A visual questioning answering approach to enhance robot localization in indoor environments.

Navigating robots with precision in complex environments remains a significant challenge. In this article, we present an innovative approach to enhance robot localization in dynamic and intricate spaces like homes and offices. We leverage Visual Question Answering (VQA) techniques to integrate semantic insights into traditional mapping methods, formulating a novel position hypothesis generation to assist localization methods, while also addressing challenges related to mapping accuracy and localization reliability. Our methodology combines a probabilistic approach with the latest advances in Monte Carlo Localization methods and Visual Language models. The integration of our hypothesis generation mechanism results in more robust robot localization compared to existing approaches. Experimental validation demonstrates the effectiveness of our approach, surpassing state-of-the-art multi-hypothesis algorithms in both position estimation and particle quality. This highlights the potential for accurate self-localization, even in symmetric environments with large corridor spaces. Furthermore, our approach exhibits a high recovery rate from deliberate position alterations, showcasing its robustness. By merging visual sensing, semantic mapping, and advanced localization techniques, we open new horizons for robot navigation. Our work bridges the gap between visual perception, semantic understanding, and traditional mapping, enabling robots to interact with their environment through questions and enrich their map with valuable insights. The code for this project is available on GitHub https://github.com/juandpenan/topology_nav_ros2.

Frailty detection in older adults via fractal analysis of acceleration signals from wrist-worn sensors.

Purpose: Frailty is a reversible multidimensional syndrome that puts older people at a high risk of adverse health outcomes. It has been proposed to emerge from the dysregulation of the complex system dynamics of physiologic control systems. We propose the analysis of the fractal complexity of hand movements as a new method to detect frailty in older adults. Methods: FRAIL scale and Fried's phenotype scores were calculated for 1209 subjects-72.4 (5.2) y.o. 569 women-and 1279 subjects-72.6 (5.3) y.o. 604 women-in the pubicly available NHANES 2011-2014 data set, respectively. The fractal complexity of their hand movements was assessed with a detrended fluctuation analysis (DFA) of their accelerometry records and a logistic regression model for frailty detection was fit. Results: Goodness-of-fit to a power law was excellent (R2>0.98). The association between complexity loss and frailty level was significant, Kruskal-Wallis test (df = 2, Chisq = 27.545, p-value <0.001). The AUC of the logistic classifier was moderate (AUC with complexity = 0.69 vs. AUC without complexity = 0.67). Conclusion: Frailty can be characterized in this data set with the Fried phenotype. Non-dominant hand movements in free-living conditions are fractal processes regardless of age or frailty level and its complexity can be quantified with the exponent of a power law. Higher levels of complexity loss are associated with higher levels of frailty. This association is not strong enough to justify the use of complexity loss after adjusting for sex, age, and multimorbidity.

Integrated health system to assess and manage frailty in community dwelling: Co-design and usability evaluation.

Objective: We aimed to co-create and evaluate an integrated system to follow-up frailty in a community dwelling environment and provide a multi-modal tailored intervention. Frailty and dependency among the older population are a major challenge to the sustainability of healthcare systems. Special attention must be paid to the needs and particularities of frail older persons as a vulnerable group. Methods: To ensure the solution fits all the stakeholders' needs, we performed several participatory design activities with them, such as pluralistic usability walkthroughs, design workshops, usability tests and a pre-pilot. The participants in the activities were older people; their informal carers; and specialized and community care professionals. In total, 48 stakeholders participated. Results: We created and evaluated an integrated system consisting of four mobile applications and a cloud server, which has been evaluated through a 6-months clinical trial, where secondary endpoints were both usability and user experience evaluation. In total, 10 older adults and 12 healthcare professionals participated in the intervention group using the technological system. Both patients and professionals have positively evaluated their applications. Conclusion: Both older adults and healthcare professionals have considered the resulted system easy to use and learn, consistent and secure. In general terms, they also would like to keep using it in the future.

Preventing frailty with the support of a home-monitoring and communication platform among older adults-a study protocol for a randomised-controlled pilot study in Sweden.

BACKGROUND: POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults. METHODS: The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried's criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants' physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants' perception of health and level of care received, and healthcare professionals' workload and satisfaction. A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period. DISCUSSION: The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design. TRIAL REGISTRATION: ClinicalTrials.gov. REGISTRATION NUMBER: NCT04592146 . October 19, 2020.

Usability, User Experience, and Acceptance Evaluation of CAPACITY: A Technological Ecosystem for Remote Follow-Up of Frailty.

Frailty predisposes older persons to adverse events, and information and communication technologies can play a crucial role to prevent them. CAPACITY provides a means to remotely monitor variables with high predictive power for adverse events, enabling preventative personalized early interventions. This study aims at evaluating the usability, user experience, and acceptance of a novel mobile system to prevent disability. Usability was assessed using the system usability scale (SUS); user experience using the user experience questionnaire (UEQ); and acceptance with the technology acceptance model (TAM) and a customized quantitative questionnaire. Data were collected at baseline (recruitment), and after three and six months of use. Forty-six participants used CAPACITY for six months; nine dropped out, leaving a final sample of 37 subjects. SUS reached a maximum averaged value of 83.68 after six months of use; no statistically significant values have been found to demonstrate that usability improves with use, probably because of a ceiling effect. UEQ, obtained averages scores higher or very close to 2 in all categories. TAM reached a maximum of 51.54 points, showing an improvement trend. Results indicate the success of the participatory methodology, and support user centered design as a key methodology to design technologies for frail older persons. Involving potential end users and giving them voice during the design stage maximizes usability and acceptance.

Home Monitoring System for Comprehensive Geriatric Assessment in Patient's Dwelling: System Design and UX Evaluation.

Population aging threatens the sustainability of welfare systems since it is not accompanied by an extended healthy and independent period in the last years of life. The Comprehensive Geriatric Assessment (CGA) has been shown to be efficient in maintaining the healthy period at the end of the life. Frailty monitoring is typically carried out for an average period of 6 months in clinical settings, while more regular monitoring could prevent the transition to disability. We present the design process of a system for frailty home monitoring based on an adapted CGA and the rationale behind its User eXperience (UX) design. The resulting home monitoring system consists of two devices based on ultrasound sensors, a weight scale, and a mobile application for managing the devices, administering CGA-related questionnaires, and providing alerts. Older users may encounter barriers in their usage of technology. For this reason, usability and acceptability are critical for health monitoring systems addressed to geriatric patients. In the design of our system, we have followed a user-centered process, involving geriatricians and older frail patients by means of co-creation methods. In the iterative process of design and usability testing, we have identified the most effective way of conducting the home-based CGA, not just by replicating the dialogue between the physician and the patient, but by adapting the design to the possibilities and limitations of mobile health for this segment of users. The usability evaluation, carried out with 14 older adults, has proved the feasibility of users older than 70 effectively using our monitoring system, additionally showing an intention over 80% for using the system. It has also provided some insights and recommendations for the design of mobile health systems for older users.

[Positive Project: maintenance and improvement of intrinsic capacity involving primary care and caregivers through a home monitoring system and a telematic services platform.] / Proyecto POSITIVE: Mantenimiento y mejora de la capacidad intrínseca que involucra a la atención primaria y a los y las cuidadores a través de un sistema de monitorización domiciliaria y una plataforma telemática de servicios.

POSITIVE (acronym for Maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is an EIT Health funded project. Its main objective is to make available to the elderly population, caregivers and the different clinical professionals involved in their care, both primary and hospital care, a home monitoring system that allows a better management and treatment of frailty, in order to maintain or improve the intrinsic capacity of the elderly, as well as to avoid disability through a telematic platform of services. The POSITIVE technological ecosystem allows data collection and remote monitoring of the state of pre-fragility and fragility in a community environment, enabling early interventions aimed at preventing disability and dependence. The home monitoring system consists of a series of questionnaires on the state of health, and 3 sensors that measure variables with high predictive power of adverse events: gait speed, power in the lower extremities and involuntary weight loss. With this system, older people are under constant supervision. In addition, POSITIVE has an automatic system of personalized prescription of physical exercise based on the VIVIFRAIL program, as well as a nutritional plan and monitoring of functional status. Using the platform's services, caregivers can be aware of any impairment. For their part, primary care professionals receive alarms related to potentially dangerous decreases in intrinsic capacity, giving them the possibility to adjust treatments accordingly with the help of a decision support system while the geriatrics service can be involved if deemed necessary.

POSITIVE (acrónimo de Maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) es un proyecto financiado por fondos EIT Health. Tiene como objetivo principal poner a disposición de la población mayor, de los cuidadores y de los diferentes profesionales clínicos implicados en su cuidado, tanto de Atención Primaria (AP) como de hospitalaria, un sistema de monitorización domiciliaria que permita un mejor manejo y tratamiento de la fragilidad, con la finalidad de mantener o mejorar la capacidad intrínseca de las personas mayores, así como de evitar la discapacidad a través de una plataforma telemática de servicios. El ecosistema tecnológico POSITIVE permite la recolección de datos y la monitorización remota del estado de pre-fragilidad y fragilidad en un entorno comunitario, habilitando intervenciones tempranas dirigidas a prevenir la discapacidad y la dependencia. El sistema de monitorización domiciliaria consiste en una serie de cuestionarios sobre el estado de salud, y 3 sensores que miden variables con alto poder predictivo de eventos adversos: velocidad de la marcha, potencia en las extremidades inferiores y pérdida involuntaria de peso. Con este sistema, las personas mayores se encuentran bajo constante supervisión. Además, POSITIVE cuenta con un sistema automático de prescripción personalizada de ejercicio físico basado en el programa VIVIFRAIL, así como un plan nutricional y seguimiento del estado funcional. Utilizando los servicios de la plataforma, los que cuidan pueden estar al tanto de cualquier deterioro. Por su parte, los profesionales de AP reciben alarmas relacionadas con disminuciones potencialmente peligrosas de la capacidad intrínseca, dándoles la posibilidad de ajustar los tratamientos en consecuencia con la ayuda de un sistema de apoyo a la toma de decisiones a la vez que se puede involucrar al servicio geriatría si se considera necesario.

Unobtrusive Sensors for the Assessment of Older Adult's Frailty: A Scoping Review.

Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults' frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010-2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs.

Automatic and Real-Time Computation of the 30-Seconds Chair-Stand Test without Professional Supervision for Community-Dwelling Older Adults.

The present paper describes a system for older people to self-administer the 30-s chair stand test (CST) at home without supervision. The system comprises a low-cost sensor to count sit-to-stand (SiSt) transitions, and an Android application to guide older people through the procedure. Two observational studies were conducted to test (i) the sensor in a supervised environment (n = 7; m = 83.29 years old, sd = 4.19; 5 female), and (ii) the complete system in an unsupervised one (n = 7; age 64-74 years old; 3 female). The participants in the supervised test were asked to perform a 30-s CST with the sensor, while a member of the research team manually counted valid transitions. Automatic and manual counts were perfectly correlated (Pearson's r = 1, p = 0.00). Even though the sample was small, none of the signals around the critical score were affected by harmful noise; p (harmless noise) = 1, 95% CI = (0.98, 1). The participants in the unsupervised test used the system in their homes for a month. None of them dropped out, and they reported it to be easy to use, comfortable, and easy to understand. Thus, the system is suitable to be used by older adults in their homes without professional supervision.

Monitoring and Intervention Technologies to Manage Diabetic Older Persons: The CAPACITY Case-A Pilot Study.

Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient.

Portable Ultrasound-Based Device for Detecting Older Adults' Sit-to-Stand Transitions in Unsupervised 30-Second Chair-Stand Tests.

Lower-limb strength is a marker of functional decline in elders. This work studies the feasibility of using the quasi-periodic nature of the distance between a subjects' back and the chair backrest during a 30-s chair-stand test (CST) to carry out unsupervised measurements based on readings from a low-cost ultrasound sensor. The device comprises an ultrasound sensor, an Arduino UNO board, and a Bluetooth module. Sit-to-stand transitions are identified by filtering the signal with a moving minimum filter and comparing the output to an adaptive threshold. An inter-rater reliability (IRR) study was carried out to validate the device ability to count the same number of valid transitions as the gold-standard manual count. A group of elders (age: mean (m) = 80.79 years old, SD = 5.38; gender: 21 female and seven male) were asked to perform a 30-s CST using the device while a trained nurse manually counted valid transitions. Ultimately, a moving minimum filter was necessary to cancel the effect of outliers, likely produced because older people tend to produce more motion artefacts and, thus, noisier signals. While the intra-class correlation coefficient (ICC) for this study was good (ICC = 0.86, 95% confidence interval (CI) = 0.73, 0.93), it is not yet clear whether the results are sufficient to support clinical decision-making.

FriWalk robotic walker: usability, acceptance and UX evaluation after a pilot study in a real environment.

Background: Scientific evidence supports that prevention strategies like multicomponent physical exercise help avoiding functional decline, falls and frailty. The robotic walker FriWalk, developed within the ACANTO project, supports the execution of controlled physical activities during hospital admission to prevent functional deterioration associated to prolonged bedrest. FriWalk shows in a clinical validation study a positive relationship with improvement in physical performance, basic activities of daily living execution and frailty status. Usability, acceptance and user experience (UX) are key aspects to ease the adoption of assistive technologies in the elderly.Objective: This work pursues the evaluation of the usability, acceptance and UX of the FriWalk from the patients and clinical professionals' perspectives.Methods: Data collected during the validation of FriWalk in a real environment have been used. Forty-two patients recruited at Getafe University Hospital (Acute Care and Orthogeriatric Units) and one clinical professional participated. SUS, TAM, UX and ad hoc questionnaires were administered.Results: Patients provided an average SUS of 52.86 and provided valuable information in the qualitative acceptance interviews. The clinical professional provided an averaged SUS and TAM of 67 and 46.6, respectively, and evaluated all UX categories as above average.Conclusions: Usability results do not qualify FriWalk as above average; the reasons explaining this have been identified and point out to the prototypical stage of the hardware. Acceptance and UX were positively evaluated and allowed the research team to propose a new organizational model to deliver the FriWalk-based prevention program. FriWalk will be soon evolved.Implications for rehabilitationFriWalk showed in a randomized clinical trial a positive relationship with improvement in physical performance, basic activities of daily living execution and frailty status.In terms of usability, user experience (UX) and acceptance, participants of the study have valued the FriWalk robotic walker as a promising help, considering that the device that has been under evaluation was still in a prototype stage.Clinical professional reported FriWalk and its corresponding exercise program description software regarding usability, acceptance and UX as satisfactory tool to prescribe and assess a rehabilitation program for hospitalized patients.

Prediction of patient evolution in terms of Clinical Risk Groups form routinely collected data using machine learning.

Chronicity is a problem that is affecting quality of life and increasing healthcare costs worldwide. Predictive tools can help mitigate these effects by encouraging the patients' and healthcare system's proactivity. This research work uses supervised learning techniques to build a predictive model of the healthcare status of a chronic patient, using Clinical Risk Groups (CRGs) as a measure of chronicity and prescription and diagnosis data as predictors. The model is addressed to the whole population in our healthcare system regardless of the disease, as data used are widely available in a consistent way for all patients. We explore different ways to encode data that are appropriate for machine learning. Results suggest that these data alone can be used to build accurate models, and show that, in our set, prescription information has a higher predictive value than diagnosis.

Objective motor assessment for personalized rehabilitation of upper extremity in brain injury patients.

BACKGROUND: The increasing number of patients with acquired brain injury and the current subjectivity of the conventional upper extremity (UE) assessment tests require new objective assessment techniques. OBJECTIVE: This research proposes a novel objective motor assessment (OMA) methodology based on the Fugl-Meyer assessment (FMA). The goals are to automatically calculate the objective scores (OSs) of FMA-UE movements (as well as a global OS) and to interpret the estimated OSs. METHODS: Fifteen patients participated in the study. The OMA algorithm was designed to detect small-scale variations in UE movements. The OSs for 14 FMA-UE movements and the global OSs were automatically calculated using the algorithm and evaluated by 2 therapists. The interpretation of the global OSs was performed at 3 levels: by item, movement and globally. RESULTS: The global OSs calculated by our algorithm had a significant correlation with the therapists' scores (0.783 and 0.938, p <  0.01). All OSs for each movement were correlated with the scores given by the therapists. The correlation coefficient can reach values as high as 0.981 (p <  0.01). CONCLUSIONS: We provide a new objective assessment tool for therapists to help them improve the diagnostic accuracy and to achieve a more personalized and potentially effective physical rehabilitation of brain injury patients.

A First Step for the Automation of Fugl-Meyer Assessment Scale for Stroke Subjects in Upper Limb Physical Neurorehabilitation.

This paper proposes a first approach for the automation of the Fugl-Meyer assessment scale used in physical neurorehabilitation. The main goal of this research is to automatically estimate an objective measurement for five Fugl-Meyer scale items related to the assessment of the upper limb motion. An objective score has been calculated for 7 patients. Obtained results indicate that the automation of the scale can be a useful tool for the objective assessment of upper limb motion of stroke survivors.

Supervised classification of psychomotor competence in minimally invasive surgery based on instruments motion analysis.

BACKGROUND: Objective assessment of psychomotor skills has become an important challenge in the training of minimally invasive surgical (MIS) techniques. Currently, no gold standard defining surgical competence exists for classifying residents according to their surgical skills. Supervised classification has been proposed as a means for objectively establishing competence thresholds in psychomotor skills evaluation. This report presents a study comparing three classification methods for establishing their validity in a set of tasks for basic skills' assessment. METHODS: Linear discriminant analysis (LDA), support vector machines (SVM), and adaptive neuro-fuzzy inference systems (ANFIS) were used. A total of 42 participants, divided into an experienced group (4 expert surgeons and 14 residents with >10 laparoscopic surgeries performed) and a nonexperienced group (16 students and 8 residents with <10 laparoscopic surgeries performed), performed three box trainer tasks validated for assessment of MIS psychomotor skills. Instrument movements were captured using the TrEndo tracking system, and nine motion analysis parameters (MAPs) were analyzed. The performance of the classifiers was measured by leave-one-out cross-validation using the scores obtained by the participants. RESULTS: The mean accuracy performances of the classifiers were 71 % (LDA), 78.2 % (SVM), and 71.7 % (ANFIS). No statistically significant differences in the performance were identified between the classifiers. CONCLUSIONS: The three proposed classifiers showed good performance in the discrimination of skills, especially when information from all MAPs and tasks combined were considered. A correlation between the surgeons' previous experience and their execution of the tasks could be ascertained from results. However, misclassifications across all the classifiers could imply the existence of other factors influencing psychomotor competence.