5Gforpersonalizedhealthandambientassistedliving

prof.drir.HermieJ.HermensUniversityofTwenteEnschedetheNetherlandsRoessinghResearchandDevelopment,Enschede,theNetherlands

IntroductionThereisanincreasingawarenessthathealthcareinthewesterncountriescannotbecontinuedinthewayithasdevelopedinthepast;Itisjustnotsustainableduetotheincreasingdemandforvolumeofcare,limitstotheamountofqualifiedpeopletoworkincareandlimitstotheamountofmoneywecanspendonhealthcare.Amaintrendthatiscontributingtothisneedforchange,istheincreasedlifeexpectancyofourwesternsociety.Astheyearsthatareadded,comewithlongerperiodoftimeinwhichwehavetocopewithchronicconditions,thevolumeofrequiredhealthcareservicesisrapidlyrising.Thisincreaseinvolumeofcareneededcannotbemetwithaproportionalincreaseinprofessionalpersonnelandmoney.Thereisastrongbeliefthattechnology,especiallyinformationandcommunicationtechnologycanmakeasignificantcontributiontomakecaremoresustainable,bysupportingpeopleintheirwishforindependentlivingandincreaseofselfmanagementcapabilities.Areasthatareespeciallyrelevantinthiscontextare:

- Unobtrusivemonitoringofhealthrelatedconditionsandbehavior- Homebasedinterventions.Enablingpeopletodotherapylikephysical

andcognitivetrainingathome,remotelysupervised- PersonalisedHealthSystemsthatprovidepeopleinreal-time

personalizedadvicesabouttheirhealth,basedonmultimodalsensing- Caringhomes,supportiveenvironmentthatintuitivelyfeelstheneedsof

itsuserandisabletoreactproperlyTheseareasarecomingupfastduetorapiddevelopmentsinsensingtechnology,artificialintelligenceandimprovedcommunicationinfrastructures[7].Inthischapter,Iwouldliketodescribesomerecentdevelopmentsintheseareasofhealthcaresupportingtechnology,bothfromatechnicalandfunctionalpointofviewandthen,basedonthepresentdevelopmentstrytoimaginehow5Gwillsupportand/oracceleratethese.

Technologytosupportpersonalizedhealthandambientassistedliving

2.1exercisingathomeWhenpatientsareabletodotheirtrainingathome,thiswouldhavegreatbenefitsforallstakeholders.Patientscandotheirtrainingwhereandwhattimetheywant,notbeingobligedtogoe.g.threetimesaweektoaphysicaltherapy

practiceorarehabilitationcentre[8].Ifitispartlyreplacingtheintramuraltherapysessions,itisalsobecomingmorecosteffectiveandenlargingthecapacityofintramuralcare.Ifitisusedasanextensionofintramuralrehabilitation,itwillhelpindecreasingthefallbackofcapacitiesinthehomesituation.

Figure1.Exampleofapatientplatform,supportingwebbasedexercising,videoteleconsultation,selfmanagementandactivitycoaching(ContinuousCareandCoachingPlatform,RRD)IntheECprojectClear,intheperiod2011-2013,1000patientsin4Europeancountrieswereusingasystemthatwasabletodelivervideosofexercises,anexercisescheme,remotesupervisionandteleconsultationservices.Intheextensivehealthtechnologyassessmentitwasshownthatthisremotelysupervisedtreatmentwascosteffectiveandefficientwhenappliedaspartialreplacementoftheregularintramuraltherapy.Moreover,itwasshownthatthepatients,whoexercisedmore,improvedmore.Thisunderlinesthatthepatientisinthedriverseatandisabletotakecontrol.Theadvantageofthisapproachisthatitisfullywebbased,makingitindependentofplaceandtimeandrelativelylow-tech,meaningthatyouonlyneedapcorasimilardevicetogettheserviceworking.Assuch,itisagoodfirststeptointroducethiskindoftechnologyindailyhealthcare.Anextstepinthetrainingathomeinvolvesmuchmorecomplexsystemsinvolvinggamestomaketheexercisesmoreenjoyableandpersuasive,combinedwithpassiveoractiveroboticsupportsystemstocorrectthemovementand/orsupportthepatientsincarryingoutthedesiredmovementwhenmuscleforceisstillnotsufficient.Anexampleofsuchacombinedsystem,istheScriptsystem[1],developedintheEuropeanScriptproject,targetingupperextremitytrainingforstrokepatients.Itinvolvesanarm/handsupportsystemthatallowspersonaladjustmentoftheamountofsupport,sensorstocontrolthegameandanumber

Selfmanagement

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ofgamesthatvaryindifficultyandadecisionsupportsystemthatrecommendsindividualgamesettingandachoiceofthegames.

Figure2.Upperextremityexercisesystemincludingroboticsupportforthehandfunctioning,gravitycompensationandindividuallytailoredvideogames(Scriptproject.eu)Withrespecttorequiredbandwidth,andtechnicalcomplexity,systemslikeScriptaremuchmoredemanding.Optimally,onewouldallowexperiencedclinicianstolookattheperformanceofthepatientexercisingremotely,butalsohavereal-timecontroloftheroboticdeviceaswellasthevirtualworldwherethepatientisexperiencing.TheevaluationstudiesoftheScriptsystemshowthatsuchsystemsarepromisingwithrespecttoindependentandmotivatingexercisingathome,butstillratherfragile.

2.2MovementanalysisandmonitoringMovementanalysisisanimportantstepinthefunctionaldiagnosisinrehabilitation.Itfocusesonquantificationofthemovementpatternandtoinvestigatetheunderlyingdeviationsinneuromuscularcontrolandthecompensationmechanismsthatoccur.Gaitanalysishasbeenrestrictedtolaboratories,wheregaitwasquantifiedusingoptical,markerbasedsystems.Reflectingmarkersareplacedatspecificplacesonthebodyandassessedusingvideocamerasplacedaroundthesubjectthatpulsewithinfraredlightstoobtainathreedimensionalimage.Off-linetheseimagesarethencombinedwithathree-dimensionalmodelandforceplatesto

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calculatejointforces.Inthepastyears,thisisbeingseenmoreandmoreasaso-calledcapacitymeasurementasthelaboratorysituationisaratherperfectenvironmentwithaverycleancontext,wherethepatientcanbetotallyfocusedonthetaskathand.Aneedhasarisentobeabletohavequantitativemovementdatafromrealisticsituations,likeathome.Inthepastyearsthishasbeenenabledbyrapiddevelopmentofinertialsensortechnologyandprocessingalgorithmstogeneratethemovementsfromthedata.ArecentexampleofprogressmadeinthisareaconcernstheInteractionproject.

Figure3.ThedifferentcomponentsoftheInteractionmonitoringsystem(https://www.xsens.com/news/interaction-project/)Hereacompletemovementrecordingandanalysissystemhasbeendevelopedwithmotionsensorsembeddedinsmarttextiles,abletomonitortheactivitiesofapersoninhisownenvironment.Itinvolvesdifferentmodalitiesofsensinglikeinertialsensorstodetectpostureandmovements,surfaceEMGsensorstomeasuremuscleactivationpatternsand3Dforcemeasurementunderthefoot.Thesystemispresentlybeingappliedinstrokepatientstomonitorhowtheyusetheirmovementcapacitiesindailylife,afteraperiodofrehabilitation.Theresponsesfrombothpatientsandcliniciansareingeneralverypositive,underliningthatthesekindofunobtrusivemonitoringsystemshavegreatpromiseforfutureintegratedcare.

2.3PersonalcoachingsystemsTheamountofpeoplewithchronicconditionsisrapidlygrowingespeciallybecausewelivesubstantiallylongerbutthisextensionofourlivesisunfortunatelygoinghandinhandwithdealingwithchronicconditionsthataffectourqualityoflife.Chronicconditionscannotbecuredbutithasbeenshowninmanystudiesthatqualityoflifeandtheoccurrenceofco-morbiditiesisstronglyrelatedtotheextendwebehavehealthy,intermsofphysicalactivity,

Legenda:

EMGsensor

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Xsens/Xsens+UDP Interface/

Xsens+EMG interface

healthyfoodandavoidanceofstress.We,humanarenotgoodinchangingourbehavior,properandintensivecoachingisessential.Aswedonothavetheabilitytodothiswithpersons,theideawasborntodothiswithtechnicalsystemsusingonbodyandcontextsensing,smartcontextawarereasoninganduser-friendly,persuasiveinteraction[6].TheconceptofsuchPersonalCoachingSystem(PCS)isshowninfigure4.

Figure4.SchematicpresentationofanartificialPersonalcoachingSystem,involvingon-bodysensing,contextawarereasoningandpersuasivefeedback.SeveralPCShavebeenrealizedinthepastyears.Figure5showssomeexamplesofpastandon-goingwork.ProbablythefirstPCSwasasystemtotreatneck/shoulderpainduringactivitiesofdailyliving[13,14].ItinvolvedmeasurementofthemuscleactivityintheTrapeziusmuscles,wellknowntobesensitiveforstressandpain,processingthesignalintermsofamountofrelaxationandgivingpersonalfeedbackviavibrationtowarnthesubjectwhenthereisnotsufficientrelaxation.ThissystemwassuccessfullyevaluatedinaEuropeantrial,showingthesystemcanbeappliedinneck/shoulderpainpatients,withoutaffectingtheiractivitiesofdailyliving[9,12].Asecondsystemisasmartactivitycoach,developedtocoachpeoplewithchronicconditionstowardsamorehealthyactivitypatternthroughtheday.Thisoftenconcernsahigherlevelofactivitybutalsoinmanycasesbetterbalancingtheamountofactivityovertheday,toavoidatooearlyexhaustion.Itmeasurestheamountofactivityduringtheday,usinga3Dinertialsensor.Thismeasurementiscontinuouslycomparedwithadesiredactivitypatternandbasedontheresultitprovidesencouraging,discouragingorneutralmessages.Boththecontentandtimingofthemessagesaredynamicallypersonalized,usingamodelwhichtakesintoaccountmanyactivityvariablesandcontextinformation[2,3].Thesystemisundercontinuousdevelopmentbutinparallel,ithasbeensuccessfullyappliedinover100patientswithdifferentchronicconditions,likechronicpainandCOPD[10,11].Thethirdexampleisastressmanagementsystem[15,16].Stressappearstobeacomplex,notwell-definedphenomenon.Peoplealsorespondindifferentwaysto

The future coach

Model based reasoning & Interactive learning

Context aware Feedback via various devices

Context information

Self learning from responses

Wearable sensors

stress,whichmakesthatforaPCSapersonalsetofsensorsarerequiredandapersonalizedmodelthatisabletoweightthedifferentinputsintooneestimateofstress.Experimentalstudiesinthelabshowthatthisapproachisfeasible.Experimentsinfree-livingconditionsshowthatagreatamountofcontextinformationhastobetakenintoaccounttoprovideagoodreal-timestressestimateandtoenableaproperinterpretation.

Figure5.ThreeexamplesofPersonalCoachingsystems,thatusesensorandcontextinformationtoreasonaboutahealthconditioninordertoprovidepersonalizedandpersuasivefeedback.

2.4Thecaringhome;supportivehomeenvironmentsInordertoenablepeopletoliveaslongaspossibleintheirownenvironment,thereisaneedforintelligentsupportsystems.Ideally,thesystemshould“feel”theneedsoftheuserintuitivelyandabletoreactwhenrequired.Inadditionitisimportantthatthesystemispersonalizedandabletoofferawiderangeofservicesintheareaofhealth,well-beingandcomfort.Presently,manyprojectsaregoingoninthisareadealingwithseveralsubgoalsinthecontextofthecaringhome.ForexampleProjectsthataimtodeterminethebehaviorofthepersonusingdifferentmodalitiesofsensing.KeytargetpopulationhereispeoplewithMCIordementiaasthereisagreatandrapidlygrowingneedtosupervisethemaslongastheyliveintheirownhouses.AgoodexampleofanoverallapproachtothischallengeistheeWallproject.TheconceptofeWallistoofferservicesinauser-friendlywayusingalargeinteractivescreen,runinabrowserandsupportedbyanextensivecloudserviceinfrastructure.Thewaytheservicesarepresentedisinnovativebyusinga50’shomeroomenvironment.Itoffersapersonalizedsetofservicesincludinghealthserviceslikeanactivitycoach,videobasedexercising,asleepqualificationsystemandapersonalizedguidancethroughtheday.

Personalcoachingsystems

Flickr-Kaptain Kobold

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Figure6.Anintegratedcaringhomeenvironment,offeringhealth,wellnessandsafetyservicestopeoplewithchronicconditions(http://ewallproject.eu/)Integratedapproaches,likeeWall,requireconsiderablebandwidthfortheseservicesasthereislotofsensing,real-timedataprocessingandhumancomputerinteractionwithanimations.Itisgenerallyexpectedthatsuchapproachwithanintegrationofservicesandusingacloud-basedinfrastructurewillbecomecommonsoon.

Opportunitiesdueto5GOverlookingthedescribedupcomingareasthatwillhaveimpactonthehealthcare,especiallythecareforpeoplewithchronicconditions,ontheonhandandtryingtounderstandandforecastthecontribution5Gcanhavetotheseareas,onecouldmakethefollowingpredictions.

MovementanalysisandmonitoringFormonitoringpurposes,especiallyintheareaoftheanalysisoffunctionalmovements,moreandmorerathercomplexmultimodalsensorsareused,likecombinationsofgyroscopes,accelerometers,magnetometersandultrasoundtogetacomplete3Dpictureofthesubjectandhismovements.WhenthesearecombinedwithEMGmeasurementsofseveralmuscles,aconsiderablebandwidthisrequired.5Gwouldallowsuchsimultaneousmeasurementsinafreeconditionoutsidethelab.Andprobablyalsobeyondthepresentsetofmeasurements,likeadditionofEEGtoassessmotorcontrolandmoodinreal-timewouldbecomepossible,makingaholisticmonitoringofallrelevanthealthandbehaviouraspectspossible.Attheotherside,theviewingofallthesesensordatainanunderstandableandcomprehensiveway,isaconsiderablechallenge,especiallywhenthedatasetisexpandedextensively.Anupcomingtechnicalopportunityistheuseof

holographicprojections.Thiswouldallowthepresentationofthedatatothecareprofessionalinawayhe/sheisusedto,likeinhisdailypractice.Seeingthesubjectmove,whileinformationisaddedlikeinenhancedreality.The5Gbandwidthwouldhaveabigimpactinmakingthisfeasible.

PersonalcoachingsystemsPersonalcoachingsystemsareattractingmoreandmoreattentionasthewayforwardtosupportpeopleinchangingtheirbehaviour.Anearreal-timeresponseofthePCSisessential,astheuserhastobeabletolinkhisbehaviourtotherecommendationsthesystemisproviding,soheisabletobeawareofhisbehaviorandabletochangeitdirectly.MorecomplexPCSlikeoneforstressdorequireanindividuallymodeledcombinationofseveralsensorstogetanestimateofstressforfeedback.Thecapacitiesof5Gwouldsupportreal-timedatacollectionandprocessingcentrally,enablingtheuseofcomplexbehaviormodeling.

ThecaringhomeThecaringhomeisjustatthebeginningofitstime.TheupcomingInternetofthings(IoT)willextendthesensingandinteractioncapabilitiesofthehomeenvironmentconsiderablyand5Gwillenablereal-timedatacollectionofalltheon-bodyandcontextualIoTdata,enablingabetterintuitiveidentificationoftheuserneedsandrequiredresponsesofthehomeenvironment.Itwillalsoenabletheincorporationofnewsensingmethodsthatinvolvemoredata;likemooddetectionusingreal-timevideoprocessing.

DiscussionHealthcareisslowlybecomingawareofboththeneedtochangeandthepotentialbenefitsofe-healthandtelemedicineservices.Thereisalsoanincreasingawarenessofthedeterminantsofsuccessfulimplementation[4,5],basedonthemanyexperiencesgainedinthepastdecade.Presenthealthcareisnotyetfullyexploitingthecapacityofthepresent3Gand4Gnetworks.Electronicpatientrecordsdousealimitedamountoftrafficand,apartfromtheimagingdata,involvesmallamountsofdata.Onlyrehabilitationexercisingathomewherevideosareusedtoenableindependentexercisingdoesrequiresomesubstantialbandwidth.Nevertheless,itisexpectedthatthiswillchangetheupcomingyears,nowthatmanyhealthcareinstituteshavetheirEPDreadyandarenowlookingfortechnologysupportedinnovationsoftheircareservices.Andthiswillmeanthatthedescribedareaswillreceiveincreasingattention.Itisexpectedthat5Gwillenablesignificantstepsforwardintheareas.Theexpectedlargebandwidthcombinedwithhighreliabilityandavailability,willenablereal-timedatacollectionfromlargeamountofsensors(onbody,IoT),theuseofcomplexusermodelingandnewwaysofuserinteraction.Itwillalsoincreasetrustintheseareasbothbytheend-usersandcareprofessionalcommunity,speedingupthelargescaledeploymentofthesecaresupportingsolutions.

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