1. unobtrusive sensing of ADL performance for estimation of functional status Michael Rosen, Ph.D. Justin Carter, M.S. Linsey Barker, B.S.

2. the premise… Unobtrusive monitoring of ADLs in hospital and home settings is technically feasible and practical. Performance of ADLs is the most direct and ecologically valid indicator of functional status (and rehab outcome). Processed data from ADL-sensing can return valid predictive estimates of global functional status for display to on-site or remote clinicians.

3. context: means and motivation for monitoring older adults in situ … Video-audio conversational interaction for assessment, visualization of sensor readouts, followup to in-patient, counseling, support, some therapy. Automatic transmission of data from room-fixed sensors, either s&f or live, for health tracking.

4. Context: means and motivation for monitoring older adults in situ … Always-on xmission from wearable sensors for immediate detection of anomolous events, or continuous data acquisition. Automatic and user-activated emergency call systems.

5. project design … 1- develop and demonstrate a prototype sensor package and data- acquisition hardware and software installed at NRH in Independence Square.

6. unobtrusive sensors Is the sink on? Is the cabinet open? Is the stove on? in-line flow switch micro-switch magnetic contact switch

7. project design … 2- develop valid estimators Hypothesize performance metrics (PMs) based on timing and counting Regress PMs against AMPS sub- scores (gold standard) Test the hypothesis that cheap, simple, readily-retrofitted sensors can supply automated objective task- performance data from which measures of functional status can be calculated in clinically meaningful terms

8. AMPS “The Assessment of Motor and Process Skills … standardised observational assessment … therapist is able to evaluate a person's overall ability to perform domestic activities of daily living and the quality of a person's motor and process skills. An AMPS observation involves … person perform two tasks (e.g., pouring a glass of juice; making a bed; preparing eggs, toast, and coffee) that the person has had prior experience performing. The person is rated on 16 motor skill items and 20 process skill items.

9. possible performance metrics … Durations, e.g. event-to-event Counts, e.g. # times refrigerator was opened Categorical: yes/no Spatial distance moved Rates, events per time Normalized by optimal or norm or “contract” with therapist Most likely correlations may be with AMPS “process skills”, e.g. “sequences”, “searches”, “accommodates”, …

10. project design … 3- validation: across subjects by correlation with AMPS scores longitudinal (the punch line) within- subject against AMPS scores longitudinal within-subject against other clinical and practical metrics

11. status … Sensor package installed and demonstrated in Independence Square at NRH … with funding from NIDRR via the RERC on Telerehab and the U.S. Army MRMC In-hospital validation study approved and underway In-home validation studies proposed for funding

12. development plan … Bring to market the CARE package (Collection of Adls for Remote Evaluation): Wireless switch package Data logging and transfer box (H.323 protocol) Hub-site data capture and processing software Interactive display software for OTs and other service providers