Chapter 1. Introduction
starts by describing the challenges of healthcare services and the needs of
home telehealth systems. Then the review is presented to explore the current
trend of unobtrusive sensing technology for monitoring physical activities in
bed. The approach of integrating monitoring of bed activities with home
telehealth system is also presented. Finally, the purpose of this research, development
of a bed-centered telehealth system based on a motion-sensing mattress for home
and nursing home environment, is described.
Given the rapid
increase in the aging population and the decline in birth rate, there is a
growing demand for healthcare services. Important issues
regarding healthcare services include [……..]:
Increased demand of healthcare due to an increased
number of elderly and changed life styles leading to an increase in chronic
Demand for increased accessibility of care
outside hospitals, moving health services into the patient’s own homes;
Need for increased efﬁciency, individualization and
equity of quality-oriented healthcare with limited ﬁnancial resources;
Difﬁculties of recruiting and retaining
personnel in the healthcare services in general and in home and elderly care in
have turned home healthcare into one of the most important areas of healthcare provision. With the rapid development of information and communication
technologies (ICT), the related technologies of healthcare develop in parallel
to these societal changes and offer the possibilities to solve the
above-mentioned challenges. For
enhancing the care quality of nursing homes and homes with the existing
manpower and care system, technology intervention for more efficient care
services has become an important issue in healthcare.
Telehealth is a
major application of ICT in healthcare. Telehealth is defined as “the use of
electronic information and telecommunications technologies to support
long-distance clinical health care, patient and professional health-related
education, public health and health administration.” [U. S. Department of
Health and Human Services, 2001] Telehealth is a practical approach that
connects individuals and healthcare providers through telecommunication
technology in a variety of application modalities in locations other than
hospitals or clinics [Mann, 2005].
Nations Principles for Older Persons” [Adopted by General Assembly resolution
46/91 of 16 December 1991] has addressed that elderly people should be able to
reside at home as long as possible, and consequently home has become the
centerpiece of healthcare delivery system today. Telehomecare, or the more
modern term “home telehealth”, is a relatively recent innovation. According to
the Canadian governmental report, telehomecare is defined as “the use of
information and communication technologies to enable effective delivery and
management of health services at a patient’s residence” [Office of Health and
Information Highway, 1998]. Home telehealth refers to the use, by a home care
provider, of modern telecommunication and information technology to link patients
to single or multiple out-of-home sources of care information, education, or
service over short or long distances [Koch, 2006]. Home telehealth differs from
telemedicine in the sense that people who transmit and receive medical
information are not necessarily medical doctors but the patients themselves and
their families, nurses, care-givers, home-helpers and medical technical
experts, etc [Tsuji, 2002]. A study suggested that home telehealth services may
enhance the users’ timely accessibility to necessary healthcare, reduce
preventable hospitalization and decrease direct and indirect medical costs over
time [Jia, et al., 2009].
For the older
adults who are living at home or nursing homes, the bed is an integral part of
their daily lives, especially for those who require care services provided by
the nursing homes or care homes. They often spend a long time lying in bed at
home for rest and sleep, and the bed thus becomes a necessary part of their
daily lives. In a routine nursing care, the nursing staff has to visit them bed
by bed to provide necessary aids and primary nursing care on schedule in order
to ensure the safety and health of the older adults. The bed is often used as a
basic unit for care service management, as well as older adults’ life and health
A review of unobtrusive sensing technology for
monitoring physical activities in bed
of physical activities in bed could provide valuable information of the status
of an older adult. Many care systems have been developed based on activities
detected in bed, for example, detection of bed-exit and fall events [Yonezawa et al., 2005; Ogawa et al., 2009; Bruyneel et al., 2011], recognition of sleep pattern and quality [Watanabe et al., 2005; Choi et al., 2007; Cheng et al., 2008; Migliorini
et al., 2010], prediction of early signs of illness in
older adults [Mahnot et al., 2012], and the monitoring of obstructive sleep apnea syndrome (OSAS) [Bruyneel et al., 2013]. In such systems,
motion sensing in bed, or bed actigraphy, is often the core technique.
is deﬁned as the measurement of movement in bed. Various types of noninvasive
and unrestrained sensing techniques have been implemented for this purpose.
Load cells or force sensors are the most common sensing components used to
detect body movements in bed. Nishida et al.  presented the idea of a
robotic bed, as shown in Figure 1-1, which is equipped with 221 pressure
sensors for monitoring respiration and body position. Van Der Loos et al. 
proposed a system called SleepSmart™, composed of a mattress pad with 54
force-sensitive resistors and 54 resistive temperature devices, to estimate
body center of mass and index of restlessness, as shown in Figure 1-2. Many
pad-based solutions have been proposed. Erkinjuntti et al.  presented a
design of the static charge-sensitive bed (SCSB) for long-term monitoring of
respiration, heart rate, and body movements. Kaartinen et al.  used the
SCSB to determine the relation between movements in bed and sleep quality.
Watanabe et al.  designed a pneumatics-based system for sleep monitoring.
A thin, air-sealed cushion is placed under the bed mattress of the user, and
the small movements attributable to human automatic vital functions are
measured as changes in pressure using a pressure sensor. These systems
implemented sensors into the bed, an approach whose complexity and cost may
limit their practical use.
Figure 1-1.The idea of a robotic bed with 221 pressure sensors
Figure 1-2. The SleepSmart™, composed of a
mattress pad with 54 force-sensitive resistors and 54 resistive temperature
sensing techniques have been developed to provide unobtrusive monitoring of
vital parameters and physical activities. As shown in Figure 1-3, Cheng et al.
 proposed a portable device for telemonitoring physical activities to
evaluate body movements with quantitative measurement and to recognize sleep
pattern and quality. Carvalho et al.  developed textile and polymers
applications (cushions, mattresses, and mattresses overlays) able to monitor
and control the pressure in the body’s areas that are in contact with the
support surfaces, as shown in Figure 1-4. Peltokangas et al.  proposed an
integrated system that uses eight embroidered textile electrodes attached
laterally to a bed sheet for measuring bipolar contact electrocardiography
(ECG) from multiple channels, as shown in Figure 1-5. The textile-based sensing
techniques should have greater potential to facilitate long-term monitoring
with lower disturbance or discomfort.
Figure 1-3. The portable device and the textile-based
sensing sensor for telemonitoring physical activities
Figure 1-4. A textile and polymers applications
(cushions, mattresses, and mattresses overlays)
Figure 1-5. The integrated system with eight
embroidered textile electrodes on the bed
Many of these
motion-sensing techniques can extract signals of physical activities in bed in
an unobtrusive way. However, how to adapt these techniques to be viable for the
home or nursing home in terms of complexity, cost, and comfort, remains a major
commercialized bed sensors for detecting movements in bed, bed occupancy and
fall event can be found in the current market (ex: Telehealth Sensors LLC, Tunstall
Healthcare (UK) Ltd). The functions of these products mainly focus on emergency
event alert. When an abnormal event is detected, these products will alarm
local caregivers for specific care services.
1.3 Purpose of
The purpose of
this research is to develop a Bed-Centered Telehealth System (BCTS) based on
the commercialized motion-sensing mattress WhizPAD, and to extend the
bed-centered home telehealth system for broader telehealth applications in home
and nursing home environment.
creating a brand new system for home users, the design concept of the BCTS is
to integrate functions into something that already exists in the home, namely
the bed. The core sensor of the BCTS is a soft motion-sensing mattress, WhizPAD,
developed for unobtrusive sensing of physical activities in the bed at home or
in a nursing home. In WhizPAD the mattress itself is designed into a
sensor using textile-based sensing techniques, rather than adding sensing
components into the bed. WhizPAD collects signals of physical activities
in bed, which can be classified into events such as on/off bed, sleep posture,
movement counts, and respiration rate. By being integrated with information and
communication systems, the BCTS can provide home telehealth functions including
real-time sleep monitoring, care service reminder, and historical data record.
Chapter 3 describes the BCTS applications in home and nursing home scenarios.
The BCTS has the
potential to be extended for broader applications. Additional sensors for
activity of daily living (ADL) monitoring can also be added. Instead of
creating a brand new telehealth system for home users, the design concept of
BCTS is to integrate telehealth functions into something that already exists in
the home, namely the bed. Chapter 2 presents the development and
commercialization of the integrated motion sensing mattress. Chapter 3
describes the bed-centered telehealth system for home environment. The bed-centered
telehealth system for nursing home is presented in Chapter 4. Chapter 5 discusses
the extension of the bed-centered telehealth system. Finally Chapter 6
concludes the research.
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Bruyneel M., Van
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