title: A web-based non-intrusive ambient system to measure and classify activities of daily living.
abstract: BACKGROUND
  The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer's disease and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients to stay in their home environment. Despite doctors' and caregivers' awareness of the patient's cognitive status, they are often uncertain about its consequences on activities of daily living (ADL). To provide effective care, they need to know how patients cope with ADL, in particular, the estimation of risks associated with the cognitive decline. The occurrence, performance, and duration of different ADL are important indicators of functional ability. The patient's ability to cope with these activities is traditionally assessed with questionnaires, which has disadvantages (eg, lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify these activities in the patient's home. Combined with Web technology, these systems can inform caregivers about their patients in real-time (e.g., via smartphone).
  
  
  OBJECTIVE
  We hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging, and microphone recordings would be better suited for use in dementia patients. Since it does not require patient's attention and compliance, such a system might be well accepted by patients. We present a passive, Web-based, non-intrusive, assistive technology system that recognizes and classifies ADL.
  
  
  METHODS
  The components of this novel assistive technology system were wireless sensors distributed in every room of the participant's home and a central computer unit (CCU). The environmental data were acquired for 20 days (per participant) and then stored and processed on the CCU. In consultation with medical experts, eight ADL were classified.
  
  
  RESULTS
  In this study, 10 healthy participants (6 women, 4 men; mean age 48.8 years; SD 20.0 years; age range 28-79 years) were included. For explorative purposes, one female Alzheimer patient (Montreal Cognitive Assessment score=23, Timed Up and Go=19.8 seconds, Trail Making Test A=84.3 seconds, Trail Making Test B=146 seconds) was measured in parallel with the healthy subjects. In total, 1317 ADL were performed by the participants, 1211 ADL were classified correctly, and 106 ADL were missed. This led to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed an average of 134.8 ADL (SD 75).
  
  
  CONCLUSIONS
  The non-intrusive wireless sensor system can acquire environmental data essential for the classification of activities of daily living. By analyzing retrieved data, it is possible to distinguish and assign data patterns to subjects' specific activities and to identify eight different activities in daily living. The Web-based technology allows the system to improve care and provides valuable information about the patient in real-time.
authors.affiliation: Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.
authors.forename: Reto A
authors.identifier: http://orcid.org/0000-0003-4492-7345
authors.initials: RA
authors.lastname: Stucki
authors.forename: Prabitha
authors.identifier: http://orcid.org/0000-0002-7641-8898
authors.initials: P
authors.lastname: Urwyler
authors.forename: Luca
authors.identifier: http://orcid.org/0000-0002-2907-667X
authors.initials: L
authors.lastname: Rampa
authors.forename: René
authors.identifier: http://orcid.org/0000-0001-6990-4188
authors.initials: R
authors.lastname: Müri
authors.forename: Urs P
authors.identifier: http://orcid.org/0000-0002-4791-6927
authors.initials: UP
authors.lastname: Mosimann
authors.forename: Tobias
authors.identifier: http://orcid.org/0000-0002-8069-9450
authors.initials: T
authors.lastname: Nef
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D017028:Caregivers; D003201:Computers; D003704:Dementia; D018450:Disease Progression; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D059015:Wireless Technology
keywords: ADL classifier; Alzheimer; activity monitoring; assistive technology; behavior pattern; dementia; forward chaining inference engine; rule-based; smart homes; wireless sensor system