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This book documents the state of the art in the field of ambient assisted living (AAL), highlighting the impressive potential of novel methodologies and technologies to enhance well-being and promote active ageing. The coverage is wide ranging, with sections on care models and algorithms, enabling technologies and assistive solutions, elderly people monitoring, home rehabilitation, ICT solutions for AAL, living with chronic conditions, robotic assistance for the elderly, sensing technologies for AAL, and smart housing. The book comprises a selection of the best papers presented at the 9th Italian Forum on Ambient Assisted Living (ForitAAL 2018), which was held in Lecce, Italy, in July 2018 and brought together end users, technology teams, and policy makers to develop a consensus on how to improve provision for elderly and impaired people. Readers will find that the expert contributions offer clear insights into the ways in which the most recent exciting advances may be expected to assist in addressing the needs of the elderly and those with chronic conditions.



Models and Algorithms


A Personalised Virtual Coach to Counteract Ageing Decline: The H2020 NESTORE Project

Ageing population is growing faster in EU. ICT can provide solutions for Active Ageing; however, the success of novel ICT solutions depends on the user perception of their efficacy to support toward health promotion and global wellness. In this context, the H2020 project NESTORE (Non-intrusive Empowering Solutions and Technologies for Older people to Retain Everyday life activity) will develop an innovative, multidimensional, personalised e-coaching system to support healthy ageing by: (1) Generating and sustaining motivation to take care of health; (2) Suggesting healthy nutrition and personalised physical and mental coaching, as well as social interaction, to prevent decline and preserve wellbeing. NESTORE started in September 2017 and will last three years. It involves 16 partners from 7 European countries.

Maria Renata Guarneri, Alfonso Mastropietro, Maurizio Caon, Laura Fernandez Maldonado, Francesco Furfari, Giuseppe Andreoni, Giovanna Rizzo

Multi-domain Model of Healthy Ageing: The Experience of the H2020 NESTORE Project

Ageing is a complex multidimensional and multifactorial process associated with the decline in multiple physiological systems which can lead to frailties and disabilities over the lifespan. With the aim of supporting healthy older adults in order to sustain their wellbeing and capacity to live independently, the NESTORE project was recently funded by the EU Commission. In order to take into account the complex interactions among different aspects involved in the ageing processes, a model of healthy ageing was developed in NESTORE. This model included three core dimensions related to older people wellbeing (Physical/Physiological, Nutritional, Cognitive/Mental/Social). The NESTORE model was intended to provide a structured arrangement of the knowledge coming from such different domains in order to provide a simplified pool of information for: (i) the characterization of the older adults, (ii) the personalization of the coaching plans and (iii) the implementation of an effective ICT system.

Alfonso Mastropietro, Christina Roecke, Simone Porcelli, Josep del Bas, Noemi Boquè, Laura Fernandez Maldonado, Giovanna Rizzo

New Models in Managing Out-of-Hospital Care of Chronic Patients and Aging Population

Success story: When Care and Informatics know-how embrace patients’ needs and make possible new Out-of-Hospital Integrated Care Models. Healthcare is reforming to focus on the patients, to put them in the center of care and have medical professionals around them, working together in a collaborative and efficient way. Important not for profit Care providers, like Cooperatives, are playing a central role, upgrading to Integrated Solutions Coordinators. Patient engagement is crucially important in raising the level of care, and the involvement of non-medical professionals can further improve the treatment outcome. The usage of a collaborative healthcare platform can therefore provide significant benefits to the patients, and such positive results can be achieved in a user-friendly online environment.

Ilir Qose, Raffaele Conte, Francesco Sansone, Alessandro Tonacci

From Ambient Assisted Living to Society Ambient Living

The developments of TLC networks and computer-based equipment allow the test of the Ambient Intelligent (AmI) concepts. In this paper these ideas are discussed from the perspective of activities carried out as an effort to help people (mainly old people) to live independently and comfortably. Three levels of implementations are discussed: the present situation, where intelligence is mainly meant as the use of computer-based equipment, able to adapt their behaviour to different users, the developments in progress, where equipment are connected under an intelligent control in the environment, for the implementation of functionalities and the communication with other supporting people, and future extension to the entire communication network, where intelligent user agents are able to look for potentially interesting contacts and negotiate to check promising opportunities, before involving users themselves.

Laura Burzagli, Pier Luigi Emiliani, Simone Naldini

Designing Multidimensional Assessment of ICTs for Elderly People: The UNCAP Clinical Study Protocol

The elder with mild or moderate cognitive impairment (MMCI) suffers from progressive cognitive decline with increasing difficulties in performing activities of daily living. Information and Communication Technology (ICT) for Healthcare can provide solutions to relief the caregivers’ burden and to support the elder in maintaining dignity and independence. The UNCAP European project aimed at developing and testing a bundle of hardware and software technologies able to fit the individual needs of the elder with MMCI and his/her formal and informal caregivers. A multicenter clinical investigation was designed for assessing improvements in the quality of life of all users (elderly with MMCI and their caregivers) and the impact on the use of resources for care. Six pilot sites in Italy were involved in this clinical investigation. A complex set of assessment tools allowed exploring a wide range of dimensions and to extract common indicators and outcomes in accordance to the assessment dimensions required by the Health Technology Assessment approach.

S. Anzivino, G. Nollo, V. Conotter, G. M. A. Guandalini, G. Conti, F. Tessarolo

A Technological Approach to Support the Care Process of Older in Residential Facilities

Faced with an increasing number of elderly housed in residential facilities, there is a request for greater transparency regarding the state of health of the guests and the level of assistance that these guests are offered. The OPENCARE project described in this article aims to respond to this need to promote communication between residential structures and guest families, by introducing a technological platform able to meet this requirement without the need to increase the workload of the operators. Therefore, this article describes the solution adopted, which are based both on data acquired from sensors and on those entered by the operators through a suitably designed interface.

Ennio Gambi, Manola Ricciuti, Gianluca Ciattaglia, Lorena Rossi, Paolo Olivetti, Vera Stara, Rossana Galassi

A Non-invasive Method for Biological Age Estimation Using Frailty Phenotype Assessment

The human body hasPierleoni, Paola two different ages: a Chronological Age (CA),Belli, Alberto the actual time a person has been alive,Concetti, Roberto and a Biological Age (BA), the real age that indicate the decline in health and in function ability during aging.Palma, Lorenzo Among previous studies, some authors proposed methodologies to estimate the Biological Age starting from non-invasive frailty measurements to evaluate the Frailty Index, Pinti, Federica others proposed invasive and expensive methods to measure the biological aging. Raggiunto, Sara Conversely, in this paper we propose a method to estimate the BA of a subject based on the assessment of the Frailty Phenotype.Valenti, Simone This type of evolution allows an efficient estimation of the frailty in contrast with the Frailty Index which is composed by a long checklist of clinical conditions and diseases to be evaluated from medical staff. Monteriù, Andrea We developed a cloud application, able to store and elaborate the data acquired during the evaluation protocol of the Frailty Phenotype, and also able to automatically provide the state of phenotypic fragility, and finally the Biological Age of a subject.

Paola Pierleoni, Alberto Belli, Roberto Concetti, Lorenzo Palma, Federica Pinti, Sara Raggiunto, Simone Valenti, Andrea Monteriù

Enabling End Users to Define the Behavior of Smart Objects in AAL Environments

In Ambient Assisted Living (AAL), Internet of Things (IoT) technology is exploited to equip living environments with smart objects that communicate with the outside world in an intelligent and goal-oriented manner and can support the occupants’ activities. Currently, providing such objects with new capabilities requires several programming efforts. In this paper, we present an approach to combine IoT technologies and End-User Development (EUD) paradigms and tools to identify innovative scenarios where end-users are directly involved in the creation and customization of the AAL systems they use. We will present EFESTO, a Task Automation tool that offers novel visual interaction paradigms to enable end users to easily express rules for smart object configuration and discuss how the overall approach can support daily practices of non-frail elderlies.

Carmelo Ardito, Paolo Buono, Maria Francesca Costabile, Giuseppe Desolda, Rosa Lanzilotti, Maristella Matera, Antonio Piccinno

Smart Objects and Biofeedback for a Pediatric Rehabilitation 2.0

The progressive miniaturization of electronic devices and their exponential increase in processing, storage and transmission capabilities, is opening new scenarios in pervasive computing, like the Ambient Assisted Living (AAL) and Internet Of Things (IoT). Although most of the investigations in the recent years focused on remote monitoring and diagnostic efforts, rehabilitation too could be positively affected by the use of these solutions, since these small Smart Objects may enable novel quantitative approaches. In this paper, we present the preliminary efforts in designing a pediatric rehabilitation protocol based on Smart Objects and biofeedback, which we administered to a small sample of hemiplegic children. Despite the few treatments (not suitable to assess any change in the subjects’ abilities), children enjoyed participating in the study, and the initial qualitative/quantitative results highlight that such approach could represent an interesting starting point to fuel the scientific and clinical discussion towards a Pediatric Rehabilitation 2.0.

Paolo Meriggi, Martina Mandalà, Elena Brazzoli, Tecla Piacente, Marcella Mazzola, Ivana Olivieri

The Use of Smart Tools for Combined Training of People with MCI: A Case Report

Dementia and Alzheimer’s Disease affects more than 35 million people worldwide. TheMancioppi, Gianmaria onset andCastro, Emanuela the developmentFiorini, Laura of this pathological condition are generally subtle and progressively. Nevertheless,Maselli, Martina is often possible identifyingLaschi, Cecilia some precursors symptoms of the disease. A nosographic entity, Cecchi, Francesca which describes this conditionCavallo, Filippo between healthy and pathological aging, is called Mild Cognitive Impairment (MCI). Over the last years, several new technologies are entering in the field of medicine and neuropsychology, especially, Information and Communication Technologies (ICT). Today ICT are more and more being recognized as a valid instrument for assessment, treatment, and assistance of subjects who are suffering from MCI. This paper reports two case studies about the use of two new technological tools for the cognitive assessment and stimulation of elderly healthy people or subjects suffering from MCI. This study purpose is to investigate the peculiarities, in terms of cognitive performances, highlighted by the use of these smart systems, namely SmartWalk and SmartTapestry system.

Gianmaria Mancioppi, Emanuela Castro, Laura Fiorini, Martina Maselli, Cecilia Laschi, Francesca Cecchi, Filippo Cavallo

Designing and Implementing a Transferability Testing Methodology for AAL Systems Dedicated to Integrated Care Services

Implementing a multi domain ICT system for integrated care is a complex process, dependent from many different factors. The purpose of this paper is to describe the design and implementation plan for testing the transferability of an ICT based solution for Integrated Care (the ProACT system). The transfer Trial of the system will be held in Italy, while Main Trial in Ireland and Belgium. This paper outlines the details of the implementation plan, including the aims and objectives of the trial, the study methodology and design, the recruitment procedures and data collection and analysis. The target participants will be older persons with multimorbidity (PwMs), informal carers (ICs), formal carers (FCs) and healthcare professionals (HCPs). This paper also outlines the practicalities needed in preparing for the trial, such as the deployment of technology to participants, a key factor to ensure that this complex multi domain trial can run smoothly over all the one-year duration.

Massimiliano Malavasi, Evert Jan Hoogerwerf, Valentina Fiordelmondo, Lisa Cesario, Carlo Montanari, Lorenzo Desideri

The Design, Implementation and Evaluation of a Mobile App for Supporting Older Adults in the Monitoring of Food Intake

Older adults are required to adjust their eating habits to maintain a good health status. However, they may struggle to adopt these new practices. Given their increasing spread, smartphone-based interventions may be a good option for providing older adults an aid to keep track of their food intake. In the present work we adopted a user centered design approach to implement and evaluate a mobile app, i.e., ‘Salus’, to support older adults in the monitoring food intake.

Valeria Orso, Anna Spagnolli, Federica Viero, Luciano Gamberini

Reasoning in Multi-agent Based Smart Homes: A Systematic Literature Review

Multi-agent systems are widely used to model components of a smart living environment as autonomous intelligent agents. Accordingly, its advantages to achieve the comfort and efficiency goals of smart home systemsMekuria, Dagmawi Neway are well-documented in many studies. However, there is a clear lack of systematic investigation targeted at exploring the reasoningSernani, Paolo modules integrated into these systems. To close this gap, this paper examines the literature on multi-agent based smart home systems and provides a comprehensive overview of the essential requirements, Falcionelli, Nicola assumptions, strengths, limitations, challenges and future research directions of their proposed reasoning systems. Moreover, it identifies the main technologies used to representDragoni, Aldo Franco the home environment as a multi-agent system and the reasoning approaches utilized to bring decision-making ability into the smart living environment. As a result, this systematic literature review identifies the ability to learn, plan, predict, explain and reason with incomplete knowledge as the major elements of a smart home reasoning system. In addition, the findings of this work revealed the application of standard rule conflict resolution strategies and sensor data contextualization as principal solutions to address some of the problems caused by conflicting rules and agent goals. Further, it underlines the importance of utilizing hybrid reasoning approaches and the need to handle overlapping multi-inhabitant activities to realize the true potential of smart homes.

Dagmawi Neway Mekuria, Paolo Sernani, Nicola Falcionelli, Aldo Franco Dragoni

Will Robin Ever Help “Nonna Lea” Using Artificial Intelligence?

A new generation of Intelligent Robots are entering our working and living environments,Cesta, Amedeo taking care of human-level tasks. Such robotic systems are becoming more and more important also in healthcare assistance for elderly. Cortellessa, Gabriella Indeed, recent advancements in Artificial Intelligence and Robotics are fostering the diffusion of robotic agents with the capabilities needed to support both older adults and their caregivers in a variety of situations (e.g., in their homes, in hospitals, etc.). The capability of representing and reasoning about diverse kind of knowledge is crucial for allowing robotic assistants to understand the needs of the older persons as well as the status of the working environment. This paper presents a recent research initiative which aims at endowing autonomous robots with the capabilities needed to represent and reason on sensor data and to autonomously make decisions accordingOrlandini, Andrea to the inferred knowledge. The complete approach ends out being a cognitive control architecture, called Knowledge-based cOntinuous Loop (KOaLa) whose main aspect are described in this paper.Umbrico, Alessandro The application of KOaLa to our Robin telepresence robot is also exemplified to enhance the services of older people assistance.

Amedeo Cesta, Gabriella Cortellessa, Andrea Orlandini, Alessandro Umbrico

Enabling Technologies and Assistive Solutions


Age-Friendly City and Walkability: Data from Observations Towards Simulations

The use of agent-based simulationGorrini,Andrea systems can provide an innovative frameworkCrociani,Luca to support the design of age-friendly cities, focusing on walkability assessment. This is aimedVizzari,Giuseppe at managing the complex interaction between elderly pedestrians and vehicles at zebra crossings, in which the compliance to traffic norms plays a fundamental role. The data of an observation performed at a non-signalized intersectionBandini,Stefania are presented to provide useful insights for supporting the future development of agent-based models. Results focus on drivers’ compliance to crossing pedestrians, describing potentially conflictual interactions among heterogeneous agents. The discussion closes with the potential applications of the collected data set for modelling the phenomenon.

Andrea Gorrini, Luca Crociani, Giuseppe Vizzari, Stefania Bandini

A Novel Tele-Medicine System to Improve Therapy Monitoring in Chronic Respiratory Diseases

In this work we proposed a novel tele-medicine system called Smart Breath Network (SBN) with the perspective to improve the life of patients affected by a well-known respiratory disease called Chronic Obstructive Pulmonary Disease (COPD). The main therapy for COPD is home-assisted ventilation that requires frequent home intervention by specialized hospital staff in order to adjust dispensing and to verify the effectiveness of the therapy. Moreover, healthcare services need to improve the care of patients with difficult access to services, particularly those in rural or remote areas without sustaining high costs of service maintenance. The SBN system tries to fill the gap between healthcare services, that need to take care of a growing number of home-assisted COPD patients due to the today’s alarming air pollution. The SBN network gathers all patient’s respiratory data from Smart Breath Analyzers (SBAs) devices that are low-cost, simple to use, compact-sized devices that fit to almost any ventilator with bi-tube capabilities.

Antonio Vincenzo Radogna, Simonetta Capone, Giuseppina Anna Di Lauro, Nicola Fiore, Valentina Longo, Lucia Giampetruzzi, Luca Francioso, Flavio Casino, Pietro Siciliano, Saverio Sabina, Carlo Giacomo Leo, Pierpaolo Mincarone, Eugenio Sabato

The Diabesity Care Project: Diabetes Integrated Monitoring System for Self-care Empowering

According to the latest WHO estimates, today, about 50 million people in Europe suffer from diabetes, a disease which the UN have defined as a serious public health problem for the planet, probably destined to worsen in the future. Diabetes is cause for a multiplicity of health complications. Those are mainly related to retinopathy, coronary artery disease, that is, risk of myocardial infarction, and lower limb diabetic complication, more commonly known as “Diabetic Foot” caused by peripheral neuropathy and vasculopathy. It is therefore of fundamental importance for the diabetic patient to perform an accurate and constant monitoring of all those parameters that are of major clinical interest for the disease (blood glucose, creatinine, PA, FC, ECG, dry skin evaluation, alteration of blood pressure in the lower limbs). This, not only to keep the current disease under control, but above all in the perspective of a prevention process from further complications. The Diabesity Care Project intends to implement an integrated system that uses innovative materials (tissues) and multi-sensory platforms for continuous and minimally invasive monitoring of the health status of the diabetic patient and for the prevention of the conditions that cause the diabetic foot problem. This paper describes the work planned for the project, that is still under development at the present time.

Paolo Casacci, Massimo Pistoia, Gianfranco Borrelli

Fully Integrated Smart Insole for Diabetic Foot

Foot ulcer is a severe complication affecting about 25% of diabetes mellitus patients due to a lower blood supply and loss of foot sensitivity (neuropathy). A fast and reliable identification of foot pressure loads and temperature distributions changes on the plantar surface allows to prevent and reduce the consequences of ulceration. Several wearable technologies have been developed and tested by the scientific community, addressing the “diabetic foot” topic. However, the dimensions of the devices and the combined pressure/temperature monitoring capabilities don’t accommodate the requirements from both the end-users and caregivers: normally just one information—pressure loads or temperature map—is acquired, moreover the amount of thermal reading points is lower than 5 and the accuracy of thermal sensors is greater than 0.5 °C. This work presents a fully integrated, high accuracy, smart insole in which both temperature and pressure data in 8 reading points are monitored in remote way, for the assessment of the health foot.

Gabriele Rescio, Alessandro Leone, Luca Francioso, Pierfrancesco Losito, Enrico Genco, Francesco Crudele, Leonardo D’Alessandro, Pietro Siciliano

A eHealth System for Atrial Fibrillation Monitoring

In clinical practice the ability to monitor arrhythmia episodes in elderlyPierleoni, Paola people is helpful to make an accurate diagnosis and choose theBelli, Alberto proper therapeutic interventions to reduce potential health risk. In this paper we propose an eHealth system to detect atrial fibrillation events as wellGentili, Andrea as provide information about patient’s health status using commercial devices such as a smartphone and aIncipini, Lorenzo wearable sensor for heart rate monitoring. Our solution consistsPalma, Lorenzo of a smartphone application able to real time process rawValenti, Simone data from the wearable sensor, detect critical events for the patient’s health status, and generate remote alert to medical staff. In theRaggiunto, Sara smartphone application a SVM-based algorithm to detect arrhythmia episodes by handling electrocardiogram signal is implemented. To test the performance of the developed eHealth system, the proposed algorithm has been evaluated using acquisitions with atrial fibrillation events. The results show a sensitivity of 94% and a specificity of 93%.

Paola Pierleoni, Alberto Belli, Andrea Gentili, Lorenzo Incipini, Lorenzo Palma, Simone Valenti, Sara Raggiunto

Assessment of Mental Stress Through the Analysis of Physiological Signals Acquired From Wearable Devices

Mental stress is a physiological state that directly correlates to the quality of life of individuals.Zanetti, Matteo Generally speaking, but especially true for disabled or elderly subjects, the assessment of such condition represents a very strong indicator correlated to the difficulties, and, in some case, to the frustration that derives from the execution of a task that results troublesome to be accomplished.Faes, Luca This article describes a novel procedure for the assessment of the mental stress level through the use of low invasive wireless wearable devices. The information contained in electrocardiogram, respiratory signal, blood volume pulse, and electroencephalogram was extracted to set up an estimator for the cognitive workload level.De Cecco, Mariolino A random forest classifier was implemented to assess the level of mental stress starting from a pool of 3481Fornaser, Alberto features computed from the aforementioned physiological quantities. The proposed system was applied in a scenario in which two different mental states were elicited in the subject under investigation: first, a baseline resting condition was induced by the presentation of a relaxing video;Valente, Martina then a stressful cognitive state was provoked by the administration of a mental arithmetic task.Guandalini, Giovanni The random forestGiovanni, Giandomenico classifier shows an accuracy of 97.5% in discerning between these two mental states.

Matteo Zanetti, Luca Faes, Mariolino De Cecco, Alberto Fornaser, Martina Valente, Giovanni Guandalini, Giandomenico Nollo

Experimentation of a Low Cost Public Transport System for People with Visual Disabilities

According to World Health Organization (WHO), currently in the World there are around 39 million visually impaired persons. These persons have to perform exactly the same daily activities as able-bodied people. These activities can be very difficult or dangerous for visually impaired persons (e.g. using public transport, crossing streets, walking alone, etc.). Public transit is the key to independence for many sightless persons but it still remains a challenging problem despite recent progresses in assistive technology. In this work we present and evaluate a smartphone-based system to improve mobility and transportation access for visually disabled people. A pilot experimentation, carried on with five visually impaired volunteers persons has been carried on end it is here presented in order to evaluate the real feasibility of the proposed approach.

L. D’Errico, F. Franchi, F. Graziosi, C. Rinaldi, F. Tarquini

Upper Limbs Orthosis for Disability Support: The Areas of Project Development Between Technology and Design

The ISO 9999: 2016 standard synthetically defines the two different types of artificial support necessary to support or replace the functions of a part of the body, they are indicated as devices applied to the body to support neuromusculoskeletal or movement related functions: the orthosis. They are also referred to as devices applied to the body to replace anatomical structures: prosthesis. The scientific scenario in this field is extremely articulated and invests across many sectors and skills, where the relationship and collaboration systems are substantial for the complexity of the objectives to be achieved. The aid entrusted to a technologically sophisticated system, which represents a substantial functional appendix of the body, implies, for the development of innovation, not only a profound knowledge of the medical, engineering and computer aspects, but also ergonomic, formal, communicative and aesthetic. The project, or the projects that are intended to be presented in the present research work, underline, with the presentation of two case studies, the levels of in-depth analysis of the issues related to the role of design and information technology and robotics. In the following sections two cases of research projects carried out in parallel are proposed. The first “Talking Hands”, purely technical and technological, is a completely wearable device for sign language translation. The second “D’Aria” is a glove is aimed at people with rheumatoid arthritis both for the initial stages of the disease (prevention of more serious damage) and for the more advanced phases (a real aid that restores lost grip capacity). Finally, as a research perspective, this article proposes the hybridization of the two case studies. The final objective will therefore be to create an experimental prototype that hybridizes the two characteristics, creating a series of tests on patients affected by these diseases.

Davide Paciotti, Francesco Pezzuoli, Federica Cotechini

Depth-Based Fall Detection: Outcomes from a Real Life Pilot

With the increasing ageing population representing a challenge for society and health care systems, solutions based on ICT to prolong the independent living of older adults become critical. Among them, systems able to automatically detect falls are being investigated since several years, because many solutions that appear promising when tested in lab settings, fail when faced with the constraints and unforeseen circumstances of real deployments. In this paper, we present the outcomes resulting from the pilot installation of a fall detection system based on the use of depth sensors located on the ceiling of the monitored apartment, where a 75 years old woman lives alone. We highlight the system design process, moving from the research leading to an original algorithm working offline, preliminarily tested in a lab setting, to the real-time engineering of the software, and the physical deployment of the system. Testing the system in a real-life scenario allowed us to identify a number of tricks and conditions that should to be taken into account since the initial steps, but the lab experimentation alone can barely help to focus on.

Susanna Spinsante, Marco Fagiani, Marco Severini, Stefano Squartini, Friedrich Ellmenreich, Giusy Martelli

Big Data Analytics in Smart Living Environments for Elderly Monitoring

Today, data collected in smart-living environments are constantly increasing in the dimensions of volume, velocity and variety, which characterize any big data application. In such a way, it makes sense to investigate big data analytics for elderly monitoring at home. The aim of this study is to conduct a preliminary investigation of state-of-the-art algorithms for abnormal activity detection and change prediction, suitable to deal with big data. The algorithmic approaches, under evaluation and comparison, belong to the three main categories of supervised, semi-supervised and unsupervised techniques. At this purpose, specific synthetic data are generated, including activities of daily living, home locations in which such activities take place, as well as physiological parameters. All techniques are evaluated in terms of abnormality-detection accuracy and lead-time of prediction, using the generated datasets with various kinds of perturbation. The achieved results, even though preliminary, are very encouraging, showing that unsupervised deep-learning techniques outperform traditional (machine learning) ones, with detection accuracy greater than 96% and prediction lead-time of about 15 days in advance.

Giovanni Diraco, Alessandro Leone, Pietro Siciliano

A Smart Inertial Pattern for the SUMMIT IoT Multi-platform

The SUMMIT project funded by the Italian MISE under the PON2020 Action, aims to the development a IoT (Internet of Things) platform which should be flexible and adaptive to easily embed several smart objects such as sensors, multi-sensor architectures and mobile terminals. The main idea is to lunch an open and dynamic eco-system to support the development of IoT based services both for the private and public sectors. The concept of “pattern” will lead the overall development of the SUMMIT platform which represents each element to be integrated in the SUMMIT framework by assuring security, privacy and dependability properties. Above patterns will be also self-evolving on the basis of their behavioral analysis to be performed during the system operation. The three main cases of study addressed by the project will be smart energy, smart health and smart cities. Among patterns addressed by the project the development of a smart inertial platform is considered. Such platform will find application in several contexts with a strong priority in the Smart Living framework. As an example, the architecture developed can be adopted for the sake of Activity of Daily Living monitoring (including Falls), postural instability detection, aided navigation, physical activity assessment, just to cite mostly addressed needs. Actually, above application contexts represent serious needs to be addressed to enable Active Ageing and Well Being. The Smart Inertial Pattern (SIP) is based on an embedded architecture equipped with sensors (accelerometer, gyroscope, compass) and communication facilities. In this paper the use of the SIP device for the implementation of a ADL classifier exploiting an event correlated approach is presented.

Bruno Andò, Salvatore Baglio, Ruben Crispino, Lucia L’Episcopo, Vincenzo Marletta, Marco Branciforte, Maria Celvisia Virzì

RareBox App. Patient-Centered Monitoring System in the Self-management of Rare Diseases

Mobile health applications (m-health app) allow connecting patients with care professionals more quickly and dynamically. Apps designed for a smartphone allow users to access in-formation and self-monitoring when and where they need it, boosting engagement and satisfaction rates. Starting from the construct of quality of life related to health and according to a biopsychosocial care perspective (ICF approach) [1], the paper presents and discusses research phases of the RareBox project: development, implementation and evaluation of self-monitoring App on quality of life of patients with rare diseases.

Andrea Fiorucci, Stefania Pinnelli

A Cyber Secured IoT: Fostering Smart Living and Safety of Fragile Individuals in Intelligent Environments

Due to better living conditions and progress in medicine older adults today are the main group of population in terms of growing speed. Furthermore, together with disabled people, they represent the most frail category of individuals. Indeed, they are likely to present different constellations of impairments (both at physical and cognitive level). Older adults and individuals with disabilities strongly benefit from being properly assisted or from prolonging their individual autonomy. Such interventions can be implemented levering on the IoT technologies. The present paper describes a project that aims at providing older and disabled people with smart buildings that will be equipped with IoT technologies, e.g., environmental and wearable sensors. The identification of such technologies will be based on co-design activities that will focus on their accessibility and usability. Concurrent laboratory tests will be carried out to assess the best methodologies of wireless communication between the smart devices. These ambient-assisted living tools will be installed in two real-world scenarios, i.e., a nursing home and a co-housing solution. Such tools will facilitate older and disabled people in carrying out daily activities, ensuring their safety and privacy protection. The outcomes of the project will provide pivotal information on how to improve human living in different environmental contexts.

Luciano Gamberini, Luca Fabbri, Valeria Orso, Patrik Pluchino, Riccardo Ruggiero, Roberto Barattini, Alberto Sozza

Fabrication of Flexible ALN Thin Film-Based Piezoelectric Pressure Sensor for Integration Into an Implantable Artificial Pancreas

This works reports about the fabrication and the characterization of AlN-based flexible piezoelectric pressure sensor, to be integrated into an implantable artificial pancreas. The artificial organ comprises an intestine wall-interfaced refilling module, able to dock an ingestible insulin capsule. A linearly actuated needle punches the capsule to transfer the insulin to an implanted reservoir. The pressure sensor, located at the connection of the needle with the linear actuator, is designed to sense the occurred capsule punching. Polycrystalline AlN thin film was successfully sputtered at room temperature on Kapton substrate with a preferential orientation along c-axis, as peremptorily required for the intrinsic piezoelectric response of the nitride layer. The characterization, aimed to verify the sensor capability to convert the local stress into electrical charge, confirms the linear proportionality of the generated charges with the applied force within the range of the interest values (0.3–3.3 N) and at very low frequency (lower than 5 Hz) for the specific application of the ingestible capsule punching and insulin transfer.

Maria Assunta Signore, Chiara De Pascali, Gabriele Rescio, Alessandro Leone, Antonietta Taurino, Paolo Dario, Veronica Iacovacci, Pietro Siciliano, Luca Francioso

Facial Expression Recognition in Ageing Adults: A Comparative Study

Facial Expression Recognition is one of the most active areas of research in computer vision. However, existing approaches lack generalizability and almost all studies ignore the effects of facial attributes, such as age, on expression recognition even though research indicates that facial expression manifestation varies with ages. Recently, a lot of progress has been made in this topic and great improvements in classification task were achieved with the emergence of Deep Learning methods. Such approaches allow to avoid classical hand designed feature extraction methods that generally rely on manual operations with labelled data. In the present work a deep learning approach that utilizes Convolutional Neural Networks (CNNs) to automatically extract features from facial images is evaluated on a benchmark dataset (FACES), the only one present in literature that contains also labelled facial expressions performed by ageing adults. As baselines, with the aim of making a comparison, two traditional machine learning approaches using handcrafted features are evaluated on the same dataset. Our experiments show that the CNN-based approach is very effective in expression recognition performed by ageing adults, significantly improving the baseline approaches, at least with a 8% margin.

Andrea Caroppo, Alessandro Leone, Pietro Siciliano

Physiological Wireless Sensor Network for the Detection of Human Moods to Enhance Human-Robot Interaction

Although it is already possible to issue utility services that use robots, these are still not perceived by society as capable of actually delivering them. One of the main motivations is the lack of a human-like behaviour in the interaction with the user. This is displayed both at physical and cognitive level. This work investigates the optimal sensor configuration in the recognition of three different moods, as it surely represents a crucial element in the enhancement of the human-robot interaction. Mainly focusing towards a future application in the field of assistive robotics, electrocardiogram, electrodermal activity and electroencephalographic signal were used as main informative channels, acquired through a wireless wearable sensor network. An experimental methodology was built to induce three different emotional states by means of social interaction. Collected data were classified with six supervised machine learning approaches, namely decision tree, induction rules and lazy, probabilistic and function-based classifiers. The results of this work revealed that the optimal configuration of sensors which maximizes the trade-off between accuracy and obtrusiveness is the one surveying cardiac and skin activities. This sensor configuration reached an accuracy of 87.07% in the best case.

Francesco Semeraro, Laura Fiorini, Stefano Betti, Gianmaria Mancioppi, Luca Santarelli, Filippo Cavallo

An Embedded Localization System for the SUMMIT IoT Multi-platform

The SUMMIT project, funded by the Italian MISE under the PON2020 Action, has the goal to develop a flexible and adaptive IoT framework able to accelerate the development of Smart Solutions. The main idea is to launch an open and dynamic eco-system to support the development of IoT based services both for the private and public sectors. The concept of “pattern”, that will lead the overall development of the SUMMIT framework, represents the innovation of the SUMMIT project (it offers ready-made solutions to known implementation problems) which represents each element to be integrated by assuring dependability properties. The three main cases of study addressed by the project will be smart manufacturing, smart health and smart building. Among patterns addressed by the project the development of a localization system is considered. Such system will find application in several contexts and in particular in the scenarios addressed by this project. As an example, the architecture developed can be adopted for the sake of frail people monitoring. In this paper a localization system, that implements an improved trilateration algorithm, is presented.

Ruben Crispino, Bruno Andò, Salvatore Baglio, Vincenzo Marletta

Experiments, Evaluation and Lessons Learnt


Understanding the Interest Toward Smart Home Technology: The Role of Utilitaristic Perspective

Every day, innovative devices support healthcare for the escalating needs of the population ageing but the poor adoption hinder their spread older adults. The present study aims to investigate the factors that may influence perceptions and expectations of 306 Italian older adults (M = 74, SD = 7.43) towards smart home and wellbeing technology. A questionnaire was verbally administered in face-to-face sessions by trained interviewers in order to collect data. Overall, the results return a positive picture of participants’ perception of the technology though attitude towards technology is definitely driven by utilitaristic means: usefulness, easiness, safety and privacy are considered important while aesthetics, size and weight are not. Around half of our respondents have a positive interest in technology and almost all of them believe that technology may eventually improve their life. According to these findings, the paper discusses some challenges for the whole research sector that appears still fragmentary and lacking of a strong body of evidence. Moreover, the promotion of trust and empowerment actions through instructional programs is highlighted.

Vera Stara, Massimo Zancanaro, Mirko Di Rosa, Lorena Rossi, Stefania Pinnelli

Health360: An Open, Modular Platform for Multimodal Data Collection and AAL Monitoring

Health and care features a strong need for computerised tools providing support in daily life activities, especially among elderly people. Platforms capable of safely collecting several data can represent a useful add-on to the home-care of elderly people, paving the way for a patient empowerment, improving their quality of life without needing for recurrent medical examinations at clinics. Here, we present an open, modular platform capable of collecting multimodal (anamnestic, clinical, etc.) data, gathered through different approaches, including questionnaires, medical examinations, and wearable sensors, usable by the caregiver to remotely check the health status of a patient, without needing for frequent recalls at clinics. The extensive use of this platform will allow the patient performing an automated self-monitoring, eventually with the help of a caregiver directly at home, enabling remote data sharing with General Practitioners, reducing the needs for clinics admittance, without sacrificing the quality of care.

Raffaele Conte, Alessandro Tonacci, Francesco Sansone, Andrea Grande, Anna Paola Pala

Assessment of Parkinson’s Disease At-home Using a Natural Interface Based System

A system for the management of the automatic assessment of Parkinson’s Disease (PD) at-home is presented. The system is based on a non-contact and natural human computer interface which is suitable for motor impaired users, as are PD patients. The interface, built around optical RGB-Depth devices, allows for both gesture-based interaction with the system and tracking of hands and body movements during the performance of standard upper and lower limb tasks, as specified by the Unified Parkinson’s Disease Rating Scale (UPDRS). The accurate tracking and characterization of the movements allows for an automatic and objective assessment of the UPDRS tasks, making feasible the monitoring of motor fluctuations at-home and on daily basis, which are important features in the management of the disease progression. The assessment of the different tasks is performed by machine learning techniques. Selected kinematic parameters characterizing the movements are input to trained classifiers to rate the motor performance. Results on monitoring experiments at-home and on the system accuracy as compared to clinical evaluations are presented and discussed.

Claudia Ferraris, Roberto Nerino, Antonio Chimienti, Giuseppe Pettiti, Corrado Azzaro, Giovanni Albani, Lorenzo Priano, Alessandro Mauro

Seniors’ Acceptance of Virtual Humanoid Agents

This paper reports on a study conducted as part of the EU EMPATHIC project, whose goal is to develop an empathic virtual coach capable of enhancing seniors’ well-being, focusing on user requirements and expectations with respect to participants’ age and technology experiences (i.e. participants’ familiarity with technological devices such as smartphones, laptops, and tablets). The data shows that seniors’ favorite technological device is the smartphone, and this device was also the one that scored the highest in terms of easiness to use. We found statistically significant differences on the preferences expressed by seniors toward the gender of the agents. Seniors (independently from their gender) prefer to interact with female humanoid agents on both the pragmatic and hedonic dimensions of an interactive system and are more in favor to commit themselves in a long-lasting interaction with them. In addition, we found statistically significant effects of the seniors’ technology savviness on the hedonic qualities of the proposed interactive systems. Seniors with technological experience felt less motivated and judged the proposed agents less captivating, exciting, and appealing.

Anna Esposito, Terry Amorese, Marialucia Cuciniello, Antonietta M. Esposito, Alda Troncone, Maria Inés Torres, Stephan Schlögl, Gennaro Cordasco

Human and Animal Welfare Assessment During Animal Assisted Interventions (AAI): A Pilot Project in Progress

The use of technology and technological tools has always been to support the improvement of the people life quality. The present project intended to value the animal and human comfort and welfare during the Animal Assisted Interventions (AAI). The approach used in this project is in according to the biopsychosocial model, using both the International Classification of Functioning, Disability and Health (ICF) and behavioral aspects and hormonal levels evaluation in the animals in order to obtain important data to standardize an no invasive method of welfare assessment during therapy, rehabilitation, and pedagogical education activities.

Patrizia Ponzio, Assunta di Matteo, Elisabetta Macchi, Telemaco Traverso, Augusto Carluccio, Marco Berardo Di Stefano

“Casa Amica”, Project for the Construction of a Social-Assistance Structure and a Social-Healthcare Unit C.R.I., to Be Used for the Reception of Elderly People with Disabilities

Following the earthquake of 24 August 2016 and subsequent replies that have affected several municipalities in the regions of Abruzzo, Lazio, Marche and Umbria, resulting in a serious situation of danger and damage to structures and infrastructure falling within the territory, the City of Camerino and the Croce Rossa Italiana, National Committee, have signed a memorandum of understanding (of 28/04/2017) and a preliminary design document for the construction of a structure for hospitality and social-health facilities called “Casa Amica” to temporarily host the elderly with disabilities residing in the structure damaged by the earthquake. The aim of the intervention is to restore as soon as possible the functionality of the main activities serving the community by applying the most recent theories known in research, development and innovation related to the sector of technologies and services for active aging and healthy. Hence the idea of a structure that in the first instance serves to deal with the emergence of a social-sanitary type of accommodation and subsequently, to return to ordinary conditions, to meet the collective needs of the citizenship, to strengthen social and welfare activities, promote training and information activities, as well as recreational and creative activities for people of all ages. The SAAD, School of Architecture and Design “Eduardo Vittoria”, with headquarters in Ascoli Piceno, University of Camerino UNICAM, which for years has been involved in scientific research in the context of Smart City-House-Object, has Preliminary project of this innovative structure, trying to apply and experiment with all the design principles oriented to the Environment Assisted Living, Active and Healthy Aging and Smart Living culture.

Giuseppe Losco, Andrea Lupacchini, Luca Bradini

Architecture for Cooperative Interacting Robotic Systems Towards Assisted Living: A Preliminary Study

The present study aims at providingCiuccarelli, L. a robotic architecture system composed by a semi-autonomousFreddi, A. mobile robot andIarlori, S. a manipulatorLonghi, S. robot. The user, on a smart wheelchair, is able to move in an indoorMonteriù, A. environment, byOrtenzi, D. selecting, through a user-interface, the room where he/she wants to move and the object he/she would like to get. In case an objectProietti Pagnotta, D. is selected, the user is automatically driven in front of a robotic workstation, where the desired object is picked and placed by a robotic arm in front of the user. The system has been tested on a simulator, and preliminary experimental results show the feasibility of the proposed architecture.

L. Ciuccarelli, A. Freddi, S. Iarlori, S. Longhi, A. Monteriù, D. Ortenzi, D. Proietti Pagnotta

Personal Health E-Record—Toward an Enabling Ambient Assisted Living Technology for Communication and Information Sharing Between Patients and Care Providers

In this paper, we propose the Personal Health Electronic Record (PHER), a new type of Patient Health Record. This record aims to help physicians shift from a medical practice that is often based on their personal opinion or experience towards one of evidence based medicine, thus improving the communication among patients and their care providers and increasing the availability of personal medical information. The PHER can be considered an enabling Ambient Assisted Living technology because it allows patients and care providers to file and share all types of medical data and useful clinical information so that they can access whatever they need, whenever they need it. The development of diagnostic and therapeutic algorithms that are able to support the physician in planning treatment using the data stored in the PHER is also discussed.

Giovanni Dimauro, Francesco Girardi, Danilo Caivano, Lucio Colizzi

Seminal VOCs Analysis Investigating Sperm Quality Decline—New Studies to Improve Male Fertility Contrasting Population Ageing

The world is impacting with a drastic demographic change that is reflected in a progressive ageing population. If on the one side increasing health care for older people is important, stimulating the level of birth becomes decisive. The principal goal of this work is to set up of new method for early diagnosis of male infertility based on analysis of seminal Volatile Organic Compounds (VOCs), potentially biomarkers of infertility status. The identification of the volatile metabolite patterns in semen samples was done by an unconventional GC/[−MS + gas sensor] system. Once validate this approach could integrate and improve traditional semen analysis based on physiological parameters and addressed to the development of novel medical devices based on gas microsensors for male infertility screening.

Valentina Longo, Angiola Forleo, Sara Pinto Provenzano, Lamberto Coppola, Vincenzo Zara, Alessandra Ferramosca, Pietro Siciliano, Simonetta Capone

MARIO Project: Validation in the Hospital Setting

In the EU funded MARIO project, specific technological tools are adopted for the patient with dementia (PWD). In the final stage of the project, two trials were completed as shown below: first trial was performed in September 2017, and second trial was performed in October 2017. The implemented and assessed applications (apps) are My Music app, My News app, My Games app, My Calendar app, My Family and Friends app, and Comprehensive Geriatric Assessment (CGA) app. The aim of the present study was to assess the acceptability and efficacy of MARIO companion robot on clinical, cognitive, neuropsychiatric, affective and social aspects, resilience capacity, quality of life in PWD, and burden level of the caregivers. Twenty patients (M = 8; F = 12) were screened for eligibility and all were included. In Pre- and Post-MARIO interaction, the following tests were administered: Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Frontal Assessment Battery (FAB), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Multidimensional Scale of Perceived Social Support (MSPSS), 14-item Resilience Scale (RS-14), Quality of Life in Alzheimer’s Disease (QOL-AD), Caregiver Burden Inventory (CBI), Tinetti Balance Assessment (TBA), and Comprehensive Geriatric Assessment (CGA) was carried out. A questionnaire based on the Almere Acceptance model was used to evaluate the acceptance of the MARIO robot. In Post-MARIO interaction, significant improvements were ob-served in the following parameters: MMSE (p = 0.023), NPI (p < 0.0001), CSDD (p = 0.010), RS-14 (p < 0.0001), QoL-AD patients (p = 0.040), CBI (p = 0.040), SPMSQ (p = 0.040), and MNA (p = 0.010). The Almere Model Questionnaire presented a higher acceptance level in first and second trial.

Grazia D’Onofrio, Daniele Sancarlo, Massimiliano Raciti, Alessandro Russo, Francesco Ricciardi, Valentina Presutti, Thomas Messervey, Filippo Cavallo, Francesco Giuliani, Antonio Greco

Active Aging by Continuous Learning: A Training Environment for Cultural Visits

The “Città Educante” project aims at radically rethinking the learning environments through the application of the most advanced ICT technology. Among the different aspects of the project, the LECTurE module aims, by exploiting artificial intelligence techniques, at proposing contextualizedCesta, Amedeo lessons, as well asCortellessa, Gabriella interaction requests, to the involved users. In particular the lesson’s content, is specifically tailored for the older adults and personalized by taking into account users’ psycho-physiological aspects as well as geo-localization informationDe Benedictis, Riccardo and temporal constraints. In this paper, after a generic introduction to the “Città Educante” project, the LECTurE module is presented and instantiated in two relevant use cases: the on-site training, in whichFracasso, Francesca the system is used as a support to the classical teaching methodologies within a classroom, and the distributed training, in which the technology aims at moving and animating the teaching experience, also, “outside the classroom”, with additional stimuli for the users during a practical experience (e.g., a real visit in a museum to complement a theoretical art history lesson). The paper describes, then, the choices made for the realization of a first prototype and its embodiment into a concrete scenario which, by implementing a “treasure hunt” like game, aims at fostering older adults’ physical and cognitive activity.

Amedeo Cesta, Gabriella Cortellessa, Riccardo De Benedictis, Francesca Fracasso

The TV-AssistDem Project: A TV-Based Platform for Coping with Mild Cognitive Impairment

This paper describes theCortellessa, Gabriella work pursued within the TV-assistdem project, an AAL initiative, Fracasso, Francesca the aim of which is toUmbrico, Alessandro develop a technological tool to facilitateCesta, Amedeo remote support to patients affected by Mild Cognitive Impairment (MCI).Mayoral, Fermin The idea is to exploit TV-based transmission of dataBarnestein-Fonseca, Pilar and video-interactivity among health-professionals, García, Elisa Vera patients, caregivers andToma, Diana family members to support MCI older users.Boghiu, Flavia The objective of TV-assistdem goes beyond the realisation ofDewarrat, Rodolphe the necessary technologicalTriantafyllidou, Valentina effort, and extends to the delivery of aHerrero, Javier longitudinal experimentation on anPérez, Miguel Ángel European scale. The paper givesTamburini, Elena an overview of the projectDionisio, Pietro and presents the results of the user requirements elicitationCiucci, Lorenzo effort carried out during the first phase involving users to gather valuable indications for the platform development.Di Guardo, Fabrizio A presentation of the platform functionalities is also provided and the current status of the implementation effort is finally presented.

Gabriella Cortellessa, Francesca Fracasso, Alessandro Umbrico, Amedeo Cesta, Fermin Mayoral, Pilar Barnestein-Fonseca, Elisa Vera García, Diana Toma, Flavia Boghiu, Rodolphe Dewarrat, Valentina Triantafyllidou, Javier Herrero, Miguel Ángel Pérez, Elena Tamburini, Pietro Dionisio, Lorenzo Ciucci, Fabrizio Di Guardo


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