The AART-BC Project

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Background

In the UK mobility issues affect 6% of 16-44 year olds and up to 55% of 75+ year olds; upper limb functional limitations are also highly prevalent in, for example, populations with stroke or Rheumatoid Arthritis. Thus a large proportion of the population will require assistive technology (AT) and/or rehabilitation programmes (RP) at some time during their life-course. Prescriptions for AT vary from a simple orthosis, or walking stick to expensive and complex high-end wheelchairs for active spinal injured patients. Prescriptions for therapy, following a stroke or traumatic brain injury, may include regular stretching, or functional task practice. Surprisingly, considering the high resource implications, no one has the technology to understand if AT is being used, how it is being used or how people adhere to RP. Further, current systems do not generally integrate with on-the-body sensors, making interpretation of the data difficult. This leads to a continued reliance, even in large trials, on self-reporting for monitoring device usage/rejection. 

There are very few studies comparing self-reported use of AT with objective measures, but in other domains it is well established that self reporting is subject to significant bias and recall errors and therefore we cannot know what technologies are working. Further, despite the well-established benefits of physical therapy, we know little about adherence to exercise therapy regimes, which is also assessed by self-reporting. As was pointed out by a recent BMJ article; there is an urgent need for more accurate monitoring of medical interventions and process; as without knowing what people actually do it is difficult to understand the effectiveness of any intervention. This situation is a problem for researchers, but a more immediate and much larger scale problem for clinicians. With the lack of direct measurement/observation and appropriate tools with which to support patients outside of the clinical environment, clinicians have to make huge assumptions about the eventual end-use and worth of ART. 

The main assumption being that the AT is used and that on the whole (especially if they see a clinical improvement) the RP is being followed. Secondly, clinicians do not have the tools to remotely support the patient in using their AT device, or following the RP therapy instructions. 

This project therefore focuses on the development of a platform to monitor the use of AT and compliance with RP and support the patient outside of the clinic. The project will demonstrate the technology in three patient groups: wheelchair users, prosthetic users and the elderly.

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The Proposal

If it were possible to monitor the use of ART in the everyday (home) environment and outside in the urban environment, in an unobtrusive manner, this would enable clinicians, commissioners and medical technologists to better understand conditions, the ART, the compliance and quality of use, and allow better exploration of the positive effects of feedback to promote self-management. At the end of this project we will have developed a prototype generic platform (AART-BC) that uses, cheap, disposable sensors in the form of temporary tattoos, in combination with other unobtrusive sensing technologies for direct application to ATs, their users, and people in RTP. These will operate in the home, as well as outside, and will by their very nature be completely conformal and unobtrusive for embedding in daily life.

Objectives

  1. Develop new robust, low cost and massively convenient wearable sensors.
  2. Develop a sensor suite and platform capable of measuring AT use and RP compliance beyond the clinic that can give feedback to the stakeholders.
  3. Develop appropriate metrics for the new sensor suite and validate/ verify these to a specified level of accuracy.
  4. Establish the capability and usability of the system through technical studies across various end-uses.
  5. Validate the AART-BC platform.