Researchers take sensor system from lab to marketplace

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COLUMBIA, Mo. (AP) — While some go to the doctor once a year, many residents at the TigerPlace assisted living community in southeast Columbia get a virtual checkup every day.

Wireless sensor systems installed in about half of the community's living spaces constantly monitor residents' vitals and calculate their risk of falling, the Columbia Daily Tribune ( ) reported.

That monitoring system, created by University of Missouri researchers, is starting to appear in other assisted living homes and hospitals throughout the state. A new program through the Sinclair School of Nursing is helping the technology break into the mass market.

Marilyn Rantz, professor emeritus with the School of Nursing, and Marjorie Skubic, a professor with MU's College of Engineering, have worked to create the system for more than a decade. Rantz said she and Skubic have a shared passion for predicting health changes and the risk of falls because both have seen the effects one fall can have on the health of an elderly person. Rantz said her mother fell several years ago.

"If my mother's risk of falling — if we had known that it was going up — we would have known weeks before that there were changes going on," Rantz said. "She fell, was on the floor for eight hours, and her health declined."

Rantz's mother fractured her shoulder in the fall and died within six months. Skubic's mother-in-law also fell at one point and injured her shoulder. Her mother-in-law's shoulder never healed properly and caused constant pain the rest of her life, Skubic said.

The sensor system is able to detect changes in health earlier than when individuals notice themselves feeling ill, Rantz said.

"We can actually detect illnesses 10 days, two weeks, sometimes even longer before the resident would typically complain" about not feeling well, Rantz said. "It gives the nurse a heads up that something's not right with that person."

The MU research team developed a suite of sensors during the past decade.

Rantz said the monitoring system has detected numerous health issues, including upper-respiratory infections, pneumonia and urinary tract infections as well as changes in chronic health conditions, congestive heart failure, diabetes, lung disease and cognition.

The monitoring system, Rantz said, works by providing more frequent and detailed vital signs. The movement sensors use silhouettes instead of pictures or video to collect data.

Skubic said people usually only get a thorough update on their vital signs once a year when they visit a doctor. The sensors, she said, constantly are producing data.

"It's like having a checkup every day," Skubic said.

The monitoring system includes several different types of sensors placed throughout an individual's living space in discreet locations. One sensor rests between the mattress and the box spring and monitors pulse and respiration rates to detect restlessness in bed. If someone is not sleeping well, Skubic said, it's often an early indicator of a health change.

A gate-analysis system observes people as they walk — capturing their walking speed and stride — to detect whether people are at risk for falling. Rantz said many people are not evaluated for fall risk even at their annual checkup.

An individual typically needs a bed sensor, a gate analysis and at least four motion sensors placed in high-traffic areas of their home to get good readings from the monitoring system, Rantz said. The sensors are wireless and connect to the Internet.

TigerPlace was built with research in mind. When residents move in, they consent to participate in the evaluation and agree to let the researchers access their health information anonymously.

The researchers used grants to purchase the initial motion sensors, which were installed in TigerPlace apartments in October 2005. They have since tested various brands of sensor equipment at TigerPlace, working to establish a sensor system that works while keeping cost in mind.

"We've been able to use the infrastructure here to really test out the effectiveness of this equipment," Skubic said.

About half of the TigerPlace residents have the sensor systems installed in their living space, and the other half act as a control group for the research. The half that does not have the monitoring system receives the same care from the same nursing staff as those who have the sensors. They have served as a control group as the team works to collect data showing how effective the sensors are at predicting health changes.

From their data, Rantz said the care model used at TigerPlace helps people stay healthier about two years longer than in a traditional setting. The monitoring system helped people stay healthier about four years longer than in a traditional setting, she said.

As they tested various brands of equipment, Rantz said they tried to focus on what they thought would be affordable.

"If you were ever going to reach out to the public, you needed to be able to develop a system that was going to be affordable," Rantz said.

Skubic and Rantz have teamed with MU alumnus George Chronis for the past couple of years to produce a commercial version of the monitoring system. MU has been encouraging those efforts.

Hank Foley, senior vice chancellor for research and graduate studies at the university, created a five-point plan to improve research efforts at MU and to raise its status in the Association of American Universities. Part of Foley's plan included encouraging entrepreneurship among researchers.

"It's much more than understanding science now," Foley told the Tribune in 2014. "It is understanding the context, and that context is changing. Entrepreneurship, innovation and invention are considered more important today than they were before. The translation of research from the lab to the marketplace is much more crucial."

Skubic and Rantz have been working to break into the marketplace. Skubic said there is a significant difference between the equipment they produce for research purposes and the products they plan to market to consumers.

"The kind of systems that we build as research prototypes are not the sort of robust systems that you want to be able to sell to people," Skubic said. Chronis' company is "turning our research prototypes into really robust, reliable commercial products."

The technology has been installed in 13 Missouri assisted living facilities and hospitals, including Barnes Jewish hospital in St. Louis. The company producing the monitoring system will be installing the technology in a few locations outside of Missouri this fall.

Skubic and Rantz contacted Chronis about four years ago to discuss commercializing their research. When Chronis was pursuing his doctorate at MU 20 years ago, Skubic was his adviser.

Chronis initially said he did not have time because of a number of other projects demanding his attention. When they contacted him again about a year later, he decided to get involved.

"I always wanted to create something what would help people," Chronis said. "It's fascinating to be able to take an application like that, that would help people in such a real way."

Chronis started Foresite Healthcare, which has a small lab space in Columbia, in May 2013 to commercialize the product.

The company licensed the intellectual property of the monitoring system in August 2013 and has been creating the products in St. Louis. Foresite made its first installation in late 2013 and has expanded to nine full-time and two part-time employees.

Those involved in the project hope to make the monitoring system more accessible for residential use. Rantz said they have been piloting the technology in a few homes.

Sinclair@Home, through the Sinclair School of Nursing, became available this summer and installs the system in private residences. The service is available to Columbia-area residents who have high-speed Internet connections, and it costs about $350 per month after a one-time installation fee and sensor deposit. The Sinclair@Home service includes the sensors, the sensor network and off-site support from Sinclair Home Care nurses.

Home installation has some challenges that health care facilities installing the technology don't face, Chronis said. The system requires a strong Internet connection and server, which Chronis said can be difficult in some residential locations.

Most hospitals and assisted living communities already have an established network infrastructure, so it there isn't much cost related to installing the monitoring system in individual rooms. The installation cost rises when one person is paying for the monitoring system and infrastructure for a single-family home.

"A hospital can afford a system like this. They see the benefit immediately," Chronis said. "If you have a 4.5 percent fall rate, and you reduce that, you're saving the hospital hundreds of thousands of dollars a year. Whereas at home, a person may say, 'I'll take the risk because I can't afford to pay for that.' "

The hope, Chronis said, is that insurance companies will begin covering some of the costs associated with the technology as a preventative measure once they see the health benefits of the system.

The researchers are recommending the government reimburse residents for the cost of the sensors as a cost-saving measure because the system will allow individuals to live in their own homes longer.

Skubic wants to put the monitoring system in her parents' home. Rantz is eager to see it installed in more homes.

"Sometimes it kind of takes your breath away," Rantz said. "It's something that you hope for and you pray for, and I just want to see it ... become a reality in people's homes."


Information from: Columbia Daily Tribune,

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