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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 10, NO. 1, JANUARY 2006
AbstractAt the time of hospitalization, it is essential to evaluate the general health status of a patient and to follow up the
trends during therapy. Our work is focused on a set of tools for the
measurement of patient activity. In this paper, we propose a few
indicators of the patient activities of daily living, such as mobility,
agitation, repartitions of stays, and displacements. As a result of
this work, a diagnostic system was developed that could lead to a
deeper knowledge of human activity rhythms in normal situations.
Index TermsHospitalization, rhythms of activity, smart homes,
telehomecare.
I. INTRODUCTION
T IS WELL accepted that human activity follows a period of 24
h, directed by the common requirements of daily living (sleep
time, meals, etc.). Moreover, body temperature, weight, muscular strength and all biological functions follow such rhythms [1]
to ensure the global homeostasis of human metabolism. Therefore, the essential information revealed by these rhythms cannot
be ignored at the time of the diagnosis.
Currently, a set of manual scales is used to evaluate the health
status of the patients. The World Health Organization (WHO)
performance scale [2] and the Karnofsky scale [3], for example,
focus on patients ambulatory abilities and mental health. More
commonly, such scales intend to evaluate some or all Katzs
activities of daily living (ADL) [4] (e.g., dressing, eating, ambulating, transferring, hygiene). These evaluations, although performed by the clinical staff, depend on human subjectivity and
cannot be easily periodically updated. Therefore, the automatic
filling of such scales would be a real benefit for clinical evaluation. Moreover, it can benefit to home telecare for automatic
evaluation of the status of patients or elderly at home.
Most of the current works about telecare [5][8] are based
on sensor networks for a specific pathology or hazard (e.g.,
diabetes, high risks pregnancy, falls). The sensors become local
intelligent units operating on real time-critical situations [8], [9].
More recent works focus on the detections of slow changes in the
behavior (i.e., they involve greater observation periods). Some
other works deal with the fusion of the outputs of different
kind of sensors, such as cardiac rhythms, movements, postures,
Manuscript received December 2, 2004; revised May 11, 2005. This work
was accomplished within the OncologHIS, a joint project between the TIMCIMAG Laboratory and the Department of Medical Oncology of the Grenoble
University Hospital.
G. LeBellego, N. Noury, G. Virone, and J. Demongeot are with the TIMCIMAG Laboratory, UniversiteJoseph Fourier, Grenoble 38706, France (e-mail:
Gael.Le-Bellego@imag.fr; Norbert.Noury@imag.fr; Gilles.Virone@imag.fr;
Jacques.Demongeot@imag.fr).
M. Mousseau is with the Department of Medical Oncology, UniversiteJoseph
Fourier, Grenoble 38000, France (e-mail: mmousseau@chu-grenoble.fr).
Digital Object Identifier 10.1109/TITB.2005.856855
LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE
Fig. 1.
93
(FSM), where the stable states are the rooms and the transitions are the sensors detections. The evolution of the FSM is
conditioned by the presence of the person; multiple detections
and abnormal cycles are detected and generate a confidence factor ([0 . . . 1]) associated with the information. The SmartCAN
finally transfers the data through a local CAN network to the
computer equipped with a LAN board (NiCAN, National Instruments, Austin, TX). There, it is analyzed with software that
performs many kinds of statistical analysis on large periods.
It can also launch some alarms according to the results of the
analysis. In the event of an emergency, an electronic message is
sent instantly.
B. Preliminary Data
Each detection is recorded with its date and time of occurrence. Information is stored in a XML-like file.
This file is loaded in the Matlab environment, where data are
stored in a preliminary matrix built with detection events (1).
Detection[Date][Hour][Sensor Number]
With
Date[Year][Month][Day]
Hour[H][M][S]
Sensor Number [1, 5].
Fig. 2. Albert Michallon Hospitals HIS (sensors and detections areas are
indicated).
(1)
(3)
94
IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 10, NO. 1, JANUARY 2006
N
AJ (i).
(5)
J =M
86400
AM N (k).Wa (i k) (6)
k =1
Through the profile for agitation P (i), we can easily estimate the evolution of daily agitation on different period lengths.
The instantaneous amplitude of P (i) is not interpretable, but
the relative amplitudes are significant. Actually, only profiles
computed on the same period lengths M N and with the same
window Wa can be compared (Fig. 4).
2) Definition of a Profile for Mobility: P (i) is computed in
the same way as the profile for agitation, although we accumulate the transitions between two successive different detections
S J (i)
1 if i
AJ (i) =
S J (i)
0 if i
<
With
= 0 a threshold
AM N (i) =
t
a
2
N
AJ (i)
J =M
, 86400
(7)
(8)
a
,
2
86400
k =1
signals BJ,n
(i) (with N the number of room and n the number
N
n BJ,n
(i).
(10)
n =1
LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE
95
N
J,n (i)
J =M
t
Pn (i)
a
2
, 86400
(11)
a
, n [1, N ]
2
= M N ,n (i) Wa (i)
=
86400
M N ,n (k) Wa (i k).
Fig. 5.
(2 h).
(12)
k =1
Pn (i)
a
, 86400
86400/p
AM N (p k) Wa (i p k)
(13)
k =1
86400/p
AM N (p k) Wa (i p k)
(14)
k =1
86400/p
M N ,n (p k) Wa (i p k).
(15)
k =1
III. RESULTS
We programmed our algorithms under the Matlab environment. A graphical user interface (GUI) was developed to easily
apply the matching processes to the activity data. Through this
GUI, we can automatically import data from the XML files to
S(j, i)) and display the ambulatograms SJ (i). It also provides
for some basic convenient functions, such as period selection
or the selection and/or modification of the parameters of most
of the algorithms (e.g., the width a of the window). Programming under Matlab also allows us to easily interfere with the
algorithms during their processing.
A. Evaluation of Algorithms on Preliminary Data
We worked with the results of successive detections of different sensors, each one matching a different volume (room). They
produce the ambulatograms: The abscissa represents the time (in
96
IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 10, NO. 1, JANUARY 2006
Fig. 6. Mobility profile P (i) calculated with a Hanning window on the same
data: a = 14 400 s (4 h).
Fig. 9. Profile for the global mobility (25 days) and overlaying of daily profiles
of the same period (a = 7200 s, 2 h).
Fig. 7. Profile for the global mobility (25 days) (a = 7200, 2 h) performed
with different windows.
Fig. 8.
Ambulatograms for the first two days (periods of absence are in gray).
concentration of activity (e.g., around 11 to 12 AM on Fig. 8). Absences (period between two successive detections at entrance)
are also easy to detect (grayed on Fig. 8). The analysis of the
repartition of events tells us that most of the activity happens
between bedroom (40%) and door (30%). Toilets (16%) and
living room (12%) also represent a nonnegligible part of the
detections. The analysis of time repartition confirmed that the
bedroom is the main room (70% of the day), but the entrance
area raises a surprising 20%. Eventually, the daily evolutions of
these repartitions show the global evolution of the activity and
behavior of the patient, although here we can hardly talk about
significant revelations.
2) Profiles for Mobility and Agitation: During this first
study, the ActiCAN software on the SmartCAN was running
a set of rules to remove successive identical detections. Then,
because we could not study the agitation, we focused on the
profile for mobility.
The profile for mobility were processed on long (several
days/weeks) and short periods (daily). We mainly compared
the global mobility (the whole observation) with the daily mobility. The global mobility characterizes global behavior. We
could point out regular periods of activity with significant peaks
(Fig. 5). We then compared daily activity. To confirm the regularity of the activity previously observed, we overlaid them
(Fig. 9). We finally verified that one can easily isolate short or
long periods of high or low activity within a day (Figs. 5 and 6).
3) Occupation Profile: This part aims at determining the
way the patient occupies the home space. The occupation profile
gives an estimation of the density of occupation of each room
within a typical day. The great proportion of time spent in the
bedroom in the repartition (Fig. 10) is confirmed here by the
high level of the matching occupation profile compared with
other rooms. We can also observe smaller patterns such as very
regular visits to the bathroom at 11 AM (Fig. 10).
4) Relative Frequencies of Displacements: Due to the filter
applied on successive detections, we were deprived of the possibility of studying relative frequencies of displacements to and
from the same room.
LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE
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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 10, NO. 1, JANUARY 2006
Occasionally, the homes areas may not match the hypothesis we made about their general purpose (e.g., someone may
go to the bathroom to pick up a forgotten item instead of performing personal hygiene). As a consequence, we now consider
setting specific rules to distinguish expected from unexpected
activities. This could be done using the time of day, time spent,
or the number of detections.
Actually, deeper exploitations of these criteria are not possible
as long as the occupant of the home cannot be distinguished
from visitors. To monitor one (or more) patient in a smart home,
this distinction is essential. We will thus focus on an intelligent
data acquisition process: in particular, we will develop sets of
rules [12] that will be applied to the detections in the SmartCAN
(e.g., if one detection occurs too shortly after another detection
in a noncontiguous room, it might be removed). Additional
sensors (contact and thermosensors) may also be placed on
some pieces of furniture (e.g., armchair, bed) for this purpose.
Finally, visitors could be differentiated from the patient with the
detection of the direction of passages at the door (e.g., through
a double sensor, pressure carpet, optical barrier sensor)
The analysis of incoming new data will allow a stronger validation of our tools and of the accuracy of our hypothesis. We
will also suppress the filter applied on successive identical detections to study agitation and the relative frequencies, including
the displacement to and from the same room. We will finally
review the homes configuration to fit the patients comfort and
monitoring needs. A new solution and perhaps a new structure
for our system will then be proposed.
The analysis of the patients agitation, in particular, will provide us with a new criterion for activity. This information is
essential when the patient remains in bed because agitation is
the only indicator left for his activity.
Current projects involving multiple types of sensors [5], [13],
or works on intelligent analysis of the activity [9] give us a
good prospective on the future of the monitoring and analysis
of activity. Specific projects such as AILISA [19] will also
produce new valid data, as well as the opportunity to monitor a
real patient at home. The expected future fusion of those works
and especially the multisensor fusion (e.g., fall, temperature, or
weight scale) will complete this study.
Obviously, it is hoped that this will be a new benefit for
the clinical diagnosis in hospitals and for the remote care of
patients healed at home. This work may also later contribute to
the rehabilitation of some patients who could be monitored at
home instead of in a hospital suite.
V. CONCLUSION
ACKNOWLEDGMENT
LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE
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