Modelli a confronto per una tecnologia innovativa a favore delle persone non autosufficienti

filippo cavalloIstituto di Biorobotica e Istituto Dirpolis della Scuola Superiore Sant’Anna di Pisa

LA TECNOLOGIA E LA PERSONA

MERCOLEdì 9 NOvEMbRE 2011

Forum sullaNon AutosufficienzaBologna 9-10 novembre 2011Centro Congressi Savoia Hotel

Filippo Cavallo

La tecnologia e la persona

Filippo Cavallo

Electronic Engineer – PhD

Post Doctoral Researcher

The BioRobotics Institute

Scuola Superiore Sant'Anna - Polo Sant'Anna Valdera

Viale Rinaldo Piaggio, 34

56025 Pontedera, Pisa - ITALY

http://www-arts.sssup.it

Phone: +39 050 883474

Fax: +39 050 883101

E-mail: f.cavallo@sssup.it

Presentation’s schedule

• Demographical and societal background

• European Approach and initiatives

• “Human factor” in technology

• Our experience

• Conclusions• Conclusions

Presentation’s schedule

• Demographical and societal background

• European Approach and initiatives

• “Human factor” in technology

• Our experience

• Conclusions• Conclusions

Background

� New European population projections has recently underlined that the number of

elderly persons will quickly increase*.

• The fiscal impact of ageing will be substantial in almost all European Member

States through two main channels**:

– Pension (public expenditure increase up to 5% GDP)

– Health care and long-term care (public expenditure increase up to 1.5% GDP)

* European population projections for 2008-2060, published by the European Office for Statistics.

** Report on the impact of ageing populations on public spending”, Council of the European Union, 2006.

Demographic trends

• A growing number of elderly people living alone and in need of care and withphysical disabilities.

• A growing number of older people lacking basic financial and social resources,who will have difficulties obtaining a minimum of health and care services;

• More financially well-appointed and wealthy senior citizens ready to enjoytheir third age and to spend money on products securing and enhancingtheir third age and to spend money on products securing and enhancingwealth, safety, security and not forgetting entertainment and communicationsneeds.

• Changing family relationships and living situations (e.g. larger geographicdistances between relatives) affecting the level of support that family memberscan give;

• An ageing workforce in general and the need to keep older people active insociety and at work.

Economic trends

• Hospitals are increasingly trying to differentiate their offerings fromcompetitors. They offer a broader portfolio that is more tailored to individualcustomer needs.

• Tele-medicine companies are developing to complement existing stationaryand ambulant treatment – a gap is being filled.

• Services offered by care-delivery organizations in the broadest sense: -- e.g.home-care organizations, security firms, community centres - are becomingmore important than equipment and they result in a b2b business model.

• Integration of services at the site of care delivery organizations will become animportant differentiator.

Presentation’s schedule

• Demographical and societal background

• European Approach and initiatives

• “Human factor” in technology

• Our experience

• Conclusions• Conclusions

EU approach for ICT for Ageing Well

FP7 Workprogram

Indicative

Budget (M€)

Funding

schemes

Objective ICT-2011.5.1: Personal Health Systems (PHS) 60 IP, STREP; CSA

Objective ICT-2011.5.2 Virtual Physiological Human 68 IP, STREP; CSA

Challenge 5 Calls for Proposals

Objective ICT-2011.5.3 Patient Guidance Services (PGS),

safety and healthcare record information reuse35

IP, STREP, NOE,

CP, CSA

Objective ICT-2011.5.4 ICT for Ageing and Wellbeing 37IP, STREP, CP,

CSA

Objective ICT-2011.5.5 ICT for smart and personalised

inclusion33 IP, STREP; CSA

Objective ICT-2011.5.6 ICT solutions for governance and

policy modelling25 IP, STREP; CSA

AAL Joint Program Calls

ICT-based Solutions for

ICT-based Solutions for

Advancement of Older Persons’

Mobility

Call 4

Call 3

“ICT based solutions for Prevention

and Management of Chronic

Conditions of Elderly People”

“ICT based solutions for

Advancement of Social Interaction

of Elderly People”

ICT-based Solutions for

Advancement of Older Persons’

Independence and Participation in

the “Self-Serve Society”

Call 1

Call 2

Ambient Assisted Living paradigm

• “Ambient Assisted Living” (AAL) denotes concepts, products and services that

interlink and improve new technologies and social systems, with the aim of

enhancing the quality of life for all people in all stages of their lives.

• AAL could be best translated as “intelligent systems of a specific assistance for a

better and safer life in the home environment”.

ICT-enabled assisted living and innovative technological developments can really

provide aims and improvements:

• Quality of life, autonomy, participation in social life, skills and the employability

of older people.

• Home assistance for

ICT-enabled assisted living

– Patients.

– Caregivers.

• Domiciliary assistance for slowing down the course of the illness (not early

hospitalization).

• Reduction of welfare costs (nursing home costs three time the domiciliary one).

Home Automation

• Home automation* may designate an emerging practice of increased automationof household appliances and features in residential dwellings, particularlythrough electronic means…

• Possible Classification in six function domains**

Automation

Electronics

Informatics

Telecommunication

Meccanics

* Wikipedia definition

** G. Del Zanna, M. Malavasi, and G. Vaccari, “Manuale illustrato per la domotica ad uso sociale”, Tecniche Nuove

Comfort

Home Security Communication

Person Security

Well being

Person

Energy Saving

Meccanics

Building Industry

Architecture

Business in HA

• Advanced applications for exclusive private houses.

• Capitulate-based for standard installations.

• Nautical and exclusive boats

� Specific and personalized application for elderly,

disable and not sufficient people.

Presentation’s schedule

• Demographical and societal background

• European Approach and initiatives

• “Human factor” in technology

• Our experience

• Conclusions• Conclusions

Comparison AAL - HA

Comfort

Automation

Home Security Communication

Well being

Person

Energy Saving

• AAL has concepts wider than HA.

• AAL is referred to specific applications and needs of users.

Home Security Communication

Person Security

More in AAL

• Surrounding

– Social activity

– Social Interaction

– Hobbies

– Inclusion

– Work ability

– Mobility

• Dependency from:

– Habits

– Life style

– Needs

– Pathologies

– Evolution of illness

– Psycho-Social conditions– Mobility

– Learning

– Psycho-Social conditions

Primary Stakeholders-Users

-Caregivers

Tertiary Stakeholders- Organization supplying goods and services

Quaternary Stakeholders- Organization analyzing the economical and legal context of AAL

Secondary Stakeholders-Organization offering services

Users

Requirements for “human factor” in

technology

• Technological solutions combined with assistive services

• Improvement of the management of socio-medical

providers and the quality and performance of the service

itself for end-users

• Inclusion of technical, ethical, legal, clinical, economical • Inclusion of technical, ethical, legal, clinical, economical

and organizational issues

Requirements for “human factor” in

technology

• User centred design approach

• Involvement of a multidisciplinary team (end-users,

caregivers, relatives, socio-medical operators, etc.) in

the design phases

• Assessment of acceptability and usability• Assessment of acceptability and usability

Requirements for “human factor” in

technology

• the technological solutions should be:

– adequate to the end-users’ needs

– adaptive to the environment and end-users’s behaviour

– embedded not invasively in the environments, appliances and furniture

– easily wearable by end-users

pro-active with Ambient Intelligence (AmI) capabilities– pro-active with Ambient Intelligence (AmI) capabilities

– highly usable with advanced human machine interfaces.

DOMOCASA

AALIANCE

the European Ambient Assisted Living Innovation Alliance

Ambient Assisted

Living - Strategic

Research Agenda

AALIANCE

AALIANCE2 – FP7 Oct 2011 – Sep 2013

The domains in AAL

Ageing well (@home, @mobile)

PERSONAL AUTONOMY AND WELL-BEING

AAL4Person

AAL in the Community

Ageing well in one’s social environment

PARTICIPATION

Ageing well in one’s working environment

ACTIVE AND PRODUCTIVE AGEING

AAL@Work

AAL in the Community

AAL4Person

Main scenarios and needs:• Personal diseases and activities management and monitoring

• Daily support and assistance in chronic diseases to adjust

treatment with drugs and to avoid hospitalization

• Personal support in daily activities

• Physical-therapy treatments in rehabilitation

• Safety and security in every aspect of life and in various

environments

• Support for multi-disciplinary care teams

AAL@Community

Main scenarios and needs:

• Social participation in the society

• Public services and utilities

• Entertainment and leisure activities

• Support to mobility• Support to mobility

AAL@Work

Main scenarios and needs:

• Safety, security and prevention

• Cooperation and support at work

• Tele-work

Presentation’s schedule

• Demographical and societal background

• European Approach and initiatives

• “Human factor” in technology

• Our experience

• Conclusions• Conclusions

SSSA Experience in National and EU Projects

Smart EnvironmentsRobotics

RITARobot-Era

ASTROMOBILE

Mantova Alzheimer

Sorriso

Parkinson

DustBot

Movaid

Ausili

ENABLE

RISDOMMovement

Dedalo

AALIANCE

AALIANCE2

Parkinson

Consulenza tecnologica

• Centro Consulenza Ausili ASL Livorno

• Laboratorio Ausili ASL Pisa

Azienda USL 6 di Livorno CENTRO CONSULENZA AUSILI

ASSISTIVE SOLUTIONS

BISOGNI SOLUZIONI

• Emergenti nella situazione di vita• Selezionati nel progetto riabilitativo

• Informazione• Consulenza• Supporto• Formazione• Ricerca

Il sistema Ausilio

CentroAusili

RITA

• Progetto di ricerca finanziato dalla Regione Toscana

nell’ambito POR CREO FSE 2007-2013 “Studi interdisciplinari in

Regione ToscanaPOR-CREO 2007-2013

Enti Promotori:

Studio, implementazione e sperimentazione di Reti ICT in Toscana

e Assistenza socio-sanitaria per anziani e non autosufficienti

nell’ambito POR CREO FSE 2007-2013 “Studi interdisciplinari in

campo sociale” (lett. G).

• Consorzio

1. Scuola Superiore Sant’Anna

• Istituto di Biorobotica - ARTS Lab

• Istituto Dirpolis – WISS

2. Società della Salute – Zona Pisana

3. Fatronik Italia s.r.l.

4. TechnoDeal s.r.l.

Enti Promotori:Scuola Superiore Sant’Anna

SDS Pisa

Fatronik Italia

TechnoDeal

Project DevelopersDr. Michela Aquilano

Dr. Filippo Cavallo

Dr. Elettra Stradella

Project Coordinator:Prof.ssa M. C. Carrozza

Cos’è RITA?

Obiettivi specifici giuridico-sociali-tecnologici

Implicazioni etico-legali

Principio di sussidiarietà

orizzontale e ruolo del

terzo settore

Modelli organizzativi

ed erogativi

Modelli di integrazione

socio-sanitaria

Unità e decentramento

nell'assistenza socio-

sanitaria

Modelli regionali toscani

Implicazioni etico-legali

nell’utilizzo di tecnologie

innovative

Tecnologie innovative

per l’assistenza

Tecnologie per ambienti

domestici assistiti

Tecnologie indossabili per

monitoraggio

Obiettivi operativi

Reclutare un vasto numerodi utenti: pazienti e caregivers

Focus groups Questionari Interviste

32Analisi e design

della tecnologie

Analisi servizi per

anziani

Validazione delle

tecnologie

sperimentate

Analisi bisogni,

QoL per anziani

1 4

32

Livelli di analisi

Cos’è RITA?

Obiettivi specifici tecnologici

• Sviluppare soluzioni tecnologiche di AAL da inserire nell'ambiente domestico o residenziale

delle persone da assistere e a diretto contatto con i soggetti stessi.

– supporto alla vita indipendente e autonoma di persone non autosufficienti;

– attività di monitoraggio e di controllo di persone non autosufficienti svolta dai caregiver.

• Realizzare un sistema tecnologico modulabile costituito da:

– un modulo indossabile miniaturizzato;

– un modulo di localizzazione per ambienti indoor and outdoor;– un modulo di localizzazione per ambienti indoor and outdoor;

– un software di gestione degli eventi;

– un modulo black box per registrare i dati e le attività quotidiane del soggetto.

Progetto “Alzheimer Mantova”

Favorire la permanenza domiciliare e facilitare l’assistenza di persone affette da

gravi forme di Demenza, come la sindrome di Alzheimer, grazie all’aiuto di

sistemi domotici intelligenti.

Psicologi

Ingegneri Terapisti

Clinici

Utenti

PazientiIngegneri Terapisti

Smart Domestic System

Qualità di vita e bisogni degli utenti (scheda)

• Utenti e qualità di vita

– WHOQOL-BRIEF

– WHOQOL-OLD

• Bisogni / Abitudini /Aspettative

– ADL / IADL

• Scenari di Assistenzaattuale

Cognome e nome paziente Tizio Caio

Bisogno La paziente esce quotidianamente per partecipare alla Messa;

è solita avvisare i familiari con una telefonata quando rientra a

casa, ma capita che se ne dimentichi, e questo genera ansia nei

familiari stessi.

Scenario In caso di uscita ed ingresso in casa della paziente, il caregiver

(badante, parente o altro operatore) riceve sul proprio telefono

cellulare un messaggio che comunica il fatto che la paziente sia

uscita (o rientrata) e a che ora.

Funzioni � Rilevamento dell’ingresso/uscita della paziente dall’appartamento

o Rilevamento del transito da parte della pazienteattuale

• Scenari di Assistenza Ideali

• Funzioni

• Soluzioni Tecnologiche

• Valutazione:

– Priorità dei bisogni

– Fattibilità degli interventi

o Riconoscimento del verso di attraversamento (in/out)� Segnalazione dell’uscita (e dell’ingresso) della paziente al caregiver/alla

badante attraverso messaggio di testo su telefono cellulare

Soluzione � Nodo di acquisizione sensoriale ed elaborazione con: lettore RFID (Radio

Frequency IDentifiers) in corrispondenza della porta di ingresso; oppure

microcontrollore e interfaccia di comunicazione wireless su protocollo

ZigBee

� Transponder RFID indossabili (braccialetto, scarpe, altro da identificare)

per l’identificazione della paziente in prossimità della porta oppure

modulo ZigBee

� Fotocellule per il riconoscimento del verso di transito attraverso la porta

� Unità centrale di elaborazione degli eventi (PC con software dedicato)

dotata di interfaccia GSM (o altri standard di telefonia cellulare) per

l’invio di messaggi di testo.

Priorità 1 2 3 4 5

Accettabilità delle tecnologie

AccettabilitàAccettabilità

UsabilitàUsabilità

EfficaciaEfficacia EfficienzaEfficienza

Altri parametri

Altri parametri

UtilitàUtilità EsteticaEstetica

• Fase iniziale– Approccio alle

tecnologie

– Preconcetti

Fase design

Soddisfazione d’uso

Soddisfazione d’uso

Impatto sulle abitudini

Impatto sulle abitudini

IngombroIngombro

SicurezzaSicurezza PortabilitàPortabilità

ComfortComfort

• Fase design– Verifica della

rispondenza dei

prototipi

• Fase finale– Validazione

delle tecnologie

• Usabilità (ISO 9241), Technology Acceptance Model 2 (TAM2), Unified Theory of Acceptance and Use ofTechnology (UTAUT)

ASTROMOBILE

Robotic assistive platform integrated in an indoor smart environment with localization and

navigation capabilities and multimodal interfaces with users

38

Technological Challenges

• Robot and user localization based on RSSI signals of a low cost, pervasive and wireless

sensor network.

• Navigation in largely unstructured environments.

• Multimodal interactions with users based on natural language and touch screen.

Adaptability

Creative use of technology

Intelligence

• 3D robotic services.

• Multidisciplinary human and town

centred design approach.

• Mobile robotic systems integrated in

Ambient Intelligence.

• Embedded sensors for navigation in

largely unstructured environments.

• Sharing information with the Ambient

Intelligence

• Engineers

• Designers

• Elderly

People

• Robots working in indoor and

outdoor environments, that

cooperate between them and

the Ambient Intelligence.

• Pervasive wireless sensor

network for indoor and

outdoor

Innovation

Dependability

Interactivity

• More adaptive, working in largely

unstructured environments.

• Presence of modular and

interchangeable tools according to end-

user needs.

• Advanced interfaces to communicate

and exchange information with end-

users.

• Physical interaction with end-users

(acting as co-workers).

• Dependable and safe, satisfying the Asimov

laws.

• More robust, without performance

degradation with unexpected data.

• More effective, with capabilities to predict or

anticipate events.

• More natural dealing with humans without

ambiguity and uncertainty.

• Handle to

support user to

stand up,

walking

• Holder for objects

• Speech recognition and vocal

synthesis

• Multi touch screen

• Multicolored LED-based

arrays

• Cover with a mixture

of soft and hard

materials

Navigation sensor

• Odometers

• Inertial

• Laser-scan

• Ultra-sounds

Need: Unreliable memory.

Solution: Remembering events

(i.e. reminding to take

drugs).

Need: Walking and lifting difficult for motor deficits.

Solution: The robot assists the user in motor tasks.

S

C

E

N

A

R

I

O

1

Need: Health problems and accidents.

Solution: The robot recognizes dangerous

events and activates alerts for

caregivers.S

C

E

N

A

R

I

O

2

S

C

E

N

A

R

I

O

3

Scenarios

Need: Loneliness and isolation.

Solution: The robot favours the socialization of the users,

reminding appointments and encouraging them to meet

friends or contact them (i.e. video calls, virtual remote

games, etc.).Need: Support in bringing heavy

objects.

Solution: The robot assists the user in

shopping.S

C

E

N

A

R

I

O

4

S

C

E

N

A

R

I

O

5

Impact

• Efficient management and delivery of health

and social care.

• Improvement of independent living.

• Improvement of quality of life and efficient

cares of elderly people.

• Sustainable welfare services for elderly

people.

* The “3D Robotic Services” concept is being implemented and funded in the :

-ASTROMOBILE experiment of the ECHORD project (FP7-ICT-2007, October 2010 – March

2012)

-Robot-Era project (FP7-ICT-2011-7, October 2011 – September2015)

Main distinctive features of Robot-Era

� User- and town- centred design approach

� Integrated robotics systems and smart environments(both indoor and outdoor)

� Leveraging S/T competencies to develop new anduseful services

� Real (and not only realistic) environments

The OBJECTIVE of the Robot-Era proposal is to develop, implement and demonstrate the general feasibility, S/T effectiveness and social/legal

plausibility and acceptability by end-users of a plurality of complete advanced robotic services, integrated in intelligent environments, which

will actively work in real conditions and cooperate with real people and between them to provide favorable independent living, improving the

quality of life and the efficiency of care for elderly people.

Robot-Era

42

� Real (and not only realistic) environments

� Creating permanent infrastructures beyond the endof Robot-Era project

� Unique capability to support elderly people withdifferent levels of autonomy from home to the street

Robot-Era Platforms

Robot-Era End-user Target

End-user Target

� Men and women over 65 years old.

� With moderate health problems and

motor and cognitive deficits.

� Living alone or with their relatives but

without a devoted caregiver.

Application Service Domains

Single Sites Robot-Era Systems

HOME- Domestic robot

- AmI

CONDOMINIUM- Condominium robot

- AmI

TOWN- Outdoor robot

- AmI

Combined Sites Robot-Era Systems

CONDOMINIUM + - Condominium robot

- Outdoor robotHigh

Level of User Authonomy

� Entity of pathologies and/or motor-

44

� Elderly people are not the weak part of the society, that only receives assistance and

support, but an active one, that can contribute to the community with its experience and

participation.

� “Ageing well” means not only having a good health but also being independent and autonomous,

participating actively in society life, and having a good quality of life.

CONDOMINIUM +

TOWN- Outdoor robot

- AmI

HOME +

CONDOMINIUM

- Domestic robot

- Condominium robot

- AmI

HOME +

CONDOMINIUM +

TOWN

- Domestic robot

- Condominium robot

- Outdoor robot

- AmI

High

Middle

Low

� Entity of pathologies and/or motor-

cognitive impairments

� Environmental and contextual

conditions:

� meteorological conditions

� traffic, soil,

� commitments of end-users

� typology of house (apartment,

cottage, etc.)

� …

Presentation’s schedule

• Demographical and societal background

• European Approach and initiatives

• “Human factor” in technology

• Our experience

• Conclusions• Conclusions

Conclusions (1)

Technology view:

• End-user perspective in design and development of

technologies

• Technologies in a more wide technological service

• Ethical, legal issues• Ethical, legal issues

• Usability, acceptability and attitude to technology

• Adaptive, not invasive and pro-active technologies

Conclusions (2)

End-user view:

• Independent living

• Management of diseases (also chronic)

• Human dignity

• Relationship with people• Relationship with people

• Access to society (services, rights, etc.)

Conclusions (3)

Society view:

• Policy maker involvement

• Standardization and interoperability of technologies

• Sustainable welfare

• Funds / Costs• Funds / Costs

• Organization of socio-medical services