In the context of the fourth revolution in healthcare technologies, leveraging monitoring and personalization across different domains becomes a key factor for providing useful services to maintain and promote well-being. This is even more crucial for older people, with aging being a complex multi-dimensional and multi-factorial process which can lead to frailty. The NESTORE project was recently funded by the EU Commission with the aim of supporting healthy older people to sustain their well-being and capacity to live independently. It is based on a multi-dimensional model of the healthy aging process that covers physical activity, nutrition, cognition, and social activity. NESTORE is based on the paradigm of the human-in-the-loop cyber-physical system that, exploiting the availability of Internet of Things technologies combined with analytics in the cloud, provides a virtual coaching system to support healthy aging. This work describes the design of the NESTORE methodology and its IoT architecture. We first model the end-user under several domains, then we present the NESTORE system that, analyzing relevant key-markers, provides coaching activities and personalized feedback to the user. Finally, we describe the validation strategy to assess the effectiveness of NESTORE as a coaching platform for healthy aging.

/pdf/hi-this-is-nestore-your-personal-assistant-design-of-an-3xg3qxh68d.pdf

"Hi This Is NESTORE, Your Personal Assistant": Design of an Integrated IoT System for a Personalized Coach for Healthy Aging.

Sleep disorders are a growing threat nowadays as they are linked to neurological, cardiovascular and metabolic diseases. The gold standard methodology for sleep study is polysomnography (PSG), an intrusive and onerous technique that can disrupt normal routines. In this perspective, m-Health technologies offer an unobtrusive and rapid solution for home monitoring. We developed a multi-scale method based on motion signal extracted from an unobtrusive device to evaluate sleep behavior. Data used in this study were collected during two different acquisition campaigns by using a Pressure Bed Sensor (PBS). The first one was carried out with 22 subjects for sleep problems, and the second one comprises 11 healthy shift workers. All underwent full PSG and PBS recordings. The algorithm consists of extracting sleep quality and fragmentation indexes correlating to clinical metrics. In particular, the method classifies sleep windows of 1-s of the motion signal into: displacement (DI), quiet sleep (QS), disrupted sleep (DS) and absence from the bed (ABS). QS proved to be positively correlated (0.72±0.014) to Sleep Efficiency (SE) and DS/DI positively correlated (0.85±0.007) to the Apnea-Hypopnea Index (AHI). The work proved to be potentially helpful in the early investigation of sleep in the home environment. The minimized intrusiveness of the device together with a low complexity and good performance might provide valuable indications for the home monitoring of sleep disorders and for subjects’ awareness.

/pdf/multi-scale-evaluation-of-sleep-quality-based-on-motion-1vszqk8u.pdf

Multi-Scale Evaluation of Sleep Quality Based on Motion Signal from Unobtrusive Device

Monitoring system have been customized to collect data and to analyse several aspects of the users’ life, the reason of this custom solution came from the needs to join physical activity of the user, life usage, social interaction and mind activities, all these features are not present in standard devices all together, so we arrived to a new system architecture where the monitoring system is the first front end versus the user. This chapter describes the general monitoring system architecture and provides insight into the contribution and role of sensors. Such sensing solutions are not only designed to match the needs and requirements of the user but also to reduce intrusiveness and usage complexity. By doing so the system is designed around the life of its users and maximizes the effectiveness of data collection. Example from NESTORE project are taken as reference.

Monitoring in the Physical Domain to Support Active Ageing

ABSTRACT This study aimed to explore the effects of health technologies on the promotion of health through physical activities of older persons. Following PRISMA guidelines, a systematic review of relevant articles published prior to 2020 was conducted from selected indices such as COCHRANE, PubMed, Science Direct, Proquest, including the use of hand search procedure. Twenty-seven articles were analyzed with significant findings influential to older people nursing: types of health technologies used for promoting physical activity; effects of technology use in promoting physical activity of older person care; and aspects that need to be considered in technology use among older persons. Characteristics of technologies were accuracy, usefulness, reliability, comfort, safety, and relevancy. Most technologies promoting physical activities for older people were wearable technologies that use artificial intelligence. Altogether, these technologies influenced overall healthcare behaviors of older persons. With healthcare technology efficiencies, proficiencies, and dependencies, technology-based healthcare have served older people well. Most technologies for older people care, such as wearables, reliably produce characteristics enhancing dependency and accuracy of bio-behavioral information influencing physical activities of older persons. Health technologies foster the values of physical activities among older persons thereby promoting healthy living.

Effects of Healthcare Technologies on the Promotion of Physical Activities in Older Persons: A Systematic Review

Stair climb power (SCP) is a clinical measure of leg muscular function assessed in-clinic via the Stair Climb Power Test (SCPT). This method is subject to human error and cannot provide continuous remote monitoring. Continuous monitoring using wearable sensors may provide a more comprehensive assessment of lower-limb muscular function. In this work, we propose an algorithm to classify stair climbing periods and estimate SCP from a lower-back worn accelerometer, which strongly agrees with the clinical standard (r = 0.92, p < 0.001; ICC = 0.90, [0.82, 0.94]). Data were collected in-lab from healthy adults (n = 65) performing the four-step SCPT and a walking assessment while instrumented (accelerometer + gyroscope), which allowed us to investigate tradeoffs between sensor modalities. Using two classifiers, we were able to identify periods of stair ascent with >89% accuracy [sensitivity = >0.89, specificity = >0.90] using two ensemble machine learning algorithms, trained on accelerometer signal features. Minimal changes in model performances were observed using the gyroscope alone (±0–6% accuracy) versus the accelerometer model. While we observed a slight increase in accuracy when combining gyroscope and accelerometer (about +3–6% accuracy), this is tolerable to preserve battery life in the at-home environment. This work is impactful as it shows potential for an accelerometer-based at-home assessment of SCP.

/pdf/wearable-based-stair-climb-power-estimation-and-activity-3f4irwlu.pdf

Wearable-Based Stair Climb Power Estimation and Activity Classification

Wearable sensors play a significant role for monitoring the functional ability of the elderly and in general, promoting active ageing. One of the relevant variables to be tracked is the number of stair steps (single stair steps) performed daily, which is more challenging than counting flight of stairs and detecting stair climbing. In this study, we proposed a minimal complexity algorithm composed of a hierarchical classifier and a linear model to estimate the number of stair steps performed during everyday activities. The algorithm was calibrated on accelerometer and barometer recordings measured using a sensor platform worn at the wrist from 20 healthy subjects. It was then tested on 10 older people, specifically enrolled for the study. The algorithm was then compared with other three state-of-the-art methods, which used the accelerometer, the barometer or both. The experiments showed the good performance of our algorithm (stair step counting error: 13.8%), comparable with the best state-of-the-art (p > 0.05), but using a lower computational load and model complexity. Finally, the algorithm was successfully implemented in a low-power smartwatch prototype with a memory footprint of about 4 kB.

Design and Validation of a Minimal Complexity Algorithm for Stair Step Counting

Monitoring physiological and behavioural data related to the five domains of well-being (i.e., physical, mental, cognitive, social, and nutritional) is relevant for assessing the profile of people using assistive technologies, in order to provide early detection and adaptive support to his changing individual needs related to ageing. In this paper, we present a system called NESTORE that aims at addressing such a challenge. In particular, we focus on the enabling technology that composes the core set of devices of the so-called environmental monitoring system, namely the NESTORE Bluetooth Low Energy beacons. The presented system performs a range of services including data collection and analysis of shortand long-term trends in social and behavioural parameters. Furthermore, using the same set of devices the system provides insights on the status of the user’s vital space in terms of thermal comfort. We provide an overview of the NESTORE environmental monitoring system and details and evaluation of the software modules built upon the chosen technology: social interaction detection, indoor behavioural index inference, and indoor thermal comfort detection.

/pdf/exploiting-ble-beacons-capabilities-in-the-nestore-13cov2rut7.pdf

Marta T. L. Civiello

Papers

Design and Validation of a Minimal Complexity Algorithm for Stair Step Counting

Exploiting BLE beacons capabilities in the NESTORE monitoring system

Monitoring in the Physical Domain to Support Active Ageing