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作者:劉育瑋 (2014-07-17);推薦:徐業良(2015-12-11)


Chapter 1. Introduction

This chapter 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.

1.1 Home telehealth systems

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 [……..]:

Ÿ   Increased demand of healthcare due to an increased number of elderly and changed life styles leading to an increase in chronic diseases;

Ÿ   Demand for increased accessibility of care outside hospitals, moving health services into the patient’s own homes;

Ÿ   Need for increased efficiency, individualization and equity of quality-oriented healthcare with limited financial resources;

Ÿ   Difficulties of recruiting and retaining personnel in the healthcare services in general and in home and elderly care in particular.

These challenges 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].

The “United 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 management.

1.2 A review of unobtrusive sensing technology for monitoring physical activities in bed

The monitoring 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.

Bed actigraphy 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. [1997] 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. [2003] 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. [1984] presented a design of the static charge-sensitive bed (SCSB) for long-term monitoring of respiration, heart rate, and body movements. Kaartinen et al. [2003] used the SCSB to determine the relation between movements in bed and sleep quality. Watanabe et al. [2005] 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 devices

Textile-based sensing techniques have been developed to provide unobtrusive monitoring of vital parameters and physical activities. As shown in Figure 1-3, Cheng et al. [2008] 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. [2008] 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. [2012] 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 challenge.

Some 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 this research

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.

Instead of 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.


Bruyneel M., Libert W., Ninane V., 2011. “Detection of bed-exit events using a new wireless bed monitoring assistance,” Int J Med Inform, Vol. 80, No. 2, pp. 127-132.

Bruyneel M., Van den Broecke S., Libert W., Ninane V., 2013. “Real-time attended home-polysomnography with telematic data transmission,” Int J Med Inform,Vol.13, pp. 57-59.

Choi B. H., Seo J. M., Choi J. M., Shin H. B., Lee J. Y., Jeong D. U., Park K. S., 2007. “Non-constraining sleep/wake monitoring system using bed actigraphy,” Med. Biol. Eng. Comput, Vol. 45, No. 1, pp. 107-114.