Exploring a Novel Tool to Measure Wandering Behavior in the Early Childhood Classroom.

Wandering, or random movement, affects cognitive and social skills. However, we lack methods to objectively measure wandering behavior. The purpose of this pilot study was to explore the use of the Ubisense real-time location system (RTLS) in an early childhood setting to explore wandering in typically developing (TD) children (n = 2) and children with or at risk for developmental disabilities (WA-DD; n = 3). We used the Ubisense RTLS, a tool for capturing locations of individuals in indoor environments, and Fractal Dimension (FD) to measure the degree of wandering or the straightness of a path. Results of this descriptive, observational study indicated the Ubisense RTLS collected 46,229 1-s location estimates across the five children, and TD children had lower FD (M = 1.36) than children WA-DD (M = 1.42). Children WA-DD have more nonlinear paths than TD children. Implications for measuring wandering are discussed.

Views of wheelchair users and caregivers regarding a passive safety monitoring system for electric powered wheelchair operators with cognitive impairment.

The opinions of cognitively intact current wheelchair users and their professional caregivers were solicited to explore acceptability of the concept of a passive electric wheelchair-mounted movement monitor to track driving safety and cognitive impairment. Two focus groups of electric wheelchair users (N = 9), and two focus groups of staff caregivers (N = 8) were conducted at a congregate care facility. Participants also completed a questionnaire examining their perceptions of the concept. The results indicated most wheelchair users and staff caregivers were receptive to the idea of a passive safety monitoring system for wheelchairs to detect cognitive impairment. Three main and interrelated themes emerged regarding how the device could promote safety, how such a system might infringe upon the users' autonomy, and how and to whom the cognitive state information should be communicated. Legal, training, and marketing issues reflected similar concerns over balancing autonomy with safety issues. If successfully addressed, it appears there would be support for the device's use not only for older adults in institutional settings, but perhaps also among community living younger and older adults. A passive safety monitoring system for wheelchairs is acceptable to wheelchair users and can be successfully marketed if developers balance autonomy and safety concerns.

It takes longer than you think: librarian time spent on systematic review tasks.

INTRODUCTION: The authors examined the time that medical librarians spent on specific tasks for systematic reviews (SRs): interview process, search strategy development, search strategy translation, documentation, deliverables, search methodology writing, and instruction. We also investigated relationships among the time spent on SR tasks, years of experience, and number of completed SRs to gain a better understanding of the time spent on SR tasks from time, staffing, and project management perspectives. METHODS: A confidential survey and study description were sent to medical library directors who were members of the Association of Academic Health Sciences Libraries as well as librarians serving members of the Association of American Medical Colleges or American Osteopathic Association. RESULTS: Of the 185 participants, 143 (77%) had worked on an SR within the last 5 years. The number of SRs conducted by participants during their careers ranged from 1 to 500, with a median of 5. The major component of time spent was on search strategy development and translation. Average aggregated time for standard tasks was 26.9 hours, with a median of 18.5 hours. Task time was unrelated to the number of SRs but was positively correlated with years of SR experience. CONCLUSION: The time required to conduct the librarian's discrete tasks in an SR varies substantially, and there are no standard time frames. Librarians with more SR experience spent more time on instruction and interviews; time spent on all other tasks varied widely. Librarians also can expect to spend a significant amount of their time on search strategy development, translation, and writing.

An automated approach to measuring child movement and location in the early childhood classroom.

Children's movement is an important issue in child development and outcome in early childhood research, intervention, and practice. Digital sensor technologies offer improvements in naturalistic movement measurement and analysis. We conducted validity and feasibility testing of a real-time, indoor mapping and location system (Ubisense, Inc.) within a preschool classroom. Real-time indoor mapping has several implications with respect to efficiently and conveniently: (a) determining the activity areas where children are spending the most and least time per day (e.g., music); and (b) mapping a focal child's atypical real-time movements (e.g., lapping behavior). We calibrated the accuracy of Ubisense point-by-point location estimates (i.e., X and Y coordinates) against laser rangefinder measurements using several stationary points and atypical movement patterns as reference standards. Our results indicate that activity areas occupied and atypical movement patterns could be plotted with an accuracy of 30.48 cm (1 ft) using a Ubisense transponder tag attached to the participating child's shirt. The accuracy parallels findings of other researchers employing Ubisense to study atypical movement patterns in individuals at risk for dementia in an assisted living facility. The feasibility of Ubisense was tested in an approximately 90-min assessment of two children, one typically developing and one with Down syndrome, during natural classroom activities, and the results proved positive. Implications for employing Ubisense in early childhood classrooms as a data-based decision-making tool to support children's development and its potential integration with other wearable sensor technologies are discussed.

Movement Path Tortuosity Predicts Compliance With Therapeutic Behavioral Prompts in Patients With Traumatic Brain Injury.

OBJECTIVE: Rehabilitation of patients with traumatic brain injury typically includes therapeutic prompts for keeping appointments and adhering to medication regimens. Level of cognitive impairment may significantly affect a traumatic brain injury victim's ability to benefit from text-based prompting. We tested the hypothesis that spatial disorientation as measured by movement path tortuosity during ambulation would be associated with poorer compliance with automated prompts by veterans actively being treated for traumatic brain injury. SETTING: Clinical polytrauma center. PARTICIPANTS: Ten (1 female) veteran patients mean age = 35.4 (SD = 12.4) years. DESIGN: Small group correlational study without random assignment. MAIN MEASURES: Fractal Dimension, a measure of movement path tortuosity derived from a GPS logging device used to record casual outdoor ambulation at the start of the study. Compliance with smart home machine-generated therapeutic prompts received during rehabilitation at the James A. Haley Veterans Administration Hospital Polytrauma Transitional Rehabilitation Program. A patient was compliant with a prompt if they transited from where the prompt was presented to the prescribed destination (both within the Polytrauma Transitional Rehabilitation Program) within 30 minutes. Noncompliance was failure to appear at the destination within the allotted time. RESULTS: Fractal dimension was significantly inversely related to overall prompt compliance (r = -0.603, n = 10, P = .032; 1-tailed). CONCLUSIONS: The findings support the hypothesis that increased spatial disorientation adversely impacts compliance with automated prompts throughout therapy. The results are consistent with previous studies linking elevated path tortuosity to cognitive impairment and increased risk for falls in assisted living facility residents.

Decreased Movement Path Tortuosity Is Associated With Improved Functional Status in Patients With Traumatic Brain Injury.

OBJECTIVE: To determine if movement path tortuosity in everyday ambulation decreases in Veterans being treated in a residential setting for traumatic brain injury. Elevated path tortuosity is observed in assisted living facility residents with cognitive impairment and at risk for falls, and tortuosity may decrease over the course of cognitive rehabilitation received by the Veterans. If observed, decreased tortuosity may be linked to improved clinical outcomes. DESIGN: Longitudinal observational study without random assignment. SETTING: Veterans Affairs Medical Center inpatient residential polytrauma treatment facility. PATIENTS: Twenty-two Veterans enrolled in a postacute predischarge residential polytrauma treatment facility. INTERVENTIONS: None, observation-only. MAIN OUTCOME MEASURE: Mayo-Portland Adaptability Index-4, and movement path tortuosity measured by Fractal Dimension (Fractal D). Fractal D was obtained continuously from an indoor movement tracking system primarily used to provide machine-generated prompts and reminders to facilitate activities of daily living. Patients were deemed "responders" (N = 10) if a significant linear decline in Fractal D occurred over the course of treatment, or nonresponders (N = 12) if no significant decline was observed. RESULTS: Responders had lower discharge Mayo-Portland Adaptability Inventory scores (mean = 32.6, SD = 9.53) than non-responders (mean = 39.5, SD = 6.02) (F = 2.07, df = 20, P = .05). Responders and nonresponders did not differ on initial injury severity or other demographic measures. CONCLUSIONS: Fractal D, a relatively simple measure of movement path tortuosity can be linked to functional recovery from traumatic brain injury.

A unified grid-based wandering pattern detection algorithm.

The aim of this study was to develop and validate a robust algorithm for indoor and outdoor wandering pattern detection and to analyse the relationship of these patterns to other clinical measures. Much of the previous work in this area addressed the measurement of wandering indoors or outdoors and to the best of our knowledge, there has not been a unified algorithm proposed which can deal with both scenarios. We present a novel grid-based layout representation strategy to identify the patterns, which is applicable to both indoor and outdoor scenarios. The algorithm is sufficiently robust to identify interleaving and hybrid patterns and performed with identification accuracy of 90% on a real-world sample.

Elevated movement path tortuosity in voluntary outdoor ambulation in community-dwelling veterans with a history of traumatic brain injury.

OBJECTIVE: In comparison to veterans without a history of traumatic brain injury (TBI), we hypothesized that veterans with past TBI would have slower walking speed and more path tortuosity, TBI symptoms, problems with spatial orientation, and poorer executive function. SETTING: Community nonclinical. PARTICIPANTS: Seventeen males (mean age of 37.2 years) reporting prior TBI and 20 non-TBI (mean age of 42.9 years). The number of years separating date of discharge and testing was 10.8 and 15.4 for the TBI and non-TBI groups, respectively. DESIGN: Small 2 groups without random assignment. MAIN MEASURES: Brief Traumatic Brain Injury Screen, Trail Making Test-B, Clock Drawing Test, walking speed, and distance and path tortuosity in 30 minutes of voluntary outdoor walking wearing a small Global Positioning Systems recorder. RESULTS: Those with TBI reported 4 Brief Traumatic Brain Injury Screen symptoms versus 0.4 for controls (F = 49.1; df = 1,35; P < .001) but did not differ on Trail Making Test-B or the Clock Drawing Test. Veterans with TBI walked shorter distances, 2.33 km versus 2.84 km (F = 4.8; df = 1,35; P < .05), and had greater path tortuosity (fractal D of 1.22 vs 1.15; F = 3.5; df = 1,35; P < .05) but did not differ on travel speed or time spent walking. CONCLUSIONS: Traumatic brain injury has persistent symptomatic effects and significantly affects ambulation and spatial orientation years after the event. These findings corroborate and extend observations linking cognitive impairment and ambulation.

eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop.

BACKGROUND: The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. OBJECTIVE: The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. METHODS: A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. RESULTS: The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. CONCLUSIONS: This paper describes the health care professionals' competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.

Path tortuosity in everyday movements of elderly persons increases fall prediction beyond knowledge of fall history, medication use, and standardized gait and balance assessments.

OBJECTIVES: We hypothesized that variability in voluntary movement paths of assisted living facility (ALF) residents would be greater in the week preceding a fall compared with residents who did not fall. DESIGN: Prospective, observational study using telesurveillance technology. SETTING: Two ALFs. PARTICIPANTS: The sample consisted of 69 older ALF residents (53 female) aged 76.9 (SD ± 11.9 years). MEASUREMENT: Daytime movement in ALF common use areas was automatically tracked using a commercially available ultra-wideband radio real-time location sensor network with a spatial resolution of approximately 20 cm. Movement path variability (tortuosity) was gauged using fractal dimension (fractal D). A logistic regression was performed predicting movement related falls from fractal D, presence of a fall in the prior year, psychoactive medication use, and movement path length. Fallers and non-fallers were also compared on activities of daily living requiring supervision or assistance, performance on standardized static and dynamic balance, and stride velocity assessments gathered at the start of a 1-year fall observation period. Fall risk due to cognitive deficit was assessed by the Mini Mental Status Examination (MMSE), and by clinical dementia diagnoses from participant's activities of daily living health record. RESULTS: Logistic regression analysis revealed odds of falling increased 2.548 (P = .021) for every 0.1 increase in fractal D, and having a fall in the prior year increased odds of falling by 7.36 (P = .006). There was a trend for longer movement paths to reduce the odds of falling (OR .976 P = .08) but it was not significant. Number of psychoactive medications did not contribute significantly to fall prediction in the model. Fallers had more variable stride-to-stride velocities and required more activities of daily living assistance. CONCLUSIONS: High fractal D levels can be detected using commercially available telesurveillance technologies and offers a new tool for health services administrators seeking to reduce falls at their facilities.

Longitudinal investigation of wandering behavior in Department of Veterans Affairs nursing home care units.

OBJECTIVES: To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. DESIGN: Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. SETTING: One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. PARTICIPANTS: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. MEASUREMENTS: MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. RESULTS: The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. CONCLUSION: A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.

Wanderers with cognitive impairment in Department of Veterans Affairs nursing home care units.

OBJECTIVES: To explore the extent of and factors associated with male nursing home residents who wander. DESIGN: Cross-sectional design with secondary data analyses. SETTING: One hundred thirty-four nursing home facilities operated by the Department of Veterans Affairs. PARTICIPANTS: Fifteen thousand ninety-two nursing home residents with moderate or severe cognitive impairment admitted over a 4-year period. MEASUREMENTS: Selected variables from the Minimum Data Set included ratings recorded at residents' admission to the nursing home (cognitive impairment, mood, behavior problems, activities of daily living, and wandering). RESULTS: In this sample of residents with moderate or severe cognitive impairment, the proportion of wanderers was found to be 21%. Wanderers were more likely to exhibit severe (vs moderate) cognitive impairment, socially inappropriate behavior, resistance to care, use of antipsychotic medication, independence in locomotion or ambulation, and dependence in activities of daily living related to basic hygiene. A sizable proportion of wanderers were found to be wheelchair users (25%) or were wanderers with dual dementia and psychiatric diagnoses (23%), characteristics that are not well documented in the literature. CONCLUSION: These results support previous clinical understanding of wanderers to be those who are more likely to exhibit more-severe cognitive impairment. Based on a statistical model with variables generated from prior research findings, classification as a wanderer was found to be associated with other disruptive activity such as socially inappropriate behavior and resisting care. Two understudied populations of wanderers were documented: wheelchair wanderers and those with comorbid dementia and psychiatric diagnoses. Future longitudinal studies should examine predictors of wandering behavior, and further research should explore the understudied subpopulations of wheelchair and dual-diagnosis wanderers who emerged in this study.