Adaptive Assistive Rehabilitative Technology: Beyond the Clinic (AART-BC)

We currently have no idea what the Assistive Rehabilitation Technology (ART) patient does outside the clinic, and we have no idea how the patient interacts with their AT and RT on a daily basis. This means that we do not truly understand the compliance with, and efficacy of, individually prescribed Adaptive ART (AART), hence leading to sub-optimal outcomes for the patient themselves and inefficient use of NHS resources. This 36-month project has the imagination and scope to provide measurement, validation, and a feedback facility for a range of conditions and their associated AART. It brings together a highly multidisciplinary team with backgrounds that will facilitate the creation of a platform to provide information for the clinician, the carer, the end-user or for research use. The project involves 7 universities: University of Warwick (UoW), University of Cardiff (UoC), University of Salford (UoS), University College London (UCL), University of Kent (UoK), University of York (UoY), and Oxford-Brookes University (OBU). It also brings together the unique facilities of the PAMELA lab at UCL, alongside the three Human Performance Laboratories (HPL) at UoS.

If it were possible to monitor the use of ART in the everyday (home) environment and outside in the urban environment, in an unobtrusive manner, this would enable clinicians, commissioners and medical technologists to better understand conditions, the ART, the compliance and quality of use, and allow better exploration of the positive effects of feedback to promote self-management.

The project partners will develop "tattoo like" sensors to be used to monitor things like position, activity and emotional state (through galvanic skin response), that can be used to track the use of AT and/or RT in the home and beyond. The major advantages of the tattoo sensors developed in the project is likely to be their low cost and high degree of user acceptance. However, within the project we will also use additional off-the-shelf-discrete sensors (e.g. a smart-watch) to complement the data derived from the tattoo sensor suite. This approach will allow us to gather comprehensive, but unobtrusive sensor data, specific to the particular AT or RT application. The information derived from this suite of sensors will be remotely logged and analysed and an individualised condition signature (ICS) is derived for a particular user and a particular AT or RT. The ICS will then be used to feedback information to either the clinician/ carer or the end-user themselves in order for them to judge effectiveness and potentially modify use to encourage good outcomes. The ICS will also be used to characterise particular AT and RT use in the home for research stakeholders at large; observability of AT use and RT compliance is currently poor and relies on indirect methods, such as self-report.

At the end of this project we will have developed a prototype generic platform (AART-BC) that uses, innovative cheap, disposable sensors in the form of temporary tattoos, in combination with other unobtrusive sensing technologies (e.g. smart-watch), and user-informed feedback software. The system will operate in the home, as well as outside, and will by its very nature be completely conformal and unobtrusive for embedding in daily life.

The primary benefactors from this research will be the patients and their families. Development of this technology will enable patients to leave hospital sooner, have realtime feedback on their rehabilitation patterns, develop an evidence base for prescription and ultimately enable them to live fuller, more active lives. In the short term feedback to the patient on their rehabilitation practices and AT use will help to build confidence and independence. In the longer term a data base of evidence will be being compiled day-by-day which will, for the first time, enable rehabilitation practitioners to provide AT and prescribe PT based on objective evidence. The UK is in a unique position, with the NHS, to compile such a nationwide database. This resource will enable the NHS to be more efficient while simultaneously improving the quality of life of patients and their families.

The technology being developed within this project will create jobs within the UK through development of spin out companies. These SME's will develop alongside one another in an atmosphere of collaboration, and in alignment with the developments in other RCUK funded projects such as SPHERE and ARCCS. The vision is that in the 5 years following the completion of AART-BC a series of clinical trials will be conducted which will enable these SME's to grow to provide the technical solutions necessary to revolutionise the AART world.

AART-BC represents a step-change in the care pathway for patients and a revolution in the way in which we decide on appropriate AT and PT. One key hurdle which AART-BC will have overcome is how and what data people are comfortable with sharing with whom. Indirectly academics developing similar technology which aims to disrupt the standard care pathway and harness the power of ubiquitous monitoring will be able to point to AART-BC as a road map to success.

A revolution in AART provision and compliance monitoring would not be possible without well trained engineers and clinicians to enable the revolt! Much thought has gone into how we will enable the next-generation of leaders to develop the skills and networks to be able to build on what is achieved in AART-BC. Through the PDRA network and teaching materials at MSc level we will ensure there are sufficient skills within the UK workforce to continue the development of better monitoring and understanding of conditions requiring AART. We also envisage AART-BC being the platform for a change in the way people engage with their AART and indeed in the way it will be designed. This is a longer term goal and the AART-BC team has already begun to engage with industry, charities and NHS managers to ensure this is possible.