Health Care Activities

The activity modeling has been done in close collaboration with clinicians. A strong effort have been done in this step of modeling the activities of interest for the purpose to meet the clinician requirements for patient monitoring. For medical needs, we have defined two clinical scenarios to be executed by the participants. The overall aim of the clinical scenarios was to enable the participants to undertake a set of daily tasks that could realistically be achieved in

the setting of an observation room and at the same time provide objective information about dementia symptoms. The clinical scenarios are intended to assess older people performance in IADLs (Instrumental Activities of Daily Living) and in gait analysis tests (e.g., performing a balance test). The first clinical scenario (S1) is elaborated to be executed by Alzheimer disease AD participants and to be compared with normal control participants (i.e. healthy older people). The second clinical scenario (S2) is elaborated to be executed by MCI ( Mild Cognitive Impairment) participants and compared with normal control people. The activities in scenario (S1) are less complex than for scenario (S2) as the participants recruited for scenario (S1) are at an advanced stage of the illness and have more problems in memory and have more difficulties to perform goal-directed activities.

Both scenarios were divided in three parts covering basic to more complex activities: (1) Directed activities,(2)Semi-directed activities and(3)Undirected (‘free’) activities. Scenarios (S1) and (S2) have difference at the level of semi-directed activities and they keep the same content for directed activities and free activities.

¥ Directed activities (10 minutes duration): The aim of this part of the assessment is to identify characteristics of gait and walk parameters in activities with limited implication of cognitive capacities (table. 4.1). This part was based on short physical performance and required the examiner, who remained in the room, to verbally direct the participant to undertake various daily tasks. The examiner also scored the performance.

Balance testing

The examiner asks the participant to perform several physical exercises:

- Stand feet together side by side .

- Semi tandem stand, stand with the side of the heel of one foot touching the big toe of the other foot

- Tandem stand, with the heel of one foot in front of and touching the toes of the other foot Up and Go Exercise

Patient is asked to Walk through the room, from the opposite side of the video camera for 4 meters and then go back to the starting point.

Transfer Exercise: Repeated chair stands testing

The examiner asks the participant to make a first chair stand, from sit to stand position without using his/ her arms. The examiner will then ask the participant to do the same action 5 times in a row.

Table4.1: The clinical scenario: Description of directed activities.

¥ Semi-directed activities(20 minutes duration). The aim here is to determine the extent

to which the participant could undertake a list of daily activities in a given order, after having been given a set of instructions. Table 4.2 shows the semi-directed activities for the first clinical scenario (S1). For the clinical scenario (S2), participants were assessed in their ability to carry out a list of ten activities in a logical order respecting temporal execution constraints within a time frame of 15 minutes (see table. 4.3).

Prior to leaving the room, the examiner described each of the activities and the location and use of various objects needed to undertake the task. The examiner left the room only after it was clear that the participant understood the task. The participant was able to keep the instructions and refer to them at any point during the assessment. The participant was also told that the examiner would be available for questions on the other side of the door and that he/she could leave the room at any point should he/she choose to do so. During the clinical scenario, an examiner located outside of the room monitored the safety of the participants.

- Walk to the reading table and read something for 2 mn

- Walk to the coffee corner where the kettle is and make warm some water.

- Walk to the phone and compose this number: xxxxxx.

- Take the watering can and water the plant.

- Walk to the television and turn it on with the remote control.

- Walk to the reading table, take the playing cards and classify them by color (reds with reds, blacks with blacks).

- Take the green ‘ABCD’ folder on the desk with the A, B, C, D sheets in it.

- Match the A, B, C, D sheets from the folder to one‘s dispersed all over the room; A with A, etc...

- Put the ‘ABCD’ folder back on the desk.

- Get out of the room.

Table4.2: The clinical scenario: Description of semi-directed activities of the first scenario (S1).

¥ Undirected (‘free’) activities(30 minutes duration): The aim here was to assess how the participant spontaneously initiated activities and organized their time. Several items were at the participant‘s disposal, including magazines, newspapers, a book of photos, drinks (coffee, tea, fruit juice), plants, dominos, playing cards, TV and a telephone. During this period the participant was informed that the telephone might ring 30 minutes after the examiner had left the room and that the participant would be required to answer it. This was the only instruction given to the participant. They were otherwise free to do as they

- Read the newspaper

- Walk to the coffee corner where the kettle is and make warm some water.

- Water the plant.

- Answer the phone.

- Call the taxi.

- Prepare today’s medication.

- Make the check for the Electricity Company.

- Leave the room when you have finished all activities - Watch the TV.

- Prepare a hot tea.

- Write a shopping list for lunch.

1. watch the TV before the phone call.

2. water the plant just before leaving the room.

3. call a taxi, which will arrive in 10 minutes and ask the driver to drive you to the market.

Table4.3: The clinical scenario: Description of semi-directed activities of the second scenario (S2).

pleased for the duration of the time. The participant was also told that the examiner would be available for questions on the other side of the door and that they could leave the room at any point should they choose to do so.

Tables ( 4.4, 4.5 and 4.6) summarize the set of daily living activities proposed for health care monitoring.