OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

In recent years, we have witnessed a rapid surge in assisted living technologies due to a rapidly aging society. The aging population, the increasing cost of formal health care, the caregiver burden, and the importance that the individuals place on living independently, all motivate development of innovative-assisted living technologies for safe and independent aging. In this survey, we will summarize the emergence of `ambient-assisted living” (AAL) tools for older adults based on ambient intelligence paradigm. We will summarize the state-of-the-art AAL technologies, tools, and techniques, and we will look at current and future challenges.

A Survey on Ambient-Assisted Living Tools for Older Adults

Characteristics of physical activity are indicative of one's mobility level, latent chronic diseases and aging process. Accelerometers have been widely accepted as useful and practical sensors for wearable devices to measure and assess physical activity. This paper reviews the development of wearable accelerometry-based motion detectors. The principle of accelerometry measurement, sensor properties and sensor placements are first introduced. Various research using accelerometry-based wearable motion detectors for physical activity monitoring and assessment, including posture and movement classification, estimation of energy expenditure, fall detection and balance control evaluation, are also reviewed. Finally this paper reviews and compares existing commercial products to provide a comprehensive outlook of current development status and possible emerging technologies.

A Review of Accelerometry-Based Wearable Motion Detectors for Physical Activity Monitoring

A review of smart homes-Present state and future challenges

Smart wearable systems: Current status and future challenges

Objective An entertainment robot was used as occupational therapy instead of animal-assisted therapy to avoid any danger or injury to the patient and maintain cleanliness. This study compared the effectiveness of a robot animal, AIBO, with a toy. Method AIBO is made of metal and responds to spoken commands. We demonstrated AIBO to severely demented elderly people living in a geriatric home and observed their reactions. Results The most frequent reactions to AIBO consisted of looking at, communicating with, and caring for AIBO. The patients recognized that AIBO was a robot. However, once we dressed AIBO, the patients perceived AIBO as either a dog or a baby. Nevertheless, the presentation of AIBO resulted in positive outcomes for the severe dementia patients, including increased communication between the patients and AIBO. Conclusion AIBO was clearly an effective rehabilitation tool in the treatment of severely demented patients.

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Is an entertainment robot useful in the care of elderly people with severe dementia

In this study, the combined use of an accelerometer and rate gyrosensor to identify the activity phases of the timed up-and-go test (TUG-T) was proposed. Measurements during clinical rehabilitation of hemiplegic patients have been attempted using a triaxial accelerometer to measure the activity objectively, which allows a quantitative evaluation. A waist gyrosensor is useful for measuring the postural displacement with high accuracy. By using both the accelerometer and gyrosensor signals, it was possible to detect the activity phases, which were similar to those observed by the therapists. In addition, the walking activity was extracted from the TUG-T, and the RMS value and CV from the acceleration were calculated in every walking cycle. A qualitative difference between the subjects who could walk independently and those requiring supervision was revealed.

Quantitative evaluation of movement using the timed up-and-go test

Root mean square (RMS) of trunk acceleration is seen frequently in gait analysis research. However, many studies have reported that the RMS value was related to walking speed. Therefore, the relationship between the RMS value and walking speed should be considered when the RMS value is used to assess gait abnormality. We hypothesized that the RMS values in three sensing axes exhibit common proportions for healthy people if they walk at their own preferred speed and that the RMS proportions in abnormal gait deviate from the common proportions. In this study, we proposed the RMS ratio (RMSR) as a gait abnormality measure and verified its ability to discriminate abnormal gait. Forty-seven healthy male subjects (24–49 years) were recruited to examine the relationship between walking speed and the RMSR. To verify its ability to discriminate abnormal gait, twenty age-matched male hemiplegic patients (30–48 years) participated as typical subjects with gait abnormality. A tri-axial accelerometer was attached to their lower back, and they walked along a corridor at their own preferred speed. We defined the RMSR as the ratio between RMS in each direction and the RMS vector magnitude. In the healthy subjects, the RMS in all directions related to preferred walking speed. In contrast, RMSR in the mediolateral (ML) direction did not correlate with preferred walking speed (rs = -0.10, p = 0.54) and represented the similar value among the healthy subjects. Moreover, the RMSR in the ML direction for the hemiplegic patients was significantly higher than that for the healthy subjects (p < 0.01). These results suggest that the RMSR in the ML direction exhibits a common value when healthy subjects walk at their own preferred speed, even if their preferred walking speed were different. For subjects with gait abnormality, the RMSR in the ML direction deviates from the common value of healthy subjects. The RMSR in the ML direction may potentially be a quantitative measure of gait abnormality.

/pdf/a-gait-abnormality-measure-based-on-root-mean-square-of-4y1vop0zdf.pdf

A gait abnormality measure based on root mean square of trunk acceleration

In this paper, we assess the complexity (fractal measure) of body motion during walking in patients with Parkinson's disease. The body motion of 11 patients with Parkinson's disease and 10 healthy elderly subjects was recorded using a triaxial accelerometry technique. A triaxial accelerometer was attached to the lumbar region. An assessment of the complexity of body motion was made using a maximum-likelihood-estimator-based fractal analysis method. Our data suggest that the fractal measures of the body motion of patients with Parkinson's disease are higher than those of healthy elderly subjects. These results were statistically different in the X (anteroposterior), Y (lateral) and Z (vertical) directions of body motion between patients with Parkinson's disease and the healthy elderly subjects (p < 0.01 in X and Z directions and p < 0.05 in Y direction). The complexity (fractal measure) of body motion can be useful to assess and monitor the output from the motor system during walking in clinical practice.

https://iopscience.iop.org/article/10.1088/1741-2560/1/1/002/pdf

Fractal dynamics of body motion in patients with Parkinson's disease

This study described a niche telemedicine framework for home healthcare. The framework aims to transmit small but sufficient amounts of data for daily monitoring of residential subjects' basic health status. As a proof of concept, an unconstrained monitoring system of heart/respiration rates using wireless telecommunication as an application for home-visit rehabilitation therapists was developed. The system allows a nomadic home-visit therapist to acquire the health information of a patient remotely - from anywhere at any time. It consists of a sensory system for the patient and a viewer system for the therapist. A TCP/IP network connects the subsystems using a physical communication infrastructure. The proposed system showed its usefulness for both the therapist and the patient in planning and evaluating daily rehabilitation training.

Yuji Higashi

Papers

Is an entertainment robot useful in the care of elderly people with severe dementia

Quantitative evaluation of movement using the timed up-and-go test

A gait abnormality measure based on root mean square of trunk acceleration

Fractal dynamics of body motion in patients with Parkinson's disease

An unconstrained monitoring system for home rehabilitation