Technology for Prevention and Reduction of Disease and Disability

Chronic conditions, including cardiovascular diseases, diabetes or physical injuries due to falls and other accidents have significant costs for people, the healthcare system and the Canadian economy. However, close monitoring of chronic conditions can significantly reduce their effects. In addition, regular activity and exercise in older adults is associated with an overall improvement in health, functional capacity, quality of life and independence. Research in TECH-DD is producing technologies and tools that will help to actively engage older adults in society. We are developing novel ambient-based and on-person technologies that can measure physiological and activity data; systems that can mitigate the risk of injury from accidents, such as falls; and new technological platforms for exercise and prevention of injury and disability. These technologies will be transferred to market through our industry partners. Results will also inform new approaches to improve care practices and reduce healthcare expenditures.

Workpackage Leads
  • Rafik Goubran, Carleton University
  • Frank Knoefel, Bruyere Research Institute


Core Research Projects

Ambient-Based Physiological and Functional Monitoring – 5.1 AMBI-MON

Effective monitoring of at-risk older adults, whether in the home or in hospital, can help increase their safety, prevent hospitalization and promptly alert health-care providers when an intervention is needed. This project focuses on the development of sensor systems that can be embedded in the person’s environment and that deliver health and functional information in real time. For example, a bed-based pressure sensor will collect information on breathing, bed movements and characteristics of getting out of bed—all helpful in monitoring respiratory health, risk of skin breakdown and transfer safety. The goal is to quickly detect any changes in health and ability so that early interventions can prevent further decline and enhance safety.

Project Leads
  • Rafik Goubran, Carleton University
  • Frank Knoefel, Bruyere Research Institute
Researchers
  • , Simon Fraser University
  • Hilmi Dajani, University of Ottawa
  • James Green, Carleton University
  • Jean Chouinard, Elisabeth Bruyere Hospital
  • Martin Bouchard, University of Ottawa
  • Sarah Fraser, University of Ottawa

 

Technologies to Predict, Prevent, and Detect Falls – 5.2 PRED-FALL

Falls are the largest cause of injuries in adults over age 65. The aim of this project is to develop and evaluate new technologies to predict, detect and prevent falls and fall-related injuries among people at high risk in both long-term care and acute care environments. To learn more about predicting falls, we are analyzing real-life data, acquired both through networks of video cameras in long-term care facilities and with wearable sensors. Our goal is to identify differences in movement patterns during falls. In the area of fall prevention, the team is developing and evaluating low-cost solutions such as compliant flooring, fall mats and padded furniture along with wearable protective gear.

Project Leads
  • Fabio Feldman, Fraser Health
  • Steve Robinovitch, Simon Fraser University
Researchers
  • , Simon Fraser University
  • , St. Michael's Hospital
  • , University of Manitoba
  • Alex Mihailidis, Toronto Rehab Institute, University Health Network
  • Carolyn Sparrey, Simon Fraser University
  • Dawn Mackey, Simon Fraser University
  • Emily O'Hearn, Simon Fraser University
  • Greg Mori, Simon Fraser University
  • Jane Devji, Delta View Enrichment Centre
  • Karim Khan, Centre for Hip Health and Mobility
  • Leslie Karmazinuk, New Vista Society
  • Ming Leung, New Vista Society
  • Omar Aziz, Simon Fraser University
  • Ryan D'Arcy, Simon Fraser University
  • Salim Devji, Delta View Enrichment Centre
  • Samudra Dissanayake, Innovation Boulevard
  • Yijian Yang, University of British Columbia

 

An In-home Intelligent Exercise System for Physical Rehabilitation, Enhancing Musculoskeletal Function, and Preventing Adverse Events – 5.3 IIES-PHYS

Having easy and frequent access to supervised and well-planned therapy for sensory and motor functions can help ensure the long-term health of older adults. This team is developing technologies that can be used for delivering appropriate, individualized rehabilitation and exercise programs. Two separate approaches are proposed: one that provides frequent, less intense regimes for in-home use, and the other that provides less frequent but more intense regimes for use under the guidance of a therapist in a rehabilitation or community centre setting. Project co-investigators include Deirdre Dawson, Baycrest/University of Toronto; Nicole Anderson, Baycrest/University of Toronto; Catherine Donnelly, Queen’s University; Kelly Murphy, Baycrest/University of Toronto; and Feng Xie, McMaster University.

Project Leads
  • Mandar Jog, University of Western Ontario
  • Rajni Patel, University of Western Ontario
Researchers
  • Christian Duval, Quebec University
  • James Frank, University of Waterloo
  • Robert Teasell, University of Western Ontario

 

Using eHealth to Enhance the Participation of Adults with Subjective Cognitive Decline: A Pilot Feasibility Study – 5.4-CAT1 REACT

Up to 60% of older adults are aware of cognitive changes in their everyday life, despite having no underlying condition. The most common cognitive changes associated with normal aging are in memory and executive functioning, which can have a significantly negative impact on individuals’ ability to live independently and manage aspects of their everyday life.  As such, it is important to make rehabilitation accessible to older adults with cognitive complaints so that they can maintain or improve their participation. In particular, the number of older adults in the workforce is increasing yet we know little about how cognitive complaints affect performance at work. We plan to conduct a clinical trial to test a rehabilitation program designed to help older adults who have some cognitive complaints manage activities of daily living. We will examine if it is possible to deliver this rehabilitation program using videoconferencing so older adults can access care from home.

Project Leads
  • Emily Nalder, University of Toronto

 

Improved Treatment of Overactive Bladder with Electrical Stimulation – 5.5-S2 STIM-OAB

Overactive bladder (OAB) is an incurable urinary disorder that affects 18% of Canadian adults. Successful treatment can improve quality of life by alleviating anxiety, social withdrawal, depression, and preventing falls that come about when people urgently seek the bathroom. Current treatment options for OAB (and limitations) include: (a) pharmaceuticals (poor patient compliance/side effects); (b) spinal nerve stimulation (expensive and invasive implantable device); and (c) tibial nerve stimulation therapy (requires ongoing clinic-based treatment). The overall clinical efficacy of these therapies is notably limited. We have recently discovered a new nerve stimulation target that may provide improved treatment of OAB. Our goal is to show improved therapeutic benefit in patients with this novel treatment. The successful completion of this project will allow the introduction of new types of implantable devices and clinic-based treatments.

Project Leads
  • Sasha John, University of Toronto
  • Paul Yoo, University of Toronto

 

Product Verification Testing of a Pressure Ulcer Prevention/Healing Cushion – 5.6-S4

Pressure ulcers are prevalent in elderly people. Consequences include poorer quality of life, loss of independence and, in some serious cases, death. We have developed an effective “intelligent” wheelchair cushion to help in the prevention and treatment of pressure ulcers. All features have been tested in the lab environment. Experts and end-users have provided feedback. Final testing will now be conducted with end-users to ensure the device’s performance in real-world situations. Partners on this project are the Rick Hansen Institute and Retirement Concepts, which will help us to evaluate and commercialize this device.

Project Leads
  • Siamak Arzanpour, Simon Fraser University

 

Effective Go-to-market Strategy for a Modern Health Monitoring and Detection System to Increase Senior Independence. – 5.7-S4 WELBI

The purpose of this project is to develop a viable research-based marketing and communication plan for an innovative senior care technology company (called Welbi) that is helping to improve assistive care of older adults (65 years and older) in Ontario and Quebec. The project will investigate the most effective way to market and brand this assistive platform to caregivers and seniors. Go-to-market information for assistive technologies is badly needed, but currently there is very little knowledge about how companies and projects should properly engage with their users. The project is expected to produce a marketing and communication plan which will help ensure the commercial success and implementation of the seniors care technology company. AGE-WELL’s portfolio of senior care technologies will benefit from this project. Our findings will provide valuable insights to improve the dissemination of other similar AGE-WELL products and services to users and the market.

Project Leads
  • Jeff Jutai, University of Ottawa
Researchers
  • Elizabeth Audette-Bourdeau, Welbi
  • Nick Petryna, Other

 

Market Survey to Determine Features of a Wearable Technology for Retaining, Regaining or Improving Hand Function in Seniors – 5.8-S5

To encourage seniors to exercise their hand to recover, retain and/or strengthen hand function, a wearable technology was prototyped to monitor hand and finger activity. We will be conducting  a survey and focus group with healthy seniors and seniors with health conditions affecting finger and hand function. The purpose of this project is to gather information about desirable features of the technology that may enhance compliance in use. In addition, information on support services designed to motivate seniors to use the technology, such as mobile device applications and social media interactions, will be gathered in the surveys. This information will be used to advance the technology and support services that seniors will likely use to retain or improve quality of life.

 

Project Leads
  • Carlo Menon, Simon Fraser University
Researchers
  • Carolyn Weeks-Levy, Simon Fraser University

 

WearCOPD– A Wearable Application to Monitor COPD Patients at Home: Optimizing Patient Engagement, Increasing Sensor Accuracy, Determining the Ability to Detect Early COPD Exacerbations – 5.9-CAT

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, affects 1 in 4 adults and is a disabling chronic disease that incurs high cost to the healthcare system. Even with optimal treatment, COPD patients frequently experience exacerbations or worsening of their condition and are sometimes hospitalized. Ideally, exacerbations would be treated early before becoming severe. We may be able to pre-empt exacerbations by using wearable technology that senses subtle abnormalities in physiological signals which herald early exacerbations.

Our goal is to improve the care of people with COPD and reduce hospitalizations by providing patients with a way to monitor their condition and detect early exacerbations, allowing for timely intervention. We are developing and validating sensors on wearable devices that will continually monitor vital signs, physical activity and coughing. We will improve the accuracy of the sensors to optimize its ability to detect subtle changes in factors known to be affected by COPD such as physical activity and coughing, and explore new factors such as heart rate and respiratory rate that may characterize early exacerbations. We will then collect data from COPD patients to train a machine-learning algorithm to determine what characteristics and combinations of these parameters herald an oncoming exacerbation.

Furthermore, we are conducting patient engagement interviews to determine what sort of device is useful, appealing and accessible for elderly patients with COPD. Our research also trains personnel in the exciting intersection of wearable development, machine learning and health care.

There are approximately 37,000 COPD hospitalizations annually in Ontario that have an average cost of $10,086 each. If this new technology succeeds in preventing even 1%, the potential savings are $3.7 million. Our hope is that this wearable sensing platform can eventually be used in other chronic diseases as well.

Project Leads
  • Robert Wu, University of Toronto
Researchers
  • Andrea Gershon, Sunnybrook Health Sciences
  • Eyal de Lara, University of Toronto
  • Frank Rudzicz, Toronto Rehab Institute/University of Toronto
  • Hisham Alshaer, University Health Network

 

Commercialization of a haptic robot for rehabilitation of the upper limb post-stroke – 5.10-SIP A2

Age is the primary risk factor for stroke. Stroke, a main cause of long-term disability worldwide, can result in weakness and loss of movement control on one side of the body. About 65% of stroke survivors cannot use their affected arm in daily activities. Recovery of mobility and function requires intense, repetitive, and task-specific therapy. Present demands and budget restrictions in healthcare limit necessary intensive individual therapy. Robot-assisted therapy can address this problem by making rehabilitation service provision more effective and efficient by allowing therapists to work with more patients and patients to do therapy without constant therapist supervision. Our team at University of Toronto/Toronto Rehab and Quanser Consulting Inc. have developed a low-cost portable robotic system that is used with on-screen games. We have conducted preliminary usability, feasibility, and effectiveness studies with chronic stroke survivors with moderate arm recovery. Stroke survivors were motivated and reported high therapy satisfaction. Results are promising with respect to mobility gains. Our goal is to commercialize the robotic system by launching a start-up company. To expedite commercialization, the proposed project will develop commercial quality software including 1) upgrades based on our findings to the system’s user interface to make it easier for stroke survivors and therapists to use, and 2) additional therapeutic games to enhance therapy engagement. The availability and clinical use of robotic systems can result in substantial benefits to stroke survivors, therapists, and healthcare services. For stroke survivors, enhanced opportunities for efficient and effective therapy can result in greater motor and functional recovery. Therapists will advance their practice by having additional effective and efficient tools with which to work with patients and with less focus on the repetitive elements of therapy, can offer greater opportunities to work on daily activity and community re-integration goals.

Project Leads
  • Rosalie Wang, University of Toronto

 

Munoz-Pronura Neurodegenerative Diagnostics Initiative – 5.11-SIP A2

Physicians lack effective tools/strategies for differentiating between even the most prevalent neurodegenerative diseases, including Alzheimer’s, Parkinson’s, ALS, VCI, and FTD, in their early stages. Accuracy rates are improving, particularly for late-stage patients, but there is still no ‘Gold Standard’ for neurodegenerative disease diagnosis. Also, nearly all available tests analyze only one disease at a time, so any diagnosis patients may receive is liable to being incomplete if a secondary disease evades scrutiny. The medical sector urgently needs access to a tool that lets them know exactly what condition(s) afflict the individual, as early as possible, so they can take advantage of disease-modifying therapies suited for treating specific conditions (rather than unspecified neurodegeneration or “dementia” in general) before it’s too late for them to be effective.

Pronura aims to develop and commercialize a device that uses eye-tracking technology to diagnose patients with industry leading accuracy as soon as any of the diseases are present in the patient’s neurophysiology; the device is capable of scanning for all five aforementioned diseases simultaneously to mitigate incomplete as well as inconclusive diagnoses.

Commercial/clinical access to such capabilities will radically improve the ability for physicians to provide appropriate, useful disease-modifying therapies, as new tailored treatments emerge in the coming years; overall, aging patients concerned with their cognitive health will gain access to conclusive, complete, immediate answers to their concerns, while the healthcare system will have alleviated the financial burden of accommodating innumerable patients for whom they currently cannot provide meaningful aid.

Project Leads
  • Douglas Munoz,

 

Commercialization of SlingSerter for Home Care – 5.12-SIP A2

Home caregivers’ most challenging activities when caring for individuals with very limited mobility relate to transfers to and from beds, and to mobility-in-bed. Mechanical lifts reduce the demands of these activities, but do not eliminate them. Most notably, for a lift to be used, a sling must first be placed under the care recipient. This is a physically strenuous process if the care recipient cannot assist: either the individual is manually rolled onto one side, then the other to permit sling placement, or a slide sheet is used to pull a sling under their body. Sling placement is particularly difficult for home caregivers who work alone or care for people in low and/or wide beds. Unfortunately, this difficulty is so great that it often reduces the frequency of transfers or leads to the sling being left under the person, thus increasing the risk of pressure ulcers.

SlingSerter is an effortless alternative: sling straps are inflated using compressed air and gently unfurl under the care recipient. Once 3-5 straps have been placed, they are connected to a lift and used to raise the person a short distance above the bed. It is then easy for the caregiver to place a sling, change bedsheets, provide incontinence care, or reposition the person in bed.

This project will make SlingSerter available to home caregivers through a partnership with Prism Medical (a Handicare company), who have an established line of home lifting products. Guided by feedback from homecare providers, family caregivers and care recipients, we will work to prepare a version of SlingSerter that is optimized for homecare. An effortless sling insertion method will reduce physical demands on caregivers, promoting care recipient health and mobility by enabling more frequent transfers and reducing the incentive to leave slings under people between transfers.

Project Leads
  • Jack Callaghan, University of Waterloo
  • Geoff Fernie, Toronto Rehab Institute/University of Toronto

 

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