A semi-automatic mHealth system using wearable devices for identifying pain-related parameters in elderly individuals.

BACKGROUND: Mobile health systems integrating wearable devices are emerging as promising tools for registering pain-related factors. However, their application in populations with chronic conditions has been underexplored. OBJECTIVE: To design a semi-automatic mobile health system with wearable devices for evaluating the potential predictive relationship of pain qualities and thresholds with heart rate variability, skin conductance, perceived stress, and stress vulnerability in individuals with preclinical chronic pain conditions such as suspected rheumatic disease. METHODS: A multicenter, observational, cross-sectional study was conducted with 67 elderly participants. Predicted variables were pain qualities and pain thresholds, assessed with the McGill Pain Questionnaire and a pressure algometer, respectively. Predictor variables were heart rate variability, skin conductance, perceived stress, and stress vulnerability. Multiple linear regression analyses were conducted to examine the influence of the predictor variables on the pain dimensions. RESULTS: The multiple linear regression analysis revealed that the predictor variables significantly accounted for 27% of the variability in the affective domain, 14% in the miscellaneous domain, 15% in the total pain rating index, 10% in the number of words chosen, 14% in the present pain intensity, and 16% in the Visual Analog Scale scores. CONCLUSION: The study found significant predictive values of heart rate variability, skin conductance, perceived stress, and stress vulnerability in relation to pain qualities and thresholds in the elderly population with suspected rheumatic disease. The comprehensive integration of physiological and psychological stress measures into pain assessment of elderly individuals with preclinical chronic pain conditions could be promising for developing new preventive strategies.

Systematic design of health monitoring systems centered on older adults and ADLs.

BACKGROUND: Older adults face unique health challenges as they age, including physical and mental health issues and mood disorders. Negative emotions and social isolation significantly impact mental and physical health. To support older adults and address these challenges, healthcare professionals can use Information and Communication Technologies (ICTs) such as health monitoring systems with multiple sensors. These systems include digital biomarkers and data analytics that can streamline the diagnosis process and help older adults to maintain their independence and quality of life. METHOD: A design research methodology is followed to define a conceptual model as the main artifact and basis for the systematic design of successful systems centered on older adults monitoring within the health domain. RESULTS: The results include a conceptual model focused on older adults' Activities of Daily Living (ADLs) and Health Status, considering various health dimensions, including social, emotional, physical, and cognitive dimensions. We also provide a detailed instantiation of the model in real use cases to validate the usefulness and feasibility of the proposal. In particular, the model has been used to develop two health systems intended to measure the degree of the elders' frailty and dependence with biomarkers and machine learning. CONCLUSIONS: The defined conceptual model can be the basis to develop health monitoring systems with multiple sensors and intelligence based on data analytics. This model offers a holistic approach to caring for and supporting older adults as they age, considering ADLs and various health dimensions. We have performed an experimental and qualitative validation of the proposal in the field of study. The conceptual model has been instantiated in two specific case uses, showing the provided abstraction level and the feasibility of the proposal to build reusable, extensible and adaptable health systems. The proposal can evolve by exploiting other scenarios and contexts.

A psycho-educational intervention programme for parents with SGA foetuses supported by an adaptive mHealth system: design, proof of concept and usability assessment.

BACKGROUND: Technology-based approaches during pregnancy can facilitate the self-reporting of emotional health issues and improve well-being. There is evidence to suggest that stress during pregnancy can affect the foetus and result in restricted growth and preterm birth. Although a number of mobile health (mHealth) approaches are designed to monitor pregnancy and provide information about a specific aspect, no proposal specifically addresses the interventions in parents at risk of having small-for-gestational-age (SGA) or premature babies. Very few studies, however, follow any design and usability guidelines which aim to ensure end-user satisfaction when using these systems. RESULTS: We have developed an interactive, adaptable mHealth system to support a psycho-educational intervention programme for parents with SGA foetuses. The relevant results include a metamodel to support the task of modelling current or new intervention programmes, an mHealth system model with runtime adaptation to changes in the programme, the design of a usable app (called VivEmbarazo) and an architectural design and prototype implementation. The developed mHealth system has also enabled us to conduct a proof of concept based on the use of the mHealth systems and this includes data analysis and assesses usability and acceptance. CONCLUSIONS: The proof of concept confirms that parents are satisfied and that they are enthusiastic about the mHealth-supported intervention programme. It helps to technically validate the results obtained in the other stages relating to the development of the solution. The data analysis resulting from the proof of concept confirms that the stress experienced by parents who followed the mHealth-supported intervention programme was significantly lower than among those who did not follow it. This implies an improvement in the emotional health not only of the parents but also of their child. In fact, the babies of couples who followed the mHealth-supported programme weigh more than the babies of couples under traditional care. In terms of user acceptance and usability, the analysis confirms that mothers place greater value on the app design, usefulness and ease of use and are generally more satisfied than their partners. Although these results are promising in comparison with more traditional and other more recent technology-based approaches.

A machine learning approach for semi-automatic assessment of IADL dependence in older adults with wearable sensors.

BACKGROUND AND OBJECTIVE: The assessment of dependence in older adults currently requires a manual collection of data taken from questionnaires. This process is time consuming for the clinicians and intrudes the daily life of the elderly. This paper aims to semi-automate the acquisition and analysis of health data to assess and predict the dependence in older adults while executing one instrumental activity of daily living (IADL). METHODS: In a mobile-health (m-health) scenario, we analyze whether the acquisition of data through wearables during the performance of IADLs, and with the help of machine learning techniques could replace the traditional questionnaires to evaluate dependence. To that end, we collected data from wearables, while older adults do the shopping activity. A trial supervisor (TS) labelled the different shopping stages (SS) in the collected data. We performed data pre-processing techniques over those SS and analyzed them with three machine learning algorithms: k-Nearest Neighbors (k-NN), Random Forest (RF) and Support Vector Machines (SVM). RESULTS: Our results confirm that it is possible to replace the traditional questionnaires with wearable data. In particular, the best learning algorithm we tried reported an accuracy of 97% in the assessment of dependence. We tuned the hyperparameters of this algorithm and used embedded feature selection technique to get the best performance with a subset of only 10 features out of the initial 85. This model considers only features extracted from four sensors of a single wearable: accelerometer, heart rate, electrodermal activity and temperature. Although these features are not observational, our current proposal is semi-automatic, because it needs a TS labelling the SS (with a smartphone application). In the future, this labelling process could be automatic as well. CONCLUSIONS: Our method can semi-automatically assess the dependence, without disturbing daily activities of elderly people. This method can save clinicians' time in the evaluation of dependence in older adults and reduce healthcare costs.

Reducing Response Time in Motor Imagery Using A Headband and Deep Learning.

Electroencephalography (EEG) signals to detect motor imagery have been used to help patients with low mobility. However, the regular brain computer interfaces (BCI) capturing the EEG signals usually require intrusive devices and cables linked to machines. Recently, some commercial low-intrusive BCI headbands have appeared, but with less electrodes than the regular BCIs. Some works have proved the ability of the headbands to detect basic motor imagery. However, all of these works have focused on the accuracy of the detection, using session sizes larger than 10 s, in order to improve the accuracy. These session sizes prevent actuators using the headbands to interact with the user within an adequate response time. In this work, we explore the reduction of time-response in a low-intrusive device with only 4 electrodes using deep learning to detect right/left hand motion imagery. The obtained model is able to lower the detection time while maintaining an acceptable accuracy in the detection. Our findings report an accuracy above 83.8% for response time of 2 s overcoming the related works with both low- and high-intrusive devices. Hence, our low-intrusive and low-cost solution could be used in an interactive system with a reduced response time of 2 s.

A Microservices e-Health System for Ecological Frailty Assessment Using Wearables.

The population in developed countries is aging and this fact results in high elderly health costs, as well as a decrease in the number of active working members to support these costs. This could lead to a collapse of the current systems. One of the first insights of the decline in elderly people is frailty, which could be decelerated if it is detected at an early stage. Nowadays, health professionals measure frailty manually through questionnaires and tests of strength or gait focused on the physical dimension. Sensors are increasingly used to measure and monitor different e-health indicators while the user is performing Basic Activities of Daily Life (BADL). In this paper, we present a system based on microservices architecture, which collects sensory data while the older adults perform Instrumental ADLs (IADLs) in combination with BADLs. IADLs involve physical dimension, but also cognitive and social dimensions. With the sensory data we built a machine learning model to assess frailty status which outperforms the previous works that only used BADLs. Our model is accurate, ecological, non-intrusive, flexible and can help health professionals to automatically detect frailty.

SIGUEME: Technology-based intervention for low-functioning autism to train skills to work with visual signifiers and concepts.

BACKGROUND: People with low-functioning ASD and other disabilities often find it difficult to understand the symbols traditionally used in educational materials during the learning process. Technology-based interventions are becoming increasingly common, helping children with cognitive disabilities to perform academic tasks and improve their abilities and knowledge. Such children often find it difficult to perform certain tasks contained in educational materials since they lack necessary skills such as abstract reasoning. In order to help these children, the authors designed and created SIGUEME to train attention and the perceptual and visual cognitive skills required to work with and understand graphic materials and objects. METHODS: A pre-test/post-test design was implemented to test SIGUEME. Seventy-four children with low-functioning ASD (age=13.47, SD=8.74) were trained with SIGUEME over twenty-five sessions and compared with twenty-eight children (age=12.61, SD=2.85) who had not received any intervention. RESULTS: There was a statistically significant improvement in the experimental group in Attention (W=-5.497, p<0.001). There was also a significant change in Association and Categorization (W=2.721, p=0.007) and Interaction (W=-3.287, p=0.001). CONCLUSIONS: SIGUEME is an effective tool for improving attention, categorization and interaction in low-functioning children with ASD. It is also a useful and powerful instrument for teachers, parents and educators by increasing the child's motivation and autonomy.

Challenges in software applications for the cognitive evaluation and stimulation of the elderly.

BACKGROUND: Computer-based cognitive stimulation applications can help the elderly maintain and improve their cognitive skills. In this research paper, our objectives are to verify the usability of PESCO (an open-software application for cognitive evaluation and stimulation) and to determine the concurrent validity of cognitive assessment tests and the effectiveness of PESCO's cognitive stimulation exercises. METHODS: Two studies were conducted in various community computer centers in the province of Granada. The first study tested tool usability by observing 43 elderly people and considering their responses to a questionnaire. In the second study, 36 elderly people completed pen-and-paper and PESCO tests followed by nine cognitive stimulation sessions. Meanwhile, a control group with 34 participants used computers for nine non-structured sessions. RESULTS: Analysis of the first study revealed that although PESCO had been developed by taking usability guidelines into account, there was room for improvement. Results from the second study indicated moderate concurrent validity between PESCO and standardized tests (Pearson's r from .501 to .702) and highlighted the effectiveness of training exercises for improving attention (F = -4.111, p < .001) and planning (F = 5.791, p < .001) functions. CONCLUSIONS: PESCO can be used by the elderly. The PESCO cognitive test module demonstrated its concurrent validity with traditional cognitive evaluation tests. The stimulation module is effective for improving attention and planning skills.