Workpackage 5 Technology for Prevention and Reduction of Disease and Disability

Core ResearchCatalyst ProgramStrategic Investment Program


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

This project is developing sensor systems that can be embedded in an individual’s environment to deliver health and functional information in real time in order to 1) help monitor the health of older adults and 2) predict and prevent health problems.

Award Term: April 1, 2015 - March 31, 2020

AGE-WELL NCE Investment: $ 1,097,670

Total Non-NCE Contribution: $ 140,340

Project Leads
  • Rafik Goubran, Carleton University
  • Frank Knoefel, Bruyère Research Institute
Technologies to Predict, Prevent, and Detect Falls – Workpackage 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. The research team is developing and evaluating low-cost solutions such as compliant flooring, fall mats and padded furniture along with wearable protective gear.

Award Term: April 1, 2015 - March 31, 2020

AGE-WELL NCE Investment: $ 785,997

Total Non-NCE Contribution: $ 1,001,242

Project Leads
  • Fabio Feldman, Fraser Health
  • Steve Robinovitch, Simon Fraser University
An In-home Intelligent Exercise System for Physical Rehabilitation, Enhancing Musculoskeletal Function, and Preventing Adverse Events – Workpackage 5.3 IIES-PHYS

This research team is developing technologies that can be used for delivering appropriate, individualized rehabilitation and exercise programs at home or under the guidance of a therapist. Technologies include sensor-based interfaces and a telerobotic rehabilitation platform that can be used at home. 

Award Term: April 1, 2015 - March 31, 2020

AGE-WELL NCE Investment: $ 729,290

Total Non-NCE Contribution: $ 924,181

Project Leads
  • Mandar Jog, Western University
  • Rajni Patel, Western University
Selected Publications
Wearable sensor-based automatic frailty and fall risk assessment in older adults – Workpackage 5.16-CAT

Frailty in late life is a public health challenge which contributes to increased risk of multiple adverse outcomes, including falls. Based on recent estimates, 10% of community-dwelling older adults are frail and another 41.6% are pre-frail. Detection of frailty at the pre-frail stage paves the way towards alleviating the associated risks by employing intervention strategies. Additionally, since frail older adults have a high risk of falling, detection of frailty can help prediction of prospective falls, which in turn serve as a basis for fall prevention efforts. However, the ability to establish a diagnosis of frailty and prediction of future falls remains a major challenge in the geriatric population.

The aim of this project is to develop a wearable sensor-based platform for identification of frailty status and prediction of future falls in older adults. This wrist-worn, smartwatch-based platform will be used to automatically calculate measures of functional performance including walking speed, power of sit-to-stand transitions and activities of daily living. Using these measures, models will be developed for the target population to classify their frailty status into non-frail, pre-frail and frail and predict their risk of falling in the future.

The outcome will be used in identifying the transition from non-frail to pre-frail stage, which is increasingly recognized as the stage to target with different therapeutic modalities. The Canadian healthcare system is facing a serious challenge in the form of an aging population, prevalence of chronic diseases and the accompanying rising costs. In response to these challenges, the proposed novel technology, capable of identifying frailty status of older adults at the pre-frail stage and predicting prospective falls, could improve the quality of care for older adults while reducing the cost of care through early detection/intervention.

Project Leads
  • Ed Park, Simon Fraser University
Proof of concept development of an active insole to reduce falls in older adults – Workpackage 5.17-CAT

Falls and mobility impairment are common side effects of aging. Falls represent a significant injury risk and limiting mobility to avoid falls can reduce independence, quality of life, and contribute to further declines in mobility. The most cost effective way to reduce the health, economic and quality of life impact of falls in older adults is to prevent falls in the first place. In our work and that published by others we see the potential of miniature and low cost electronics for developing an affordable new insole technology to more effectively prevent falls and their related injuries. Feedback from seniors has highlighted the importance of discrete assistive technologies. In addition, for our industry partner Kintec Footlabs, developing custom insoles for seniors to assist with sensory impairment, pressure relief and pain is an important element of their business. Integrating smart technology, balance monitoring and active feedback into an insole platform that many seniors already use in a cost effective way has the potential to impact fall prevention and mobility on a large scale. In this first stage of the project we will be advancing instrumented insole technology that we developed to monitor plantar pressure patterns during daily activities to integrate active vibration feedback. Active vibration feedback at both the sensory and subsensory levels has been shown to improve balance, reduce falls and increase mobility. We will use this proof of concept insole technology to define and assess the vibration intensity, sensory and actuator locations and mobility performance in a cohort of seniors to tune settings and identify the design criteria for an effective system. A low cost instrumented insole provides the potential to gather quantitative population data on balance and mobility for the first time and the opportunity to deploy injury prevention technologies at a meaningful scale.

Project Leads
  • Carolyn Sparrey, Simon Fraser University
Rehabilitation as a health strategy for persons with chronic conditions and associated issues of aging: A web based application – Workpackage 5.18-CAT

Project Goal:

To determine the usability and utility of iamable, a web based application developed to provide access to rehabilitation strategies to patients who are receiving treatment from occupational therapists (OTs) and physiotherapists (PTs) in primary care.

The usability evaluation will occur in 3 phases.

  1. Concurrent Think Aloud method, conducted in collaboration with the McMaster Digital Transformation Research Centre, with 8-10 older adults who identify as “familiar users” of technology.
  2. Heuristic evaluation with ‘double’ experts (2-4 physiotherapists and occupational therapists with experience with technological innovations in practice).
  3. Iamable app utilization by dyads of patients and therapists across 5 primary care sites; 26 dyads will be asked to integrate the Iamable app into ‘usual care’ to support the patient’s chronic disease self-management.

Project Outcomes include:

  • An evidence-based, SM app which will be utilized by people with chronic conditions and by members of interdisciplinary health care teams.
  • Increased accessibility, availability and affordability of rehabilitation strategies to optimize function and participation of people with chronic disease.
Project Leads
  • Julie Richardson, McMaster University
Commercialization of SlingSerter for Home Care – Workpackage 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
  • Geoff Fernie, Toronto Rehab Institute, University Health Network
  • Jack Callaghan, University of Waterloo
Development strategy for an interactive health monitoring system to increase senior independence and well-being – Workpackage 5.13-SIP A3

This project will build on the previous SIP WP5.7 project completed by Welbi with AGE-WELL. The purpose for this project is to develop improvements for Welbi, a senior care technology company that is helping improve assistive care of older adults (65 years and older) in Canada. The project will focus on the development of a new chatbot feature for Welbi’s mobile health tech application. There are very few senior-focused health applications on the market today that collect detailed quantitative data as well as qualitative data. Welbi will collect quantitative data via its integration with existing wearable technology devices from manufacturers such as Fitbit. This project will help with the development of the new chatbot feature which is powered by machine learning and artificial intelligence, and this will help Welbi collect the qualitative data needed to take its predictive software to the next level.

This project will help Welbi develop a plan and hire the necessary staff to commercialize this new feature of the software platform. AGE-WELL’s portfolio of senior care technologies will benefit from this project. This project will help improve Welbi’s software so that it can have tremendous benefits and major impacts on the lives of seniors living in Canada as well as family members acting as caregivers for them. Welbi’s mobile application has the potential to greatly increase the independence of seniors and ensure they and their family members stay aware of any health changes or potential risks that are detected. The new chatbot will be specifically designed for seniors, and this feature will greatly increase levels of interaction with them. The chatbot will collect data about the senior’s health and well-being, and will also provide health information, related tips, and activity recommendations based on health status, activity levels, location, and weather.

Project Leads
  • Jeff Jutai, University of Ottawa
Longitudinal study of bed entry/exit and sleep patterns for older adults through Data Analytics – Workpackage 5.14-SIP A3

Problem statement
As people age, a number of things change in their lives, including mobility and sleep patterns. Typically, with increasing age mobility declines and fall risk increases. Any acute illness can also affect mobility. Similarly, sleep is increasingly interrupted, such as going to the bathroom more frequently. Poor sleep can cause poor mobility the next day. With the development of sensors that can be deployed in older adults’ homes, there is an opportunity to identify mobility and sleep biomarkers that can predict changes in health status for increased fall risk. However, monitoring potentially thousands of aging older adults is a huge challenge and the IBM Data Analytics tools may provide a platform to be able to meet this challenge.

Research purpose
The SAM3 research team has between 9 and 12 months of continuous bed pressure and corresponding health data and fall history for each of over 20 older community-dwelling adults from a previous project. This big data set provides a unique opportunity to analyze typical longitudinal data as expected in a real deployment within IBM software tools to allow existing lab only implementations to potentially have commercial deployment.

Anticipated impacts
If the research team can convert mat big data into sleep and mobility knowledge that can be used to identify changes in health status, SAM3 will be one step closer to bringing a novel solution to market. Then mats with smart algorithms may be able to identify health changes in older Canadians before they get so severe that they require expensive hospitalizations. A goal will be the identification of methods to implement and scale the analysis algorithms, which is necessary for any sensor based solution to get to market. This would be a win for older Canadians and society as a whole.

Project Leads
  • Bruce Wallace, Carleton University
Towards a personalized treatment of overactive bladder – Workpackage 5.15-SIP A3
Overactive bladder (OAB) is an incurable urinary disorder that affects up to 18% of Canadian adults. Successful treatment can improve quality of life by alleviating anxiety, social withdrawal, depression, and preventing falls while urgently seeking the bathroom. Falls are the largest cause of injuries in adults over age 65, among which OAB is highly prevalent (30%). Current treatment options (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 provided near the ankle (which requires ongoing clinic-based treatment). The clinical efficacy and long-term compliance of these therapies are notably limited. Additionally there can be significant side-effects. We recently showed clinically that our novel saphenous nerve (SAFN) stimulation therapy effectively improved OAB symptoms, without any reported side-effects. We also showed that this could be done using transcutaneous stimulation via stimulation pads applied to the skin rather than requiring a percutaneous needle procedure in the clinic. The goal of this renewal application is to investigate the time course and dose-related treatment profile of our novel OAB therapy in newly-recruited patients. The successful completion of this project will provide an informed approach to treatment titration (i.e. optimizing stimulation regimen) of individual patients using a therapy that can be provided at the patient’s home.
Project Leads
  • Sasha John, University of Toronto
  • Paul Yoo, University of Toronto
Rehabilitation mobile app for older adults following total knee replacement – Workpackage 5.19-SIP A4

The average inpatient cost for joint replacement surgery in Canada is more than $1 billion annually (Canadian Institute for Health Information, 2018). It is critical therefore to reduce negative outcomes, such as the need for revision surgeries, through rehabilitation. Currently, 80% of older adults with total knee replacement (TKR) surgery fail to do necessary rehabilitation, resulting in higher rates of revision surgeries and surgical complications, a lower quality of life, higher pain medication use, and considerable cost to the individual and the health-care system. We are proposing a mobile application (app) that can be used at home to motivate and instruct older adults during their recovery following a TKR. The app would provide daily video guided exercises typically prescribed by a physiotherapist, daily reminders such as taking medication, and checklists for identifying early signs of infection after surgery. We have already developed the unique ability to allow an older adult to measure their knee movements (range of motion) with just their mobile device. This is a form of measurement that previously could not have been done without a health-care provider. All of this information: the range of motion, the amount of exercises completed, and the checklist items, are all carefully tracked daily, weekly and monthly and provided to the older adult via the app to track progress. This app tackles key barriers to rehabilitation compliance namely: cost, accessibility and convenience. We will provide a mobile application that is affordable, accessible to the older adult without having to travel for appointments and allows the older adult to complete their rehabilitation in the comfort of their own home.

Development of an automatic braking system for rollator walkers – Workpackage 5.20-SIP A4
Every day, millions of people rely on a rollator walker for support with independent mobility. A key feature of rollator walkers is the ability to lock the brakes in place for stability when standing or sitting (on the device). Current rollator walkers have a manual braking system that requires users to remember to engage the brake to prevent the device from rolling away and causing a fall. This dependence on memory to engage the brake creates a significant safety hazard for users, particularly for those with cognitive impairments (e.g. dementia). This project aims to reduce the risk of falling due to failing to manually engage the brakes on a rollator walker by developing an automatic braking system. The purpose of our research is to develop an automated braking system that is user-friendly and feasible for commercialization. Our method will include user and product testing that trials the device on a population with consideration of parameters such as diagnosis, physical status and cognitive ability. Automatic rollator walker brakes are currently not active in the market, despite millions of rollator walkers used daily. “A simple fall can set in motion a whole cascade of events that is detrimental to seniors and also to the health-care system” (LeClerc, 2017). Most rollator walker users are seniors. An estimated 1/3 of seniors fall at least once annually, with annual spending to treat falls among seniors estimated at $2 billion in Canada and $50 billion in the United States. Preventing falls eliminates injuries, hospitalizations, deconditioning due to prolonged recovery times, chronic pain, and deaths. Our device will facilitate a higher quality of life by facilitating user independence and safety, which promotes ongoing successful aging and improved general fitness. This can save millions of health-care dollars due to fall prevention and maintenance of overall health.
Project Leads
  • James Tung, University of Waterloo
Health Sensing Algorithms for Pressure Sensitive Mats – Workpackage 5.21-SIP A5
Commercialization of the Proactive Recreation and Wellness Platform – Workpackage 5.22-SIP A5
Context awareness indoor activity monitoring for aging-in-place – Workpackage 5.23-SIP A5
Project Leads
  • Qiyin Fang, McMaster University
Development of a test system to measure and evaluate safe force thresholds on delicate tissue – Workpackage 5.24-SIP A5

Able Innovations aims to commercialize novel, zero-effort technology that is capable of eliminating the need for human involvement in transfers of individuals with restricted mobility. The current technologies and processes employed for transfer (i.e. bed to wheelchair, chair to chair, chair to bed etc.) result in injuries to caregivers as well as older adults, are extremely labour intensive, and create an undignified experience for older adults. A crucial step in the commercialization of this technology is to ensure that their proposed technology is safe to interact with delicate human skin and tissue. Due to the way a “compact conveyor” mechanism interfaces with older adults, it is important to thoroughly understand the interface between the device and client. To examine the shear and forces the device could exert on delicate skin and tissue, a proposed test system will be developed and employed. This system would include a complex array of sensors and data acquisition monitors on a test mannequin configured in a manner to collect relevant interface information. This information will be used to determine the optimal form-factor design of the transfer mechanism(s) and provide crucial data on its safety. This project will have a direct immediate impact on the ability of Able Innovations to commercialize their technology, and can have a profound impact on how new technologies and processes are evaluated. In addition to publishing the results of this study, potential commercialization of the test system itself will be explored. The proposed system could be used to test and evaluate other technologies and processes where client handling is of paramount importance.