Get "Smart"

The Need

With aging there are a number of associated challenges, including decreased mobility/stability and increased health problems. Ambulatory assistive devices, including rollators (similar to walkers but with wheels that better support “normal walking” gait), are often employed to overcome safety issues, enabling users to maintain mobility and their ability for independent living; this is important because mobility and the ability for independent living are highly correlated with a person’s health and well-being, and quality of life.

We are thus faced with a growing senior population that requires increased health care. Simultaneously, older adults have a strong desire to remain living in the community longer, whether it is in their own home or in a retirement accommodation. There is also a growing need to enable older adults to live independently. High demands that already exist on family members ("sandwich generation") can make it prohibitive for them to also serve as caregivers. In addition, there is a shortage of health care professionals and health care budgets already account for a significant portion of federal and provincial budgets. There is a need to find solutions that enable older adults to maintain functional independence, and that enable the ability to monitor and support their health and well-being.

The Opportunity

Advances have led to opportunities for technology to provide feasible solutions that can facilitate independent living for older adults and effective health care, including the prevention and early detection of health care issues. There have been significant advances in sensor technology and signal processing that have increased the reliability and robustness of non-invasive and non-obtrusive monitoring; this includes multi-sensor and multi-modal approaches. The widespread of personal consumer electronics (e.g., cellular phones, personal device assistants) have led to the development of microprocessors with increased computational power, decreased power requirements, and decreased cost. Simultaneously, communication technology, wireless communications in particular, is expanding rapidly and has led to the introduction of faster and cheaper data communications, including low-power wireless transceivers. These advances in technology, coupled with their decreased cost, enable feasible remote monitoring and point-of-care solutions. The aging population, along with general increased interest in personal health and well-being, provides an impetus for commercial developments.

The Objective

The Smart Rollator is an interdisciplinary research program. The current project seeks to develop sensor technologies integrated on a rollator that enables:

1. improved health care through monitoring of adherence and progression during rehabilitation, as well as early identification of health care issues; and
2. quantitative assessment of rollator usage to improve the design and prescription of rollators.

Reliable real-world monitoring integrated in the Smart Rollator will enable remote monitoring and point-of-care solutions. In addition, the Smart Rollator is designed to promote the independent living of older adults. Ambulatory assistive devices, such as rollators, provide an effective means of delivering such solutions. Smart Rollator concepts are not limited to rollators and are also applicable to wheelchairs, conventional walkers, and other remote monitoring systems (e.g., handheld and wearable technologies); however, early adoption is anticipated with rollators. From a medical perspective, the Smart Rollator is anticipated to enhance a health care practitioner's ability to provide appropriate ongoing care and treatment. Even simplistic technological solutions can provide valuable information. For example, speed/distance monitoring would enable physiotherapists to monitor a user's adherence to prescribed treatment plans and have a way of quantifying their progression during rehabilitation. Other monitors, such as cardiac monitoring via the electrocardiography and/or photoplethysmography, can provide information regarding general health and well-being including long term trends, as well as short term information, such as quantitative indicators of effort during rollator usage. From a social perspective, the Smart Rollator will impact both the users of the systems and the people they would normally be dependent upon. As noted previously, quality of life is highly correlated with a person's ability to live independently. Finally, from an economic perspective, such work can help mitigate health care costs by extending the ability for older adults to live independently, as well as preventing injury and diseases, or identifying issues early on.

The Approach

In order to arrive at impactful solutions, a user-centered and holistic approach is being undertaken. The Smart Rollator is a participatory research program, which has the active involvement of multiple stakeholders, including: rollator users, rollator manufacturers, rollator designers, and health care professionals. Research and development is driven by user needs, including the needs of the rollator users but also the health care professionals that facilitate their care. The Smart Rollator is also an interdisciplinary effort, where experts from different disciplines (e.g., engineering, product design, and physiotherapy) work collaboratively. Interdisciplinary is distinguished from multidisciplinary, where different disciplines are included but their efforts are not integrated together.

Universal design principles are employed in the Smart Rollator. Consideration must also be given to the different variety of mobility conditions (e.g., injury, multiple sclerosis, Parkinson’s Disease), as well as the high probability for compound impairments (e.g., visual impairments, arthritis). Having an interactive and iterative design process will lead to the development of commercial solutions within a short time frame and allow for feedback that will help guide future work and enhancements.

Accessibility is an important factor in the Smart Rollator. This is not limited to accessibility in terms of form and/or function but also economic accessibility; that is, solutions should consider cost factors to ensure it does not become an access barrier.

System Overview

The Smart Rollator is comprised of multiple minimally-obtrusive monitoring subsystems integrated on a rollator (Figure 1). Technology will be integrated in a manner such that it will remain unnoticed by the user during normal daily activities. These monitoring subsystems include: distance/speed monitoring, force monitoring, and cardiac monitoring. An embedded microprocessor system collects data onto local memory, which are transferred periodically to a remote data server via a local data terminal; this local data terminal may be situated by a user's bed, enabling data transfers each night. Automatic wireless transmission from the rollator to the local data terminal is used to avoid unnecessary user interfaces that may be confusing for the target older adult population.

Remote data terminals enable a variety of people (e.g., physiotherapists, family) to access and examine the data, and generate reports. Automated alarms or notifications regarding potential health problems can be issued appropriately. For example, changes in rollator loading forces may be indicative of a neuromuscular disorder or injury (e.g., asymmetric or increased loading); a health care professional can be notified to examine such changes and as well as long-term trends, and follow up during the user's subsequent visits. Serious trauma (e.g., falls) would require more immediate attention (e.g., 911).

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Figure 1 - Schematic of the Smart Rollator System Future

The Smart Rollator is part of a number of related endeavors that are addressing the growing needs of the aging population, including smart apartments, and wearable and portable monitoring devices. Opportunities exist currently for feasible technological solutions to assist older adults in maintaining their independence. Beyond these opportunities, there lie others which may have a larger impact. Providing users technology that promotes rehabilitation instead of just assistance may eliminate the need for an assistive device. For example, future actuated Smart Rollator used in progressive physiotherapy can help strengthen muscles and train individuals to reacquire their facilities for balance and postural control. The population is aging but innovations, such as the Smart Rollator, can help ensure that people can continue having quality and productive lives for many years to come.