Physical Training In-Game Metrics for Cognitive Assessment: Evidence from Extended Trials with the Fitforall Exergaming Platform.

Conventional clinical cognitive assessment has its limitations, as evidenced by the environmental shortcomings of various neuropsychological tests conducted away from an older person's everyday environment. Recent research activities have focused on transferring screening tests to computerized forms, as well as on developing short screening tests for screening large populations for cognitive impairment. The purpose of this study was to present an exergaming platform, which was widely trialed (116 participants) to collect in-game metrics (built-in game performance measures). The potential correlation between in-game metrics and cognition was investigated in-depth by scrutinizing different in-game metrics. The predictive value of high-resolution monitoring games was assessed by correlating it with classical neuropsychological tests; the area under the curve (AUC) in the receiver operating characteristic (ROC) analysis was calculated to determine the sensitivity and specificity of the method for detecting mild cognitive impairment (MCI). Classification accuracy was calculated to be 73.53% when distinguishing between MCI and normal subjects, and 70.69% when subjects with mild dementia were also involved. The results revealed evidence that careful design of serious games, with respect to in-game metrics, could potentially contribute to the early and unobtrusive detection of cognitive decline.

COLAEVA: Visual Analytics and Data Mining Web-Based Tool for Virtual Coaching of Older Adult Populations.

The global population is aging in an unprecedented manner and the challenges for improving the lives of older adults are currently both a strong priority in the political and healthcare arena. In this sense, preventive measures and telemedicine have the potential to play an important role in improving the number of healthy years older adults may experience and virtual coaching is a promising research area to support this process. This paper presents COLAEVA, an interactive web application for older adult population clustering and evolution analysis. Its objective is to support caregivers in the design, validation and refinement of coaching plans adapted to specific population groups. COLAEVA enables coaching caregivers to interactively group similar older adults based on preliminary assessment data, using AI features, and to evaluate the influence of coaching plans once the final assessment is carried out for a baseline comparison. To evaluate COLAEVA, a usability test was carried out with 9 test participants obtaining an average SUS score of 71.1. Moreover, COLAEVA is available online to use and explore.

Correction: Beristain Iraola et al. User Centered Virtual Coaching for Older Adults at Home Using SMART Goal Plans and I-Change Model. Int. J. Environ. Res. Public Health 2021, 18, 6868.

The author would like to change the authorship in the previous publication [...].

Teaching university students co-creation and living lab methodologies through experiential learning activities and preparing them for RRI.

During the last decade, the living lab and co-creation concepts have started being blended with the Responsible Research and Innovation approach, aiming to evaluate potential societal anticipations toward fostering an inclusive RRI behavior. Teaching co-creation concept and living lab methodologies to university students has started been considered as valuable for future researchers along with the demand of companies and public sectors which turn toward user-center techniques for inspiration to develop innovative and services. To this end, the scientific publications presenting work on teaching co-creation and living lab methodologies are not so many while there are no published research studies on experiential learning activities for teaching co-creation and living lab approaches to university students. This study presents a course based on living labs and co-creation methodologies through experiential learning activities, consisted of four different lectures and an open event. The study involves stakeholders from the academia, the citizens, and the public sector. The results show that lectures with the participation of end-users were the most enjoyable. Furthermore, students thought that they learned the most when they first met the end-users. This lecture was perceived as a successful way to gain methodical knowledge for user-centered design and software development.

User Centered Virtual Coaching for Older Adults at Home Using SMART Goal Plans and I-Change Model.

Preventive care and telemedicine are expected to play an important role in reducing the impact of an increasingly aging global population while increasing the number of healthy years. Virtual coaching is a promising research area to support this process. This paper presents a user-centered virtual coach for older adults at home to promote active and healthy aging and independent living. It supports behavior change processes for improving on cognitive, physical, social interaction and nutrition areas using specific, measurable, achievable, relevant, and time-limited (SMART) goal plans, following the I-Change behavioral change model. Older adults select and personalize which goal plans to join from a catalog designed by domain experts. Intervention delivery adapts to user preferences and minimizes intrusiveness in the user's daily living using a combination of a deterministic algorithm and incremental machine learning model. The home becomes an augmented reality environment, using a combination of projectors, cameras, microphones and support sensors, where common objects are used for projection and sensed. Older adults interact with this virtual coach in their home in a natural way using speech and body gestures on projected user interfaces with common objects at home. This paper presents the concept from the older adult and the caregiver perspectives. Then, it focuses on the older adult view, describing the tools and processes available to foster a positive behavior change process, including a discussion about the limitations of the current implementation.

Integration of cognitive and physical training in a smart home environment for the elderly people.

Our research work is towards a service that can support senior citizens towards their independent living and active ageing. As it is suggested, physical and cognitive exercise training can contribute to a significant prolongation of personal autonomy and participation in society across prevailing age-related impairments such as cognitive decline. In the current paper, the approach of combination of both physical and cognitive training--adopted by LLM project--is discussed related to other similar projects that have taken place in the area of elderly home care and training. The aim of this work is to describe the technical design details of the integration process of the LLM service, which is based on a Web service architecture and to discuss alternative interface elements to be included in the LLM platform in terms of enabling user accessibility and acceptance.

A New Approach for Ageing at Home: The CAPTAIN System.

Our work exhibits how previous projects on the Active and Healthy Ageing field have advanced to the conception of CAPTAIN, a radically new approach towards increased end-user acceptance. The goal is to create intuitive technology that does not require specific skills for interaction and blends in with real life. CAPTAIN will be co-designed by all types of stakeholders, including older adults, involved in all stages, from the initial design to delivery of the final system.

Exergames for Parkinson's Disease Patients: How Participatory Design Led to Technology Adaptation.

Parkinson's disease (PD) is a neurodegenerative disorder that affects more than 10 million people worldwide. Assistive technology and exergames come to play a beneficial role in positive mood and socialization improvement, overall quality of life and improved confidence with everyday functional activities. More and more Exergames inserts in the market but how many of that are fitting the patient's needs? How many of that took into consideration theirs's opinion. This study describes the Minimum Viable Product (MVP) model "Develop-measure-learn" circle in a co-creation way with the PD patients to develop and improve Exergames for them, and the tools that are needed to accomplish. The most important outcome of this procedure was the proposed development of more realistic games, giving the researchers the step of starting the investigation of 3D solutions.

Moving Real Exergaming Engines on the Web: The webFitForAll Case Study in an Active and Healthy Ageing Living Lab Environment.

Exergames have been the subject of research and technology innovations for a number of years. Different devices and technologies have been utilized to train the body and the mind of senior people or different patient groups. In the past, we presented FitForAll, the protocol efficacy of which was proven through widely taken (controlled) pilots with more than 116 seniors for a period of two months. The current piece of work expands this and presents the first truly web exergaming platform, which is solely based on HTML5 and JavaScript without any browser plugin requirements. The adopted architecture (controller application communication framework) combines a unified solution for input devices such as MS Kinect and Wii Balance Βoard which may seamlessly be exploited through standard physical exercise protocols (American College of Sports Medicine guidelines) and accommodate high detail logging; this allows for proper pilot testing and usability evaluations in ecologically valid Living Lab environments. The latter type of setups is also used herein for evaluating the web application with more than a dozen of real elderly users following quantitative approaches.

Design, Implementation, and Wide Pilot Deployment of FitForAll: An Easy to use Exergaming Platform Improving Physical Fitness and Life Quality of Senior Citizens.

Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre-postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33±5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

Internet of things for an age-friendly healthcare.

In healthcare applications a large cohort of recent implementations utilises IoT-oriented infrastructures (XMPP) as well as smart mobile devices as communication gateways. IoT characteristi Communication/Connectivity, Pervasive Computing and Ambient Intelligence, are all highly related to Active and Healthy Aging environments. This paper presents a new idea, that of IoT enabled devices which are directly connected to the IoT (a glucose meter is used as an example herein), complying with the XMPP messaging protocol and the incorporation of a recently released Controller Application Communication (CAC) framework for distributed, cross-platform communication. A web based exergaming platform and a disease management tool, provide the vehicles for the demonstration of the feasibility and the successful implementation and integration of the aforementioned infrastructure.

Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder.

Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen's d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.

Real time emotion aware applications: a case study employing emotion evocative pictures and neuro-physiological sensing enhanced by Graphic Processor Units.

In this paper the feasibility of adopting Graphic Processor Units towards real-time emotion aware computing is investigated for boosting the time consuming computations employed in such applications. The proposed methodology was employed in analysis of encephalographic and electrodermal data gathered when participants passively viewed emotional evocative stimuli. The GPU effectiveness when processing electroencephalographic and electrodermal recordings is demonstrated by comparing the execution time of chaos/complexity analysis through nonlinear dynamics (multi-channel correlation dimension/D2) and signal processing algorithms (computation of skin conductance level/SCL) into various popular programming environments. Apart from the beneficial role of parallel programming, the adoption of special design techniques regarding memory management may further enhance the time minimization which approximates a factor of 30 in comparison with ANSI C language (single-core sequential execution). Therefore, the use of GPU parallel capabilities offers a reliable and robust solution for real-time sensing the user's affective state.

A Web services-based exergaming platform for senior citizens: the Long Lasting Memories project approach to e-health care.

This piece of research describes an innovative e-health service that supports the cognitive and physical training of senior citizens and promotes their active ageing. The approach is adopted by the Long Lasting Memories (LLM) project, elements of which are discussed herein in the light of the functionalities provided to the users and the therapists. The aim of this work is to describe those technical elements that demonstrate the unique and integrative character of the LLM service, which is based on a modular Web service architecture, rendering the system available in different settings like the homes of seniors. The underlying database as well as the remote user interface empower therapists to set personalized training schemes, to view the progress of training sessions, as well as, adding new games and exercises into the system, thereby increasing the services sustainability and marketability.