SENSACTION-AAL is a Specific Targeted Research Project (STREP) funded by the European Commission in the frame of the FP6 initiative. The ultimate goal of the SENSACTION-AAL project was to assist older people in maintaining independent mobility and daily life activities and prevent injuries by introducing smart body fixed sensor based technology allowing medical professionals to initiate interventions in the home environment.

SENSACTION-AAL offered the opportunity for a significant advancement of the state-of-the-art in the field of ambulatory assisting devices for enhancing safety and security in balance and movement.  To achieve this goal, the SENSACTION-AAL project designed, tested and released a novel smart, wireless on-body system which enables:

1. Monitoring of activities of daily living;
2. Real-time active control of physical performance using principles such as sensory augmentation and biofeedback;
3. Unexpected falls detection and management.

This system is equipped with both sensors and actuators in-the-loop. The SENSACTION-AAL architecture exploited new ICT solutions that make the proposed system:

1. Easy-to-wear and easy-to-use;
2. Active anywhere, anytime;
3. Cost effective.

This solution is highly usable and can support the elderly people in their preferred environment. The key challenge was the development of an integrated system that brings together the different components involved, i.e network cells, communication protocols, embedded real-time algorithms for actuator control, signal processing algorithms, data warehousing and web-based data access. An in-vivo accurate validation was carried out with the support of end-users to assess the satisfaction of key user requirements and produce a solution which is adequate for industrial take-up; clinical pilots were carried out in Stuttgart, Groningen and Tel Aviv.

This project could have important influence on the quality of life of European citizens. The proposed solutions will in fact empower persons with disabilities and aging citizens to play a major role in the society and will help them to augment their autonomy and realize their potential.

Several results of the SENSACTION-AAL project are currently on the market; these include the wireless platform/device MotionBee, sold by STMicroelectronics, and DynaPort Hybrid Module sold by McRoberts.

Description of target users and groups

The main beneficiaries of this project are frail older adults at risk of falls, andolder adults in general, especially for the proven pre-emptive capabilities of home-based training  with respect to falls and injuries. Patients suffering from neurodegenerative disorders (e.g. Parkinson’s Disease) and post-stroke are also potential beneficiaries, since they experience a deterioration in their mobility; they would benefit from the combined use of monitor, trainer, and the ward. Finally, the project proposes solutions to two major risks the elderly population faces: the risk of falling in the home environment and the risk of becoming inactive.

Major benefits, in summary, would be that:

1. The system may provide means to perform customised, repetitive rehabilitation exercises directly at home via closed-loop bio-feedback therapy. This reduces patient discomfort and caretaker loads in terms of time and mobility, and has a direct impact on mobility skills and hence on quality of life;
2. The system is able to perform a mobility monitoring during daily life activities. This will improve knowledge on quantity and quality of motor activity at home, which is currently missing in all medical evaluations;
3. The system can remotely transmit alarm and raw data in case unrecovered falls are automatically detected. This will enhance daily home safety and  security of elderly people living on their own and increase knowledge on falls, which is still hazy.

Description of the way to implement the initiative

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Technology solution

The unique characteristic of the devices we developed is that, unlike many health monitoring systems that require multiple sensors as well as separate components for data storage and transmission, our system carries out movement sensing, data collection and data transmission in a single compact package.

Major novelties of the solutions are:

1. A device which is all-in-one, for what concerns its functionalities; movement sensing (by means of a tri-axial accelerometer and gyroscope in both the DynaPort Hybrid and the MotionBee), data storage (micro SDcard in the DynaPort), data transmission (via Bluetooth on the DynaPort, via ZigBee on the MotionBee) and even local data processing (on the MotionBee) are key features of the device. The proposed solutions picked the latest technological advances in sensors, memories, communication stacks and batteries to allow such performing outcome. Major challenge was the selection of appropriate components, their optimal matching with user-centred specifications and high-quality system integration.
2. A unique device: a monitoring device that does not need multiple sensors or appliances in different parts of the body. This answered to specific requirements raised with the aid of end-users in the initial stage of the development phase; the major challenge was the development of new algorithms for activity classification and fall detection based on a single sensing unit worn on the waist, with adequate sensitivity and specificity.
3. A device with triple functionalities: it is a smart monitor, but also a virtual trainer for taking home-based rehabilitation exercises, with the aid of a PDA to act as an MP3 player, and a remote assistant, to manage, with the aid of a PDA switched on nearby, the messaging and remote data transmission in the case of an unrecovered fall. The major challenge was the design of a modular architecture that, while cost-effective, is capable to answer to very different but frequent needs in an ageing population.

Technology choice: Proprietary technology

Main results, benefits and impacts

• Scientific impact, medical knowledge:
  • The system improves the knowledge on identification of persons at greatest risk of falls. Home monitoring and intervention shall promote early detection, improved documentation of changes over time and in response to intervention, and enhance our ability to identify, treat and reduce fall risks;
  • Improved knowledge on patient cases: the use of the system will provide an outstanding data base, which will help to analyse risk factors for falls including an accurate information about fall incidence;  
  • Improved knowledge on integration of healthcare services at different levels: since the information can easily flow in multiple directions and the results of prescribed therapies will be readily documented, this approach will also provide an invaluable link between the older adult, the primary caregiver and the rehabilitation specialist, this leading to an integration of different healthcare services at various levels. SENSACTION-AAL approach shall, eventually, reduce the financial burden associated with the caring of older adults;
  • improved knowledge on medical algorithms: wearable monitoring systems and therapeutics are readily quantifiable. This ability shall promote standardisation, an important goal of all rehabilitation initiatives.  

• Scientific impact: biomedical engineering applications:
  • The SENSACTION-AAL project deployed advanced  technologies including microelectronics and telecommunications in the strategic field of digital health; thereby, it contributed to the European competitiveness in this strategic market.   

• Social impact - user needs advancement:
  • Safety and independent mobility are highest priority for senior citizens. Activity monitoring can identify persons at risk and telemonitoring can identify inadequate activity, instable gait patterns, or falls that can trigger visits by therapists or home care agencies. 

• Senior Citizens' health:
  
  • Home monitoring and intervention will promote early detection, improved documentation of changes over time and in response to intervention, and enhance the ability to treat and reduce fall risk. Such a better diagnosis will also allow better rehabilitation and therapy prescriptions in Parkinson’s disease, multiple sclerosis, stroke events, osteoporosis, etc. 
  • Quality of life: since most falls occur at home, physical training and technical solutions should strategically aim at improving stability in this environment. SENSACTION-AAL devices may potentially contribute to an improved quality of life for several millions of individuals in Europe.  The delocalisation of monitoring and rehabilitation implies fewer visits to the hospital and to the doctors. For patients who are currently kept in hospital because their condition must be closely monitored, this also implies a reduced permanence in hospitals with consequent improvement of their life quality.

• Sustainability of the EU’s health services:
  • Better and faster diagnosis and fall risk assessment will reduce hospital stays and the number of repeated visits of patients for re-diagnosis and treatment;
  • Patient treatment at home will reduce the work-load on health professionals and reduce person transport associated with illness;
  • Reduced cost of hospital diagnostic services.

Lessons learnt

Meeting the healthcare needs of the older people is almost mandatory to reduce the enormous pressure of an ageing society on the European healthcare systems. Empowerment of physical activity may offer such a simple solution. After the first-hand experience within theSENSACTION-AAL project we are more and more convinced that the key challenge faced by Europe as a whole is reducing the cost  of providing medical assistance to older people without compromising the quality of care. In this context, the fact that physical activity-based interventions can improve  the overall health of older people is extremely significant. Improvements  can be brought about for those who suffer of age-related pathologies but also for those who remain unaffected, by further reinforcing the potentialities of this new approach to healthcare. In specific areas of the elderly population, such as those prone to falls or patients with Parkinson’s or Alzheimer’s disease, research indicates that physical activity-based interventions have the potential to improve both cognitive and motor functioning and hence reduce hospitalization.

Ambient Assisted Living (AAL) has the effective potential to enhance autonomy and quality of life of elderly people at home and reduce the need for caretakers and personal nursing services at home. The offer of suitable and well accepted technologies for senior citizens is still limited nevertheless our experience with ICT solutions including wearable sensors and home-based programs proved that, if older users are involved in the system design since its earlier stages, they are the best prompters of solutions to face the challenges of an ageing population.

Falls have a social and a dramatic personal cost in terms of loss of independence and self-esteem. Hundreds of thousands of older Europeans experience falls every year; having met several of them during the project  in different European countries allowed us to have an holistic view of private stories and public health issues. Several fall detection solutions are available on the market, but there is a need for a joined coordinated effort to build up a critical mass to get validated results(asking young subjects to simulate falls is not the best way to get to know real falls); there is need of data sharing on falls (a Physionet-like repository); as well as a need for an accepted taxonomy; standardization and interoperability are mostly welcome. A reduction in falls shall also immediately turn into an economic advantage given the high cost of each single fall that may amount to 20 000 € including treatment and transportation costs; as a consequence, personal, customised, wearable health systems provide cost-effective solutions towards a sustainable and pervasive healthcare.

Scope: Cross-border, International, Local (city or municipality), Regional (sub-national)