SCH: INT: Collaborative Research: BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment

一些痴呆症患者（PWD）表现出的躁动引起的照顾者负担、压力和抑郁是导致PWD从就地养老过渡到长期护理机构的主要原因。护理人员提供的非药物干预（例如，分散注意力，提供休息，使环境平静，轻声说话，温柔的触摸，最喜欢的音乐选择等）可以减少PWD中躁动的频率和严重程度。然而，躁动可能是不可预测的，并受到环境的影响，而躁动的早期迹象往往未被发现，并可能升级为更难以管理的攻击性躁动。因此，大多数用于处理痴呆症躁动的方法都是被动的，而不是主动的，并且在躁动升级时施用得太晚而无法有效。预测躁动发作和检测躁动早期阶段的工具将使护理人员能够早期干预并最终减少躁动，从而减轻护理人员的负担，延长原地老龄化以及相关的生活质量和成本效益。这种基于护理人员赋权的护理策略可能对残疾人士的就地养老能力产生重大影响。在整个项目过程中，将开展社区外展工作，让残疾患者及其护理人员参与进来，由此产生的知识产品可以传播给不同社会文化生态系统的一系列利益相关者，从研究人员到家庭成员和临时提供者。该项目以普遍访问的做法为基础，展示了一种对最广泛的用户群体有益和可访问的设计。该项目还将为工程师、临床医生和护理社区之间的协作方法建立框架，以解决关键的医疗保健需求，这将成为新课程模块和会议研讨会的基础。该项目将克服实现这种工具的基本科学障碍，采用行为和环境感知与干预的三个阶段的研究计划。首先，将开发一个穿戴式和家用传感器系统，以提供连续的、非侵入性的躁动评估和环境环境监测。其次，该系统将部署在社区居住的残疾人士家中，以模拟躁动与环境之间的关系，并识别早期躁动的特征，这两者都将为实时护理人员通知策略的制定提供信息。第三，概念验证将通过一项人类受试者试点研究进行演示，护理人员在可能的躁动发作之前接收实时通知，以改变环境，并在躁动的早期阶段实施残疾障碍干预。成功完成这三个阶段的项目将推动后续大规模的实践证明研究。调查团队结合了技术功能（计算机工程）、可访问性（以人为本的设计）和适用性（医学研究和临床护理）方面的专业知识，以解决多模态感知系统的基本挑战，建模网络社会物理系统动力学和实时通知-所有这些都在关键社会需求的背景下。不同的传感器流将通过融合跨多个时间尺度的各种数据类型来聚合，聚合的数据将使用新的躁动评估和环境表征方法进行分析，提取的信息将用于开发动态系统模型，定制的自动通知将使护理人员能够在躁动升级之前进行干预，同时满足实时干预要求。这些模型将是针对pwd护理人员群体的，需要动态的现场培训，并将为网络社会物理系统提供新的本体，该系统将环境、技术和社会群体结合起来，以预测和减轻破坏性的神经事件。痴呆复杂系统干预的本体尚不存在，但将从该项目团队的探索性、综合性和分析性努力中出现。有关该项目的更多信息，请参见该项目的网站：http://wirelesshealth.virginia.edu/content/BESI

Caregiver burden, stress, and depression resulting from agitation exhibited by some people with dementia (PWD) are the primary reasons cited for PWD transitioning from aging-in-place to long-term care facilities. Non-pharmacological interventions provided by caregivers (e.g., distraction, providing rest, calming the environment, speaking softly, gentle touch, favorite music selections, etc.) can reduce the frequency and severity of agitation in PWD. However, agitation can be unpredictable and influenced by the environment, and early signs of agitation often go undetected and can escalate to aggressive agitation that is more difficult to manage. As a result, most methods used to deal with agitation in dementia are reactive rather than proactive and are administered too late in an agitation escalation to be effective. A tool to predict agitation episodes and detect early stages of agitation would empower caregivers to intervene early and ultimately reduce agitation, thus reducing caregiver burden and extending aging-in-place and the associated quality-of-life and cost benefits. This caregiver empowerment based strategy to PWD care could have a significant impact on the ability of PWD to age-in-place. Community outreach efforts will be conducted that engage PWD and their caregivers throughout the project, and the resulting knowledge products can be disseminated to a range of stakeholders across various sociocultural ecosystems, from researchers to family members and respite providers. The project rests on the practice of universal access, demonstrating a design that is beneficial to and accessible by the broadest range of user groups. This project will also establish a framework for a collaborative approach between engineers, clinicians, and the caregiving community to address critical healthcare needs, which will be the basis of new course modules and conference workshops.This project will overcome the fundamental scientific barriers to realizing such a tool with a three-phase research plan to employ Behavioral and Environmental Sensing and Intervention. First, a system of body-worn and in-home sensors will be developed to provide continuous, non-invasive agitation assessment and environmental context monitoring. Second, this system will be deployed in the homes of community-dwelling PWD to model the relationship between agitation and the environment and to identify features of early-stage agitation, both of which will inform the development of real-time caregiver notification strategies. Third, proof-of-concept for will be demonstrated through a human subject pilot study, with caregivers receiving real-time notifications to alter the environment in advance of probable agitation episodes and to administer PWD interventions in the early stages of agitation. Successful completion of this 3-phase project will motivate a follow-up large-scale proof-of-practice study.The investigative team combines expertise in technology function (computer engineering), accessibility (human centered design), and applicability (medical research and clinical care) to address fundamental challenges of multimodal sensing system-of-systems, modeling cyber-socio-physical system dynamics, and real-time notifications - all within the context of a critical societal need. Diverse sensor streams will be aggregated by fusing assorted data types across multiple time scales, aggregated data will be analyzed using novel agitation assessment and environmental characterization methods, extracted information will be used to develop dynamic system models, and customized automated notifications will empower caregivers to intervene before agitation escalation - all while meeting real-time intervention requirements. These models will be PWD-caregiver dyad specific, requiring dynamic in-situ training, and will present new ontologies for cyber-socio-physical systems that incorporate contexts, technologies, and social dyads to predict and mitigate disruptive neurological events. Ontologies for complex systems interventions in dementia do not yet exist but will emerge from the exploratory, integrative, and analytical efforts of this project team.For further information on this project, see the project web site: http://wirelesshealth.virginia.edu/content/BESI