DOREMI NEWSLETTER

Doremi has received funding from the European Union under the Seventh Framework Programme (FP7), grant agreement n° 611650.

The contents of this newsletter are the sole responsibility of Doremi and can in no way be taken to reflect the views of the European Commission.

July 2015

All countries in Europe are experiencing ageing of their populations. Health trends show that mild disability and chronic disease are generally increasing. As a consequence, ageing of the population will negatively impact on long-term care costs unless appropriate measures are implemented in time.

To be effective, these measures should reduce risk factors linked to functional decline and chronic diseases and provide personalised training to stimulate older people to keep an active lifestyle.

The DOREMI project focuses on three main health aspects related to frailty in older people: unhealthy nutrition, sedentariness and cognitive decline.

These aspects are the main items at the basis of the DOREMI environment: a context-aware and smart system able to learn and reason about older people, their intentions, preferences and aims. The system is able to provide feedback and propose solutions to improve their lifestyle.

The specialist will be able to select and assign a personalised lifestyle protocol that will be associated

to a set of game typologies (cognitive games, social games or exergames). At home, the old person will be able to select the game scenario which best corresponds to personal preferences and habits. Subsequently, the system will follow a monitor-learn loop to understand how the old person evolves according to the compliance of the assigned protocol.

In the first 18 months, the DOREMI partners were involved in the definition of an active ageing lifestyle protocol to be applied during experimental trials in the UK and Italy pilot sites, and in all the technical (hardware and software) solutions to support it.

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Contents in this newsletter DOREMI focuses on unhealthy nutrition, sedentariness and cognitive decline page 1-2

DOREMI activity recognition and reasoning systems page 3

Game-based active ageing page 4

Validation of the DOREMI intervention model page 5-6

DOREMI focuses on unhealthy nutrition,

sedentariness and cognitive decline

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In particular the partners have carried out an extensive literature analysis of unhealthy nutrition, sedentariness and cognitive decline, and focused on strategies to control these impairments, and on the definition of the protocol to be applied during experimental trials. Active lifestyle, especially physical activity, healthy dietary habits and cognitive stimulation all play a fundamental role in preserving a healthy state. This approach, acting on well-being, can reduce and postpone the natural psychological decline in older people.

Nutrition Prospects for healthy ageing are characterised at first

by “a proper nutrition”. Appropriate knowledge of

food components is much more effective than

prescriptions of multivitamin and mineral

supplementation in lowering major health diseases

affecting older people.

With the support of the Mini-Nutritional Assessment

(MNA) test, we will have a validated nutrition

screening and assessment tool able to identify

geriatric patients aged 65 and over who are at risk of

unbalanced nutrition intake (excess or defect). During

the trial, thanks to the continuous evaluation of

weight and the support of a diet app (Metadieta®),

we will be able to remotely make changes to our

users’ food intake and to detect the effectiveness of

personalised diet prescriptions on weight. This will

create a dietary loop which can monitor, stimulate

and involve older people to reach a satisfying

nutrition level.

Physical activity No age group gets more benefits from fighting sedentariness with regular exercise than older people. Research and trials provide specific recommendations on how to keep an active, physically correct daily lifestyle that includes exercises promoting endurance and flexibility, strengthen muscles, and improve balance.

DOREMI will use the Physical Activity Scale for the Elderly (PASE) test, which will help the user profiling in terms of activity quantification (time and type of actions). Through the bracelet, developed by one of the technical partners in the project, we will be able to monitor users’ activities, especially physical exercises, and have a continuous check of their heart rate. The bracelet will be used to check the exercise safety and monitor physiologically the cardiac performance of our users. Moreover, with the DOREMI virtual companion, our users will be stimulated to follow prescribed daily activities to fight sedentariness and improve their health status.

Cognitive decline Unhealthy dietary and sedentary habits influence cognitive decline, which in turn has an impact on the independence and the autonomy of older people, and which also plays a primary role in progressively leading to a less and less balanced diet and less and less physical activity.

DOREMI will develop games focusing on the different cognitive functions, which are analysed by Montreal Cognitive Assessment (MoCA) and other cognitive function tests: orientation, registration, attention and calculation, recall, language and praxis. Users will be stimulated to play in order to slow down cognitive decline. The DOREMI platform provides a daily schedule for playing these games and it will give feedback to specialists about users’ cognitive improvements.

The monitor-learn loop enabled by the

DOREMI systemic solution

The DOREMI dietary loop

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The activity recognition and reasoning systems are

key components that enable DOREMI to assess the

daily progress of the user and to adapt the active

ageing lifestyle protocol accordingly. Specifically, the

activity recognition system monitors the user’s

physical activity, social interaction and balance by

means of a number of sensors, some of which are

embedded in a wristband. The reasoner system

exploits the information provided by the activity

recognition to implement the decision making of

DOREMI and support the user who is following the

lifestyle protocol prescribed by the specialist. In turn,

these systems enable DOREMI to give feedback to

the user about his or her lifestyle, and to inform

specialists about users’ conditions.

The last months of activity in DOREMI have

witnessed the finalisation of the architecture and

interfaces of these systems, and the first campaigns

of data collection and analyses necessary to configure

these systems in view of their use in the pilot sites in

the UK and Italy. One of the most important results

achieved in this period is the design and

implementation of an automatic carpet able to assess

the balance of the user, according to the Berg balance

scale. The solution adopted in DOREMI is based on an

innovative setting in which the user performs only

one of the 14 of Berg’s exercises on a balance board,

and an especially crafted artificial intelligence model

estimates the Berg’s balance scale score (a number

ranging from 0-56). The preliminary results, obtained

by experimentation on 20 volunteers (with ages

ranging between 60 and 70), outperform the state of

the art in automatic evaluation of the Berg’s score.

The next important development will concern the

activity recognition components assessing users’

physical activity. For this work, an important

campaign of data collection and analysis will start in

July with the participation of 15 volunteers aged 60-70.

DOREMI activity recognition and reasoning systems

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Italian serious games specialist and DOREMI partner Imaginary

has developed the video games environment that supports the

physical and cognitive stimulation aspects of the DOREMI

project. The game environment along with four games that

stimulate cognitive activity are ready. On the physical activity

stimulation side, Imaginary has completed an exercise area

which contains videos for both indoor and outdoor exercises. A

virtual social area where users can interact is also being

finalised. These games, activities and the environment

incorporate what are known as gamification mechanics which

means that they use the same psychology and methods that

gameplay uses to engage and motivate users.

The games are designed in collaboration with specialists and

user groups using a so-called participatory design approach

which means that during the development phases each step is

checked periodically by both groups. Thus they are not only

clinically appropriate according to experts’ indications, but they

also include aspects of users’ expectations. This is the only way

to ensure that medical games and exercises are welcomed by

those who are supposed to use them and that they include

exactly those aspects which are motivational for the specific

users.

Imaginary’s experience and international network of

connections is creating great interest and potential collaboration

opportunities both within and outside Europe. Imaginary’s

technology consultant, David Wortley, who has been supporting

the concepts and strategies behind some of Imaginary’s DOREMI

games has been collaborating on Ageing Society issues with

leading experts in Korea, USA, Singapore and the UK to not only

bring international best practices to DOREMI products and

services but also raise awareness of the DOREMI project

internationally.

Two examples of games that project partner

Imaginary is designing and developing in

collaboration with specialists and user groups.

Game-based active ageing

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We have now started to integrate the technologies

developed previously in the project and to validate

the DOREMI intervention model. The validation

process is divided in three steps that progressively are

advancing during the second and the third years of

the DOREMI project.

We will begin with testing and validating the single

components of the DOREMI package.

During the second phase the wireless sensor network

and the gamification environment will be validated

separately and finally we will conduct an overall

validation of the DOREMI global package by means of

a longitudinal and multicentric pilot study in the UK

and Italy.

The DOREMI balance board, which is one of the

components of the DOREMI package, will allow us to

collect data about balance and weight. Having a good

balance is particularly important when one grows old.

It means that one is able to maintain the position of

the body when one is standing, walking and moving

around. Balance disorders are quite common,

affecting almost 40% of the older adults.

Besides causing uncomfortable sensations such as

vertigo and unsteadiness, balance disorders can be

related to higher risk of falls. Falls can cause injuries,

such as hip fractures and traumas, and increase risk of

early death. At the moment we are starting to test

the DOREMI balance board involving volunteer users

who kindly make themselves available to participate

in the project.

Data from the DOREMI balance board will give

information about balance and weight to healthcare

specialist so that they will be able to detect balance

disorders at an early stage to prevent falls.

DOREMI balance board

Validation of the DOREMI intervention model

DOREMI coordinator Oberdan Parodi testing a volunteer’s balance

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Two of the age related issues that the DOREMI

project addresses are cognitive decline and social

isolation. Cognitive decline is a progressive loss of the

cognitive capacity and it gives rise to a wide range of

symptoms such as difficulty in focusing attention and

forgetfulness. Cognitive decline can if not detected in

time progress into severe conditions such as

dementia and depression. Lifestyle can affect the

progression of cognitive decline, in fact cognitive

training, social relationships and healthy nutrition

can improve the cognitive abilities, preventing

dementia and other mental diseases. The DOREMI

platform includes a wide range of social and cognitive

games to stimulate the subject to maintain an active

and healthy lifestyle. We are testing these tools with

end users to verify the accessibility and usability and

to collect data to test the efficacy of the

interventions.

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Subscribe to this newsletter To subscribe to the DOREMI newsletter, please contact: daniel.holmberg@age-platform.eu

Contact the coordinator The Italian National Research Council (CNR-IFC) is the coordinator of the DOREMI project.

Contact: info@doremi-fp7.eu

Daniele Musian of Si4Life and Antonio Ascolese of Imaginary

are testing the cognitive and social games with a user group.

Contact and partners