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

Lead Research Organisation: University of Warwick
Department Name: Sch of Engineering

Abstract

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.

Planned Impact

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.

Publications

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Amor JD (2018) Validation of a Commercial Android Smartwatch as an Activity Monitoring Platform. in IEEE journal of biomedical and health informatics

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Barbareschi G Evaluation of wheelchair transfers performance based on body segments acceleration in Journal of Rehabilitation and Assistive Technologies Engineering (JRATE)

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Batchelor JC (2015) Inkjet printed ECG electrodes for long term biosignal monitoring in personalized and ubiquitous healthcare. in Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference

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Bennasar M (2016) Huntington's Disease Assessment Using Tri Axis Accelerometers in Procedia Computer Science

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Bennasar M (2018) Automated Assessment of Movement Impairment in Huntington's Disease. in IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society

 
Description We presented our research at a congress called NAIDEX where we obtained feedback from end users and demonstrated the technology widely. Warwick now has a spin out company based on the technology developed within this grant - Augmented Insights Ltd.
First Year Of Impact 2017
Sector Digital/Communication/Information Technologies (including Software),Healthcare
Impact Types Societal,Economic

 
Description RSC Commission on future of surgery - C Holt contributed to the Call for Evidence for the "Implications for Future Surgical Technology" document via the Royal Academy of Engineering Biomedical Engineering Panel
Geographic Reach National 
Policy Influence Type Participation in a national consultation
URL https://futureofsurgery.rcseng.ac.uk/?_ga=2.104617412.577568556.1550158526-60008457.1547478615
 
Description EPSRC DTP
Amount £75,000 (GBP)
Organisation Cardiff University 
Sector Academic/University
Country United Kingdom
Start 10/2018 
End 04/2022
 
Description ISSF Welcome Trust, Cardiff University
Amount £47,945 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2016 
End 02/2017
 
Description MRC Confidence in Concept, College of Biological and Life Sciences, Cardiff University
Amount £49,980 (GBP)
Organisation Medical Research Council (MRC) 
Department MRC Confidence in Concept Scheme
Sector Academic/University
Country United Kingdom
Start 09/2016 
End 08/2017
 
Description Manchester Academic Health Sciences - Ignite Fund
Amount £24,151 (GBP)
Organisation University of Manchester 
Department Manchester Academic Health Science Centre
Sector Academic/University
Country United Kingdom
Start 01/2018 
End 06/2018
 
Description Manufacturing the Future
Amount £1,305,276 (GBP)
Funding ID EP/P02713X/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Academic/University
Country United Kingdom
Start 08/2017 
End 07/2020
 
Description Manufacturing the Future
Amount £1,289,916 (GBP)
Funding ID EP/R02331X/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Academic/University
Country United Kingdom
Start 04/2018 
End 03/2021
 
Description Project grant
Amount £74,907 (GBP)
Organisation The Dunhill Medical Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2017 
End 07/2018
 
Description Service improvement grant
Amount £29,973 (GBP)
Organisation Parkinson's UK 
Sector Charity/Non Profit
Country United Kingdom
Start 05/2017 
End 11/2018
 
Description UBIHealth Networking Project (staff)
Amount £5,500 (GBP)
Organisation University College London 
Sector Academic/University
Country United Kingdom
Start 07/2016 
End 08/2016
 
Description UBIHealth Networking Project (student)
Amount £5,000 (GBP)
Organisation University College London 
Sector Academic/University
Country United Kingdom
Start 06/2016 
End 07/2016
 
Description Product Design Research, Cardiff Metropolitan University 
Organisation Cardiff Metropolitan University
Country United Kingdom 
Sector Academic/University 
PI Contribution Two network meetings with PDR to define collaborative research; one in particular related to lifestyle monitoring, wearables and patient feedback systems and devices.
Collaborator Contribution Organised the second workshop and joined the OATech+ partners list
Impact A mapping exercise to identify common research goals and cross-fertilisation of expertise and ideas.
Start Year 2016
 
Description School of Healthcare, Cardiff University 
Organisation Cardiff and Vale University Health Board
Country United Kingdom 
Sector Public 
PI Contribution Working with academics in Healthcare to develop further sensor sets and wearables for monitoring of knee and low back pain patients as part of the Arthritis Research UK Biomechanics and Bioengineering Centre
Collaborator Contribution Attendance at several discussions regarding patient rehabilitation schedules and exercises for total knee replacement. Discussions regarding our development of patent based sensor sets in the lab an clinic before home testing. Contributions to the ethical approval applications and protocols.
Impact IRAS approval for the initial lab based studies with patients.
Start Year 2015
 
Description School of Healthcare, Cardiff University 
Organisation Versus Arthritis
Department Biomechanics and Bioengineering Centre
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Working with academics in Healthcare to develop further sensor sets and wearables for monitoring of knee and low back pain patients as part of the Arthritis Research UK Biomechanics and Bioengineering Centre
Collaborator Contribution Attendance at several discussions regarding patient rehabilitation schedules and exercises for total knee replacement. Discussions regarding our development of patent based sensor sets in the lab an clinic before home testing. Contributions to the ethical approval applications and protocols.
Impact IRAS approval for the initial lab based studies with patients.
Start Year 2015
 
Description World Health Organisation: initial discussions on assistive technology provision 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution The Global Disability Innovation Hub team presented to Chapel Knasnabis, who commissioned the work to create the WHO Priority Assistive Products List (APL). Discussions have continued as to how we could roll out: 1) New courses in inclusive design and assistive technology design; 2) Design of low-cost assistive technologies. The team have subsequently been asked to join his team in Geneva to map out how we can formalise this collaboration.
Collaborator Contribution Presentations on: 1) Wheelchair innovations - how do we harness sensors and systems to monitor dynamically wheelchair use globally and use this to inform policy at a micro and macro level 2) Wheelchair innovations - Could fuel cells be the solution to power requirements for difficult terrains 3) Inclusive design - what can we learn from the London 2012 Games? General discussions on the way in which inclusive design, assistive technology design and manufacture and entrepreneurship lie at the heart of solving the global challenges of accessibilty.
Impact Chapel Knasnabis to present at the first Global disability Innovation Hub summit:https://www.disabilityinnovation.com/summits
Start Year 2016
 
Company Name AUGMENTED INSIGHTS LTD 
Description Providing back end intelligent algorithms to extract information by looking for patterns in data - in the first instance in behavioural patterns in humans. 
Year Established 2018 
Impact Spin-out is at its early stages yet has obtained government funding and university funding to proceed past the business plan stage.
Website http://www.augmentedinsights.co.uk
 
Description After Dark at the Museum, National Museum of Wales, Cardiff, 2018 and 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The School of Engineering has been working with the National Museum of Wales to help bring science and engineering to a wider public. One of their first collaborative events was After Dark at the Museum, a hugely successful night which attracted an audience of more than 1,700 guests.
The guests, which included many families and young children, were treated to a number of hands-on exhibitions and activities as well as tours of the Museum. The Cardiff University Schools of Engineering, Chemistry, and Physics and Astronomy took part in the event as well as volunteers from the Institute of Physics and the Royal Society of Chemistry.

Some of the university research demonstrated included damage detection in aerospace structures, identifying the location of sound, arthritis research, drone technology and energy generation.
Year(s) Of Engagement Activity 2018,2019
URL https://www.cardiff.ac.uk/news/view/1013991-after-dark-at-the-museum-a-resounding-success
 
Description BBC Online report for national news 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Cardiff Uni bid to create osteoarthritis 'smart patch'
By Max Evans
BBC News
21 January 2017

Dr Davide Crivelli and Prof Cathy Holt, School of Engineering Cardiff University

Scientists are hoping to create a smart patch which could detect the early onset of osteoarthritis in patients' knees. Cardiff University's team uses damage sensors from aircraft wings to catch subsonic cracking sounds in joints before the disease fully develops. They believe a disposable patch using them could save expensive diagnosis and treatment of advanced osteoarthritis.

This was subsequently reported online and in print in some of the following outlets - Sun, Daily Mirror, Daily Mail and Daliy Express. also the Irish News, Arthritis Digest, ARUK Website, Cardiff University Website

https://www.express.co.uk/life-style/health/757955/Arthritis-patches-breakthrough-detection-treatment-new

https://www.dailymail.co.uk/sciencetech/article-4147568/The-10p-patch-tell-arthritis.html

https://www.mirror.co.uk/science/patches-costing-just-10p-could-9673650

http://www.irishnews.com/magazine/2017/01/24/news/sensors-from-aircraft-wings-are-being-used-to-detect-arthritis-903044/

http://arthritisdigest.co.uk/smart-patch-enable-earlier-detection-osteoarthritis/

https://www.arthritisresearchuk.org/news/general-news/2017/january/new-smart-patch-study-could-aid-early-detection-of-osteoarthritis.aspx

https://www.cardiff.ac.uk/news/view/551410-osteoarthritis-smart-patch
Year(s) Of Engagement Activity 2017,2018
URL https://www.bbc.co.uk/news/uk-wales-south-east-wales-38604860
 
Description Cardiff Half Marathon - Engagement with Wearable Technology for Exercise and Rehabilitation Monitoring 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A stand at the Cardiff Half Marathon demonstrating the use of research to help experts investigate knee and back conditions. The use of state of the art wearable technology for exercise and rehabilitation monitoring was demonstrated by Dr Philippa Jones as part of the Arthritis research UK Biomechanics and Bioengineering Centre at Cardiff. The Cardiff Half attracted over 22,000 runners and 50,000 spectators over the weekend event.
Year(s) Of Engagement Activity 2017
URL https://www.cardiff.ac.uk/news/view/946685-experts-investigate-knee-and-back-conditions
 
Description Expo exposure at National Assisted Living Show 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Demonstration of assistive technology (including skin mountable RFID movement sensors) to the disabled community, families and carers at a national trade show.
Year(s) Of Engagement Activity 2016,2017
URL http://www.naidex.co.uk/
 
Description Media coverage BBC South Central 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Monitoring a person with parkinsons to row the indian ocean and pacific ocean
Year(s) Of Engagement Activity 2016,2017
URL https://www.facebook.com/bbcoxford/videos/1346403382068746
 
Description NAIDEX 2016 Exhibition 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact NAIDEX is the UK's largest disability, rehabilitation and homecare event with over 200 exhibitors showcasing their products to more than 9,000 visitors. The AART-BC Project will have a stand at the exhibition to begin the dissemination of information about the project to potential users and policy makers, including people with mobility disabilities, their carers, professionals who work with them, and those who procure systems for healthcare. We will also use this opportunity to collect data from people with mobility disabilities about their use of assistive technologies, their problems with these technologies and their wishes for improvements and new functionality. We will also recruit participants to work with us in the project.
Year(s) Of Engagement Activity 2016
URL http://www.naidex.co.uk
 
Description Public Lecture: University of Auckland 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Public Lecture at the university of Auckland on advances on 'The challenges of creating an accessible transport network in London' as part of the Research Cafe on: Accessible transport and mobility in an age and disability friendly city (Led by Professor Shanthi Ameratunga, Faculty of Medical and Health Sciences, 13-17 February 2017)have led to:
1) Follow-up discussions with Deloitte, Auckland and University of Auckland about creating a formal partnership with the Global Disability Innovation Hub
2) A number of interesting questions on the day and via email regarding how technology could be used differently to help improve accessibilty.
Year(s) Of Engagement Activity 2017
URL http://www.arts.auckland.ac.nz/en/about/our-research/research-centres-and-archives/engaged-social-sc...
 
Description Raising awareness of AART-BC with Clinicians 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Talks to acting clinicians at the Oxford University Hospital Foundation Trust, Oxford Health NHS Trust, Buckinghamshire Health NHS Trust, Stoke Mandevilly Hospital in the form of presentations / informal chats during organised seminar series. Presentation and informal chats sparked a large interest and lively discussions surrounding mobility use and lack thereof as identified from a clinician point of view. Aim of the presentation was recruitment. Engagement activity reached clinicians with n>40-50.
Year(s) Of Engagement Activity 2016,2017
 
Description The Cardiff Huntington's disease Centre & BRAIN Unit Research Open Day 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Hear talks by leading neuroscientists on the latest Huntington's disease research developments.

Keynote Speaker: Professor Stephen Dunnett, Behavioural Neuroscientist 'My Life in Research'

Joined by: Professor Anne Rosser & Professor Liam Gray

Learn about our many ongoing research activities with research poster displays and interactive stalls.

Refreshments will be provided in addition to a charity cake sale in aid of the Huntington's Disease Association of England and Wales
Year(s) Of Engagement Activity 2016
URL http://sites.cardiff.ac.uk/events/view/the-cardiff-huntingtons-disease-centre-brain-unit-research-op...
 
Description UCl-James Dyson foundation Summer School: Redesign the Wheelchair 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact The Summer School attracts hundreds of applications, from which we select 8 girls and 8 boys to come to UCL for one week. During this time they learn about engineering design practice, how to code sensors to measure wheelchair biomechanics, and making skills. They hear from experts in biomedical, mechanical and interaction engineering. Ultimately they first learn how to push a wheelchair (from wheelchair users) and understand how the basic issue NHS wheelchair could be improved for wheelchair users, then get to hack the wheelchair. They prove their designs at the end of the week. Our latest research is infused into the summer schools, in particular elements of coding and data visualisation. The summer school changes their view of what it is to be an engineer.
Year(s) Of Engagement Activity 2014,2015,2016
URL http://www.engineering.ucl.ac.uk/schools-engagement/news/james-dyson-foundation-summer-school-2016-r...
 
Description Versus Arthritis Media Spokes Person 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact CATHY HOLT - was invited to comment on in a Daily Mail interview regarding different walking styles and altered knee loading. She was Informed that it would be published in the Daily Mail in March 2019. The impacts/outcome have yet to be observed.
Year(s) Of Engagement Activity 2018,2019
 
Description Visit and talk to European Parkinson's Therapy Centre 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Talk regarding exercise adn Parkinson's on Italian media
Year(s) Of Engagement Activity 2015