Special issue on technology and neuropsychological rehabilitation: Overview and reflections on ways to conduct future studies and support clinical practice.

In this editorial, we wish to highlight and reflect on research advances presented in the articles comprising this special issue on technology and neuropsychological rehabilitation, which happens to be published more than a decade after the first special issue on the subject. In 2004, the journal recognised the great potential of information technology for increasing the support provided to people with cognitive deficits, and published emerging state-of-the art practices in the field. Since that time, research and technology have made tremendous progress, and the influence of information technology on research methods has transformed the field of neurorehabilitation. The aim of this editorial is thus to shed light on methodological and conceptual issues requiring further attention from researchers and clinicians in the fields of neuropsychological rehabilitation and technology, and to stimulate debate on promising avenues in clinical research.

Preventing and managing indoor falls with home-based technologies in mild and moderate Alzheimer's disease patients: pilot study in a community dwelling.

BACKGROUND: Alzheimer's disease (AD) is known to increase the risk of falls. We aim to determine the effectiveness of home-based technologies coupled with teleassistance service (HBTec-TS) in older people with AD. METHODS: A study of falls and the HBTec-TS system (with a light path combined with a teleassistance service) was conducted in the community. The 96 subjects, drawn from a random population of frail elderly people registered as receiving an allocation for lost autonomy from the county, were aged 65 or more and had mild-to-moderate AD with 1 year of follow-up; 49 were in the intervention group and 47 in the control group. RESULTS: A total of 16 (32.7%) elderly people fell in the group with HBTec-TS versus 30 (63.8%) in the group without HBTec-TS. The use of HBTec-TS was significantly associated with a reduction in the number of indoor falls among elderly people with mild-to-moderate AD (OR = 0.37, 95% CI = 0.15-0.88, p = 0.0245). CONCLUSION: The use of the HBTec-TS significantly reduced the incidence of primary indoor falling needing GP intervention or attendance at an emergency room among elderly people with AD and mild-to-moderate dementia.

[Alzheimer's disease and geolocation: initial results of the Estima study]. / Maladie d'Alzheimer et géolocalisation: premiers résultats de l'etude Estima.

Geolocation devices for patients suffering from Alzheimer's disease constitute an improvement in their care. However, this system arouses debate. The Estima study offers a series of results and recommendations concerning the use of these devices. It consists of three complementary sections: a sociological study, an observational retrospective study and an ethical analysis.

A Smart Shoe Insole to Monitor Frail Older Adults' Walking Speed: Results of Two Evaluation Phases Completed in a Living Lab and Through a 12-Week Pilot Study.

BACKGROUND: Recent World Health Organization reports propose wearable devices to collect information on activity and walking speed as innovative health indicators. However, mainstream consumer-grade tracking devices and smartphone apps are often inaccurate and require long-term acceptability assessment. OBJECTIVE: Our aim is to assess the user acceptability of an instrumented shoe insole in frail older adults. This device monitors participants' walking speed and differentiates active walking from shuffling after step length calibration. METHODS: A multiphase evaluation has been designed: 9 older adults were evaluated in a living lab for a day, 3 older adults were evaluated at home for a month, and a prospective randomized trial included 35 older adults at home for 3 months. A qualitative research design using face-to-face and phone semistructured interviews was performed. Our hypothesis was that this shoe insole was acceptable in monitoring long-term outdoor and indoor walking. The primary outcome was participants' acceptability, measured by a qualitative questionnaire and average time of insole wearing per day. The secondary outcome described physical frailty evolution in both groups. RESULTS: Living lab results confirmed the importance of a multiphase design study with participant involvement. Participants proposed insole modifications. Overall acceptability had mixed results: low scores for reliability (2.1 out of 6) and high scores for usability (4.3 out of 6) outcomes. The calibration phase raised no particular concern. During the field test, a majority of participants (mean age 79 years) were very (10/16) or quite satisfied (3/16) with the insole's comfort at the end of the follow-up. Participant insole acceptability evolved as follows: 63% (12/19) at 1 month, 50% (9/18) at 2 months, and 75% (12/16) at 3 months. A total of 9 participants in the intervention group discontinued the intervention because of technical issues. All participants equipped for more than a week reported wearing the insole every day at 1 month, 83% (15/18) at 2 months, and 94% (15/16) at 3 months for 5.8, 6.3, and 5.1 hours per day, respectively. Insole data confirmed that participants effectively wore the insole without significant decline during follow-up for an average of 13.5 days per 4 months and 5.6 hours per day. For secondary end points, the change in frailty parameters or quality of life did not differ for those randomly assigned to the intervention group compared to usual care. CONCLUSIONS: Our study reports acceptability data on an instrumented insole in indoor and outdoor walking with remote monitoring in frail older adults under real-life conditions. To date, there is limited data in this population set. This thin instrumentation, including a flexible battery, was a technical challenge and seems to provide an acceptable solution over time that is valued by participants. However, users still raised certain acceptability issues. Given the growing interest in wearable health care devices, these results will be useful for future developments. TRIAL REGISTRATION: ClinicalTrials.gov NCT02316600; https://clinicaltrials.gov/ct2/show/NCT02316600.

Videophones for the delivery of home healthcare in oncology.

A videophone system was used to link cancer patients, undergoing chemotherapy at home, with care providers in the Home Healthcare Facility at the University Hospital Centre of Grenoble. The participant patients expressed their satisfaction both with the use and the technical quality of the system. Improvement was observed in the Hospitalisation Anxiety and Depression Scale (HADS), SF36 Health Survey Questionnaire and Palliative care Outpatient Scale (POS) scores during and at the end of the experiment. The results indicated that the use of videophones was both feasible and satisfactory, and that they may have a positive effect on the cancer patient's quality of life at home. Further studies are necessary to prove this final observation.

Learning recurrent behaviors from heterogeneous multivariate time-series.

OBJECTIVE: For the last years, time-series mining has become a challenging issue for researchers. An important application lies in most monitoring purposes, which require analyzing large sets of time-series for learning usual patterns. Any deviation from this learned profile is then considered as an unexpected situation. Moreover, complex applications may involve the temporal study of several heterogeneous parameters. In that paper, we propose a method for mining heterogeneous multivariate time-series for learning meaningful patterns. METHODS: The proposed approach allows for mixed time-series - containing both pattern and non-pattern data - such as for imprecise matches, outliers, stretching and global translating of patterns instances in time. RESULTS: We present the results of our approach on synthetic data generated in the context of monitoring a person at home, as well as early results on few real sequences. The purpose is to build a behavioral profile of a person in their daily activities by analyzing the time variations of several quantitative or qualitative parameters recorded through a provision of sensors. CONCLUSIONS: The results are very promising. They also highlight the difficulty of tuning the parameters of the method.

Computational representation of Alzheimer's disease evolution applied to a cooking activity.

This article presents a computational model and a simulation of the decrease of activities of daily living performances due to Alzheimer's disease. The disease evolution is simulated thanks to the cognitive architecture ACT-R. Activities are represented according to the retrieval of semantic units in declarative memory and the trigger of rules in procedural memory. The simulation of Alzheimer's disease decrease is simulated thanks to the variation of subsymbolic parameters. The model is applied to a cooking activity. Simulation of 100 hundred subjects shows results similar to those realised in a standardized assessment with human subjects.

Multi-sensors acquisition, data fusion, knowledge mining and alarm triggering in health smart homes for elderly people.

We deal in this paper with the concept of health smart home (HSH) designed to follow dependent people at home in order to avoid the hospitalisation, limiting hospital sojourns to short acute care or fast specific diagnostic investigations. For elderly people the project of such a HSH has been called AISLE (Apartment with Intelligent Sensors for Longevity Effectiveness). For this purpose, system having three levels of automatic measuring (1) the circadian activity, (2) the vegetative state, and (3) some state variables specific of certain organs involved in precise diseases, has been developed within the framework of a 'Health Integrated Smart Home Information System' (HIS2). HIS2 is an experimental platform for technologic development and clinical evaluation, in order to ensure the medical security and quality of life for patients who need home based medical monitoring. Location sensors are placed in each room of the HIS2, allowing the monitoring of patient's successive daily activity phases within the patient's home environment. We proceed with a sampling in an hourly schedule to detect weak variations of the nycthemeral rhythms. Based on numerous measurements, we establish a mean value with confidence limits of activity variables in normal behaviour permitting to detect for example a sudden abnormal event (like a fall) as well as a chronic pathologic activity (like a pollakiuria), allowing us to define a canonical domain within which the patient's activity is qualified to be 'predictable'. Alerts are set off if the patient's activity deviates from a predictable canonical domain. Moreover, we can follow the cardio-respiratory state by measuring the intensity of the respiratory sinusal arrhythmia in order to quantify the integrity of the bulbar vegetative system, and we finally propose to carefully watch abnormal symptoms like arterial pressure or presence of plasma proteins in the expired air flow for early detecting respectively hypertension or pulmonary oedema.

Telemonitoring of patients at home: a software agent approach.

To address the issue of the increasing social, economical and medical needs of maintaining at home people in loss of autonomy while preserving privacy and quality of life, the authors present a software agent based telemonitoring and alarm raising system. The article describes the overall architecture, the various components of the model, and the methodology that has been used. It specifically addresses the issue of reflecting in the object oriented model of the system various dimensions including: the physical world of in-home bio-signal sensors, the numerical world of software agents and Internet-related technologies, and the medical and social worlds of patients, physicians and caregivers. In the model, the main stream of information goes from the biophysical world of patients at home to the socio-medical world of carers through a chain of devices including in-home sensors, local area network, home computer, remote server, and carers' computers. Each device hosts software agents with different levels of knowledge and complexity. Internet and Java technologies provide the building blocks of the designed telemonitoring software. Laboratory experiments have been realized using a fully equipped 'smart' demonstration home for telecare. The study takes place into a more general research project on 'smart' homes for telecare conducted at the Hospital Centre of Grenoble, France.

Watching symptoms and illnesses through the eyes of Multiple Correspondence Analysis: a case study in toxicology.

The goal of the reported research was the design of a computerized tool aimed at aiding an emergency specialist, in a toxicological emergency unit, to quickly identify, at the admission time, the various poisons ingested by a comatose patient. This medical decision making problem has been proved to be computationally intractable since a lot of patient cases sharing the same clinical table have different diagnoses in terms of psychotropes combinations. The paper explores the idea that the outcome of Multiple Correspondence Analysis (MCA), a mathematical data analysis method, can be thought of as visual and analytical aids for the physician facing this decision problem. We argue that the expert's clinical reasoning can be enhanced by the factorial maps and some computerized results provided by MCA. Using a learning database of 505 diagnosed cases, we realized a whole decision aiding system called TOXSYMEDIA. A test-base of 97 patients was used to partially assess the system. The method and resulting tool revealed to be appreciable to early inform the physician about the possible combination of ingested psychotropes.

Efficacy of simple home-based technologies combined with a monitoring assistive center in decreasing falls in a frail elderly population (results of the Esoppe study).

BACKGROUND: Increasing age often implies increasing frailty, and the oldest old are often described as a frail group with a high risk of developing functional impairments and multi-morbidities like falls at home, which often result in dependence in daily activities. This preliminary study evaluate the efficacy of light path coupled with tele-assistance service for preventing unintentional falls at home in a frail elderly population. METHODS: Study design is a longitudinal prospective cohort study from 1st July 2009 to 30 June 2010. The program included 194 adults aged 65 and over living at home and registered on a list of frail elderly people. Participants were uniformly asked about their history of falls during the year prior to their most recent health examination. The recall period was one year. RESULTS: We observed that 77 (40.5%) elderly fell at home, 29 (30.9%) in the exposed group and 48 (50.0%) in the unexposed group. The use of light path coupled with tele-assistance was significantly associated with the reduction in falls at home, odd ratio=0.33 95%CI [0.17-0.65] p value=0.0012. There was also a greater reduction in post-fall hospitalization rate among exposed group with odd ratio=0.30 95%CI [0.12-0.74] p value=0.0091. CONCLUSIONS: This preliminary study showed that the use of light path coupled with tele-assistance service significantly reduced the incidence of unintentional falling at home among frail elderly population. This result should be confirmed by a randomized trial.

A computational model of activities performance decrease in Alzheimer's disease.

This article presents a computational model and a simulation of the decrease of performance in daily living activities due to Alzheimer's disease. The framework offered by the cognitive architecture ACT-R is used to develop the model. Typical errors committed in performing tasks by Alzheimer patients are modelled thanks to different parametrisable memory mechanisms of ACT-R and the disease evolution is represented by the increase of errors in the execution of the task. The model is applied to a cooking activity. Simulation of 100 subjects shows results similar to those realised in a standardized assessment with human subjects. We conclude on the need to introduce executive mechanisms in the modelling of behaviours associated to people with cognitive deficits.

Environmental cognitive remediation in schizophrenia: ethical implications of "smart home" technology.

OBJECTIVE: In light of the advent of new technologies, we proposed to reexamine certain challenges posed by cognitive remediation and social reintegration (that is, deinstitutionalization) of patients with severe and persistent mental disorders. METHOD: We reviewed literature on cognition, remediation, smart homes, as well as on objects and utilities, using medical and computer science electronic library and Internet searches. RESULTS: These technologies provide solutions for disabled persons with respect to care delivery, workload reduction, and socialization. Examples include home support, video conferencing, remote monitoring of medical parameters through sensors, teledetection of critical situations (for example, a fall or malaise), measures of daily living activities, and help with tasks of daily living. One of the key concepts unifying all these technologies is the health-smart home. We present the notion of the health-smart home in general and then examine it more specifically in relation to schizophrenia. CONCLUSION: Management of people with schizophrenia with cognitive deficits who are being rehabilitated in the community can be improved with the use of technology; however, such technology has ethical ramifications.

Which Graphical Approaches should be Used to Represent Medical Knowledge?

Medical knowledge is growing both in quantity and complexity. Although sources of medical knowledge have been digitalized, the way the knowledge they contain is presented to users has not changed and is still highly text-based. However, it has been shown that this information could be presented more efficiently using graphical approaches, such as graphical languages and information visualization. We present here a survey of existing methods and applications, and discuss the potential value of these methods for medical practice. These graphical approaches have great potential for improving medical knowledge consultation, provided they are well-designed, well-evaluated and standardized for re-use.

Health "Smart" home: information technology for patients at home.

This article reviews the emerging concept of health "Smart" homes (HSH) and its potential through the use of telemedical information systems and communication technologies. HSH systems provide health care services for people with special needs who wish to remain independent and living in their own home. The large diversity of needs in a home-based patient population requires complex technology. Meeting these needs technically requires the use of a distributed approach and the combination of many hardware and software techniques. We also describe the wide scope of new information, communication, and data-acquisition technologies used in home health care. We offer an introduction to the HSH concept in terms of technical, economic, and human requirements. Examples of HSH projects are presented, including a short description of our own smart home and telehealthcare information system project.