Meet Casa Agevole, a built in home in Fondazione Santa Lucia, Rome.


Designed by architect Fabrizio Vescovo, this 60m2 house includes several rooms -dinne room, kitchen, two bathrooms, two dorms and a main room- and has been designed to allow a person driving a wheelchair to move inside via a millimetric planning of the layout of the different elements.

This house have been deployed as a testing place for assistive technologies for projects in cooperation with FSL and it has already been successfully used in several EU projects. At the moment, it includes several ultrasonic localization sensors, a zigbee sensor network and a KNX-EIB installation, all connected to a gateway PC.

First things first, before having someone drive a prototype, it is important to know about his/her condition. Of course, the doctor is the main source of information, but in order to process results afterwards, some index is always useful, we are engineers, after all!!. The key is to obtain a quantified disability profile to correlate this data with the amount of help they may require, demand or receive.

Disability is technically defined as a lack of ability relative to a personal or group standard or norm, but, in fact, there is often simply a spectrum of ability. It may involve physical, sensory, cognitive or intellectual impairment, mental disorder and/or various types of chronic disease.

In experimental work, though, it is better to define disability as the degree of difficulty to independently perform basic Activities of Daily Living (ADL) [Katz]. Disability is not an attribute that is clearly present or absent, but rather a matter of degree.

One of the best ways to obtain global information about patient needs is represented by the multi-dimensional approach and, in particular, in case of elderly patients the most common approach is the CGA, a multidimensional process designed to assess an elderly person's functional ability, physical health, cognitive and mental health, and socio-environmental situation. It includes different disability scales to evaluate the cognitive and physical state and condition of individuals. Here are the most popular ones.

The MMSE or Folstein test [Crum] is a brief 30-point questionnaire test that provides a quantitative measure of cognitive status in adults. Any score
over 27 (out 30) is effectively normal, event though it changes depending on age and education. In the time span of about 10 minutes, it samples various functions, including arithmetic, memory and orientation.

IADL, also called Lawton's scale [Lawton], is based on a questionnaire to evaluate the capacity of the subject to perform daily tasks ruled by cognitive functions (judgement, language, orientation, calculation, memory, planning). Thus, IADL measures the degree of autonomy of an elderly individual. This test appears complementary to MMSE, that rather evaluates cognitive functions. For example, a subject with memory disorders or difficulty of calculating shows a reduced score. 4 tests are particularly important since they are well correlated with cognitive functions evaluated by the MMSE test. They include the ability to : i) Use telephone; ii) Use transportation; iii) Take medication; and iv) Handle finances. For example, using a telephone under his own initiative is related to the intention and planning of a task (to look up the name of somebody in a phone book) and to the comprehension of language (to have a conversation). On the other hand, to be limited to a small number of well known phone numbers or to answer the telephone without calling implies automatic mechanisms. An evaluation of these 4 activities allows early detection of cognitive deterioration, several years (approximately 3 to 5) before a dementia is diagnosed. Detection of an alteration of at least one of these 4 activities calls for a more precise neurological assessment.

The GDS [Yesavage] is a self-report inventory, constructed to assess depression and general well-being in the elderly. It is a brief questionnaire in which
participants are asked to respond yes/no to 30 questions in reference to how they felt on the day of administration. Scores of 0-9 are considered normal, 10-19
indicate mild depression and 20 - 30 indicate severe depression.

The Barthel Index [Mahoney] consists of 10 items that measure a person's daily functioning, specifically ADL and mobility. Items can be divided into a
group that is related to self-care (feeding, grooming, bathing, dressing, bowel and bladder care, and toilet use) and a group related to mobility (ambulation, transfers, and stair climbing). The maximum score is 100 if 5-point increments are used,
indicating that the patient is fully independent in physical functioning. The lowest score is 0, representing a totally dependent bedridden state.
Apraxia is a neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire to and the physical ability to perform the movements. It scores from 0 (worse result) to 10.

One of the amazing things of Internet is this bunch of nice people that work hard to publish freebies for us lazy lurkers in the web. And sometimes it is even legal :D

This is the case of PlaceLab, the MIT experimental living lab within the House-n project. Located in Cambridge, Massachusetts, this house-environment has been designed as a flexible and multi-disciplinary observational research facility for the scientific study of people and their interaction patterns with new technologies and home environments. Volunteers do live there in a Big Brother-fashion for variable periods of time and they agree to be monitorized via a variety of sensors deployed all over the house. MIT people have been so kind as to share with us their PlaceLab datasets, with nifty explanations on data format, source of information, sensor nature and anything we may need to reuse the information in our own experiments.

Population today is progressively aging in developed countries. The increase in the proportion of older persons (60 years or older) is being accompanied by a decline in the proportion of the young (under age 15). Nowadays, the number of persons aged 60 years or older is estimated to be 629 million and expected to grow to almost 2 billion by 2050, when the population of older persons will be larger than the population of children (0-14 years) for the first time in human history [DPI]. Naturally, people living longer also implies an increasing number of people affected by chronic diseases, such as heart disease, cancer and mental disorders. Chronic diseases may frequently lead to disability. It is estimated that the costs of health care could rise from 1.3 trillion to over 4 trillion dollars for these reasons [Ciole&Trusko, 1999]. Costs are particularly high if persons are not independent due to a disability.

Disability is a difficult concept to define, unless in a broad sense. It could be accepted that a person has a physical or cognitive disability when they lose the capacity to do some things on their own, meaning that their independence is threatened and that they require assistance in every day tasks. More specifically, disability implies not being able to to carry out the so called basic Activities of Daily Living (ADL) such as bathing, eating, using the toilet and walking across a room, as well as shopping and meal preparation.

Under these circumstances, either home assistance has to be granted or the person needs to be institutionalized. In nursing facilities, though, costs are higher and the quality of life is often reduced [Barton,1997]. Lack of human resources to assist elder people leads naturally to
create systems to do it in an autonomous way (e.g. [Volosyak,2005]). Studies on the use of assistive devices in a general population in Swedish descriptive cross-sectional cohort studies [Ivanoff,2005] reported that one-fifth at the age of 70 and almost half the population at the age of 76 had assistive devices, usually in connection with bathing and mobility. Another study of 85-year-olds in a general elderly population found that 77% of them had one or more assistive devices, also more frequently for bathing and mobility. The same pattern has been found in other general population studies, although the prevalence rates vary from 23 to 75% according to studied population, age group and type of assistive devices.

To sum up, prevalence rates vary, but the use of assistive devices is very common among the elderly and their use increases with age. It is consequently of extreme importance to create a new generation of tools to assist people with disabilities, so that their independence and autonomy is improved. Specifically, it is stated by health professionals that mastering of mobility assistive device skills enhances a person's autonomy and participation in ADL [Cortes et al, 2004]. Training these skills is also an important part of the rehabilitation process. Furthermore, assessment of wheelchair skill performance can provide valuable information about daily functioning and participation and even be used to check the progress of degenerative processes or rehabilitation therapy.