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Virtual Coaching Activities for Rehabilitation in Elderly

Periodic Reporting for period 1 - vCare (Virtual Coaching Activities for Rehabilitation in Elderly)

Reporting period: 2017-09-01 to 2019-02-28

Against the background of demographic development, the continuity of care from the professional treatment into the home environment becomes critical to ensure the patients’ quality of life (QoL). As QoL is deeply related to the patients’ abilities to engage in their care and the health expectations of them, evidences show that one of the most relevant domain is the rehabilitation of the patient after an acute pathological episode or in the course of a disabling chronic disease. Rehabilitation is a complex process by which a patient and a multitude of professional caregivers (e.g. physicians, rehabilitation nurses, occupational, speech-language, and vocational therapists, psychologists) are involved. Rehabilitation usually begins in the acute-care hospital after the person’s health condition has been stabilized. Secondly and ideally, at home the rehabilitation team is continued and enriched by additional caregivers, including the “informal” ones, until the daily routines in the home environment are sufficiently manageable again. Even though rehabilitation does not “cure” the effects of a disease (i.e. in stroke it does not reverse brain damages), rehabilitation can substantially help people to achieve the best possible long-term outcome living independently, and participating in everyday life in their communities.

Unfortunately, the continuity of rehabilitation often interrupts with the transition to the home. Virtual Coaches can be a key technology to ensure the continuity of care, reinforce self-management, enhance adherence to the care plan and risk prevention and ultimately empower patients. Rehabilitation guidance by a virtual coach does not replace specialists but rather supplements their work to guarantee the continuity of care in the home environment.

Therefore, the vCare project develops and investigates a Virtual Coaching solution encapsulating a set of coaching services for empowering and motivating people, helping them to proceed with a personalized rehabilitation by means of a virtual avatar. For this, vCare monitors the patients’ daily activities, conditions, and habits to provide personalised feedback to recover the QoL. For that, the coaching programmes are initialised by specialists

by assigning a well-elaborated clinical pathway as a tailored rehabilitation plan to the patient (according to the personal context). According to this plan, vCare enables the personalization of the intensity and way of interaction and will trigger suitable exercises (serious games, cognitive training programs, etc.), suggestions and feedback. Additionally, the context information that helps to monitor daily life activities and individual habits will be integrated.

Refraining from static rehabilitation programmes (that might be feasible in the inpatient sector), the continuous adaptation to patients’ needs and context ensures the patients’ empowerment to adequately deal with their circumstances. In general, there would be two options in case a patient leaves the desired range. Firstly, the physician could intervene and take measures to come back on track. Admittedly, the physician has a great expertise and abilities to do so but is also not at the patient’s site and examines him/her only occasionally (given the case of home rehabilitation). Secondly, the Virtual Coach could intervene as it is in immediate proximity and permanently examines the patient. The Virtual Coach’s expertise has to be enriched by means of providing medical knowledge, sequence plans or interaction schemes in terms of modes that are usable for the Virtual Coach. This relates to clinical pathways (as the representation of the adequate treatment procedure), smart-home sensors (replacing the eyes of a human caregiver) or sensors for vital data, the avatar itself (replacing the caregiver’s face and interaction possibility) or the machine learning and reasoning (replacing the human’s assessment abilities). Thus, vCare will provide a
According to the project workplan, the first project months were foreseen to assemble and conceptualise the knowledge of the project’s clinical professionals in order to have a solid basis for the technical development phase. In particular, the medical partners have collected the basic needs to, later on, come to the desired increase of the patients’ quality of life. This includes the compilation of basic healthy and behavioural models for virtual coaching, the standardised rehabilitation strategy for each of the four focal pathologies, and of the impact on wellbeing during everyday behaviour. Further, the derived use cases together with the rules and pathway descriptions build the basis for the foreseen behaviour of the coach and interactions with the patients. The technical design in turn took these clinical precepts and has started by deriving the technical architecture, technical design principle, the smart home architecture specification, precepts for the recipients and caregiver interfaces, overview of usable technologies for knowledge representation languages machine learning approaches and identification of relevant model types and their characteristics. The basic coaching services have been selected and the coaching services interfaces have been defined.
The vCare project aims to go beyond the state-of-the-art technology integrating and processing different data sources to personalise the coaching recommendation based on clinical pathways and patient preferences. Therefore, the project mission is to utilize the virtual coach in terms of the virtual avatar as communication mean for the patient. Acting like a physical coach, the VC channels the information and provides suitable recommendations to the patient, as well as engages the patient “like a coach” to stay in their training plan and also provides a backlink of the outcome as well as a possibility of intervention to the physician.

The vCare solution is deluged with several sensors to evaluate patient’s health status, care plan adherence, and other factors that are necessary for smooth recovery of quality of life. It also provides an interface for caregivers to extract patients’ relevant information and to tune the treatment.

Further, vCare will integrate semantic technologies (reasoning, behavioural models, predictive analytics, going beyond only rule-based but more intelligent adaptations), well-elaborated coaching services and clinical pathway services having the virtual coach as the central and controlling element.

The VC encapsulates coaching and supportive services as well tele-monitoring services. The latter provide the data-related basis for the virtual coach’s decision logic and as well as tracing data the service provision is based on.

However, the innovativeness of vCare does not only reside in the utilization of single technologies but in the combination of these technologies. This is to individualise/personalise the home care/rehabilitation and somehow fill the gap the caregiver’s in the home environment absence has caused.