicine Jounal and E-Health, 2009
Direct Assessment of Everyday Cognition
PROSPECTIVE MEMORY
Prospective memory task – probability of remembering to take medications as desired tracked using a familiar plastic pill box.
vs
Conventional memory task – recall a list of unrelated words.
ORCATECH MedTracker
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Medication Adherence: A Sensitive Measure of Cognitive Function
• Adherence assessed with MedTracker taking a vitamin BID; target times set by seniors
• Mean Age - 83 yrs
• Assessed continuously x 5 wks
• Based on ADAScog: Lower Cognition Group (n =18) vs Higher Cognition Group (n = 20)
• Very mild cognitive change in independent elderly is associated with medication adherence
• Medication adherence can be a very early marker of cognitive and functional impairment.
Hayes T et al., Journal of Aging Health, 2009
0
10
20
30
40
50
60
70
80
90
100
Lower Cognition
Higher Cognition
Median time within 12.0 mins of goal
Median time within 53.4 mins of goal
% A
dh
ere
nt
* Significantly worse Adherence in Lower Cognition Group
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MotionDetectors
Contact/DoorSwitches
PhoneSensors
Load Cells /Bed Sensors
LocationTracking
MedicationTracker
Computer
Raw Sensor Data
Sleep
Phone Use
Weight
MedicationEvents
DeparturesArrivals
GaitVelocity
ComputerInteractions
WeightScale
Mobility
LocationEstimation
Sleep Hygiene
Socialization
MedicationAdherence
Depression
PhysicalImpairments
Direct Assessment
Inference
Memory
Attention
Information Level Fusion
Sensor Level Fusion
Cognitive Decline
Change Detection
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Mirabella Portland, a new generation of Living Laboratories
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Weekly on-line reports provides unique insights into
function: patterns of low mood
“During the last week, have you felt downhearted or blue for more than three days?”
(2008-2010)N = 122; 14,566 reports
Seasonal Pattern ofLow Mood Reports
Thielke, unpublished, 2013
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Social Engagement RCT Hiroko Dodge, PI
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Face-to-Face
Internet email/VOIP
Telephone
Channels of Engagement