This work was supported by a Career Development Award # [E7503W] and a Merit Award # [RX002413-01A2] from the United States (U.S.) Department of Veterans Affairs Rehabilitation Research and Development Service. The contents of this work do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

All methods described here have been approved by the Institutional Review Board at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, PA.
1. Installation and Set-Up of a Real-Time Locating System (RTLS)
<ol>
	<li>Review facility policies, safety, and personal information protections for residents with facility stakeholders. Determine whether written or verbal support on the use of RTLS in the facility is required. In discussions with stakeholders include local protocols and ...

<ol>
	<li>Bowen, M. E., Crenshaw, J., Stanhope, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Balance+ability+and+cognitive+impairment+influence+sustained+walking+in+an+assisted+living+facility.">Balance ability and cognitive impairment influence sustained walking in an assisted living facility.</a> Arch Gerontol Geriatr. 77, 133-141 (2018).</li><li>Washburn, R. A., McAuley, E., Katula, J., Mihalko, S. L., Boileau, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+physical+activity+scale+for+the+elderly+(PASE):+evidence+for+validity.">The physical activity scale for the elderly (PASE): evidence for validity.</a> J Clin Epidemiol. 52 (7), 643-651 (1999).</li><li>McAuley, E., Mihalko, S. L., Rosengren, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Self-Efficacy+and+Balance+Correlates+of+Fear+of+Falling+in+the+Elderly.">Self-Efficacy and Balance Correlates of Fear of Falling in the Elderly.</a> J Aging Phys Act. 5 (4), 329-340 (1997).</li><li>Boulgarides, L. K., Mcginty, S. M., Willett, J. A., Barnes, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+Report+Use+of+Clinical+and+Impairment-Based+Tests+to+Predict+Falls+by+Community-Dwelling+Older+Adults.">Research Report Use of Clinical and Impairment-Based Tests to Predict Falls by Community-Dwelling Older Adults.</a> Phys Ther. 83, 328-339 (2003).</li><li>MacRae, P. G., Schnelle, J. F., Simmons, S. F., Ouslander, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Physical+Activity+Levels+of+Ambulatory+Nursing+Home+Residents.">Physical Activity Levels of Ambulatory Nursing Home Residents.</a> J Aging Phys Act. 4 (3), 264-278 (1996).</li><li>Ruuskanen, J. M., Parkatti, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mobility+and+Related+Factors+Among+Nursing+Home+Residents.">Mobility and Related Factors Among Nursing Home Residents.</a> J Am Geriatr Soc. 42, 987-991 (1994).</li><li>Resnick, B., Galik, E., Gruber-Baldini, A. L., Zimmerman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perceptions+and+Performance+of+Function+and+Mobility+in+Assisted+Living+Communities.">Perceptions and Performance of Function and Mobility in Assisted Living Communities.</a> J Am Med Dir Assoc. 11, 406-414 (2010).</li><li>Beattie, E. R., Song, J., LaGore, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+wandering+behavior+in+nursing+homes+and+assisted+living+facilities.">A comparison of wandering behavior in nursing homes and assisted living facilities.</a> Res Theory Nurs Pract. 19 (2), 181-196 (2005).</li><li>Martino-Saltzman, D., Blasch, B. B., Morris, R. D., McNeal, L. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Travel+behavior+of+nursing+home+residents+perceived+as+wanderers+and+nonwanderers.">Travel behavior of nursing home residents perceived as wanderers and nonwanderers.</a> Gerontologist. 31 (5), 666-672 (1991).</li><li>Cohen-Mansfield, J., Wirtz, P. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characteristics+of+adult+day+care+participants+who+enter+a+nursing+home.">Characteristics of adult day care participants who enter a nursing home.</a> Psychol Aging. 22 (2), 354-360 (2007).</li><li>Hope, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wandering+in+dementia:+a+longitudinal+study.">Wandering in dementia: a longitudinal study.</a> Int Psychogeriatr. 13 (2), 137-147 (2001).</li><li>Bowen, M. E., Wingrave, C. A., Klanchar, A., Craighead, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracking+technology:+lessons+learned+in+two+health+care+sites.">Tracking technology: lessons learned in two health care sites.</a> Technol Health Care. 21 (3), 191-197 (2013).</li><li>Bowen, M. E., Rowe, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraindividual+Changes+in+Ambulation+Associated+With+Falls+in+a+Population+of+Vulnerable+Older+Adults+in+Long-Term+Care.">Intraindividual Changes in Ambulation Associated With Falls in a Population of Vulnerable Older Adults in Long-Term Care.</a> Arch Phys Med Rehabil. 97 (11), 1963-1968 (2016).</li><li>Kearns, W. D., Algase, D., Moore, D. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultra+Wideband+Radio:+A+Novel+Method+for+Measuring+Wandering+in+Persons+with+Dementia.">Ultra Wideband Radio: A Novel Method for Measuring Wandering in Persons with Dementia.</a> International Journal of Gerontechnology. 7 (1), 48-57 (2008).</li><li>Alarifi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultra+Wideband+Indoor+Positioning+Technologies:+Analysis+and+Recent+Advances.">Ultra Wideband Indoor Positioning Technologies: Analysis and Recent Advances.</a> Sensors (Basel). 16 (5), (2016).</li><li>Kearns, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporo-spacial+prompting+for+persons+with+cognitive+impairment+using+smart+wrist-worn+interface.">Temporo-spacial prompting for persons with cognitive impairment using smart wrist-worn interface.</a> J Rehabil Res Dev. 50 (10), (2013).</li><li>Jeong, I. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+a+Real-Time+Location+System+for+Assessment+of+Patient+Ambulation+in+a+Hospital+Setting.">Using a Real-Time Location System for Assessment of Patient Ambulation in a Hospital Setting.</a> Arch Phys Med Rehabil. 98 (7), 1366-1373 (2017).</li><li>Nasreddine, Z. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Montreal+Cognitive+Assessment,+MoCA:+a+brief+screening+tool+for+mild+cognitive+impairment.">The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.</a> J Am Geriatr Soc. 53 (4), 695-699 (2005).</li><li>Saczynski, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Montreal+Cognitive+Assessment:+Creating+a+Crosswalk+with+the+Mini-Mental+State+Examination.">The Montreal Cognitive Assessment: Creating a Crosswalk with the Mini-Mental State Examination.</a> J Am Geriatr Soc. 63 (11), 2370-2374 (2015).</li><li>Tinetti, M. E., Williams, T. F., Mayewski, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fall+risk+index+for+elderly+patients+based+on+number+of+chronic+disabilities.">Fall risk index for elderly patients based on number of chronic disabilities.</a> Am J Med. 80 (3), 429-434 (1986).</li><li>Contreras, A., Grandas, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+of+falls+in+Parkinson's+disease:+a+cross-sectional+study+of+160+patients.">Risk of falls in Parkinson's disease: a cross-sectional study of 160 patients.</a> Parkinsons Dis. , 362572 (2012).</li><li>Kearns, W. D., Nams, V. O., Fozard, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tortuosity+in+movement+paths+is+related+to+cognitive+impairment.+Wireless+fractal+estimation+in+assisted+living+facility+residents.">Tortuosity in movement paths is related to cognitive impairment. Wireless fractal estimation in assisted living facility residents.</a> Methods Inf Med. 49 (6), 592-598 (2010).</li><li>Tinetti, M. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+multifactorial+intervention+to+reduce+the+risk+of+falling+among+elderly+people+living+in+the+community.">A multifactorial intervention to reduce the risk of falling among elderly people living in the community.</a> N Engl J Med. 331 (13), 821-827 (1994).</li><li>Bowen, M. E., Craighead, J., Wingrave, C. A., Kearns, W. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-Time+Locating+Systems+(RTLS)+to+Improve+Fall+Detection.">Real-Time Locating Systems (RTLS) to Improve Fall Detection.</a> International Journal of Gerontechnology. 9 (4), 464-471 (2010).</li><li>Kearns, W. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Path+tortuosity+in+everyday+movements+of+elderly+persons+increases+fall+prediction+beyond+knowledge+of+fall+history,+medication+use,+and+standardized+gait+and+balance+assessments.">Path tortuosity in everyday movements of elderly persons increases fall prediction beyond knowledge of fall history, medication use, and standardized gait and balance assessments.</a> J Am Med Dir Assoc. 13 (7), e667-e665 (2012).</li><li>Bowen, M. E., Craighead, J. D., Klanchar, S. A., Nieves-Garcia, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multidrug-resistant+organisms+in+a+community+living+facility:+tracking+patient+interactions+and+time+spent+in+common+areas.">Multidrug-resistant organisms in a community living facility: tracking patient interactions and time spent in common areas.</a> Am J Infect Control. 40 (7), 677-679 (2012).</li></ol>

There are several critical steps to be followed prior to beginning the RTLS project that are worth discussion. While a typical common area in a long-term care facility (about 10m x 13m or 1,000 square feet) requires four sensors, this varies based on the environment and the number of sensors required for the project are based on the level of precision required and the environment. Protrusions and glass walls, for example, will require additional sensors. If there are no line of sight issues, four sensors will cover an ev...

An older adult&#39;s ability to perform daily activities of daily living and be physically active is associated with gait quality and balance ability.1 Previous work shows correlations between balance ability and self-reported physical activity among sedentary older adults.2 These correlations remain across older adult populations. For example, among older adults in the community, self-reported activity levels are significantly correlated with balance3 and walking capacity;4 the physical activity of ambulatory long-term care residents is positively correlated with both gait and balance (using the Tinetti Performance Oriented Mobility Assessment).5 Institutionalization is associated with decreased walking activity in later life6 and result in a high prevalence of sedentary behavior in this population.7 In fact, a reported 80% or more of the waking hours of an institutionalized resident is spent sitting or lying down5 and few long-term care residents achieve the recommended 30 minutes of daily moderate activity.7 Inadequate physical activity is associated with de-conditioning, hospitalization and other poor health outcomes in this population. Understanding the walking activity of this population may aid in tailored gait and/or balance interventions to increase physical activity.
Some institutionalized older adults with cognitive impairment (CI) begin walking excessively as a result of disease progression. Wandering occurs when there are little/no breaks in activity over the course of several hours/days. Wandering is associated with fatigue, weight loss, injurious falls, sleep disturbances, getting lost, and death.8 Compared to nursing home residents with no or mild/moderate CI, residents with severe CI demonstrate 20% more activity characterized as wandering, 26% of which are &#34;lapping&#34; behaviors, a type of wandering where a resident circles the room.9 Despite this, it is difficult for health care staff and other observers to distinguish between physical activity and wandering. Intra-individual changes in walking activity can be subtle and wandering is not a behavioral problem to be curbed until the older adult attempts to elope (e.g., escape the facility). Wandering is common; the prevalence of wandering varies from study to study but an estimated 38%10 to 80% of older adults with CI will wander at some point over the course of the disease.11
It is difficult to understand the walking activity of institutionalized older adults as the population is heterogeneous (e.g., varying cognitive levels, health conditions) and activity is difficult to objectively measure. Self-report methods of activity by health care staff better reflect elopement or attempted escapes from the facility, and continuous observation over the long-term is vulnerable to inter-rater errors, time-consuming and expensive.12,13 Real-time locating system (RTLS) technologies have the potential to objectively and continuously measure walking activity among older adults with CI. Notably, there is heterogeneity in the RTLS field and multiple systems may theoretically be used: ultra-wideband (UWB; see attached Table of Materials), infrared + radio frequency, ultrasound and machine vision systems. However, to assess wandering behaviors, a tracking technology that is small and unobtrusive, wireless, capable of wide-area tracking, with no line of sight issues and accuracy to within 20cm is needed and there are few (if any) systems other than a RTLS using UWB that fulfills these requirements. For example, infrared + radio frequency technology rely on creating &#34;zones&#34; which detail when a resident passes through, but is not specific enough to determine wandering behaviors except within a meter or two, which is far too gross for these purposes. Ultrasound and machine vision have issues with identification and reflections; machine vision systems have good resolution but cannot differentiate residents without resorting to using an RFID tag to compensate for the inadequate capabilities of current artificial intelligence. A RTLS utilizing UWB has a wider range and spatial resolution of about 20cm -- versus one meter or more for other systems -- making it the most precise and capable of capturing all activity patterns.14,15 The RTLS using UWB discussed here is also stable, having been designed for 24/7 industrial applications. Researchers and clinicians have previously used this system where precision is essential - to prevent and predict falls, to assess dementia and changes in cognition - in a wide variety of settings -- assisted living, hospital, nursing homes, and rehabilitation units.13,16,17
This paper will detail the protocol of a RTLS using UWB to measure walking activity [walking distance, sustained walking distance, and sustained gait speed (average meters per second/week calculated during sustained walking only)] and paper and pencil tests of CI, gait ability and balance quality, as the latter of which are key components of walking activity. Study findings will focus on using RTLS to distinguish between walking distance, which is associated with physical activity and thus positive health outcomes, and sustained walking distance which is associated with wandering and thus negative health outcomes.

<table border="0" cellpadding="0" cellspacing="0" style="width:700px;" width="701">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">UWB Sensor</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;"></td>
			<td style="width:167px;">There are two product lines to choose from; IP30 is the latest</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Tags</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;"></td>
			<td>There are two types of tags to choose from; if IP30 sensors are chosen, use DFLAT33 mini tags</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Timing Distribution Unit</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;">UBITIMING</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Network and Timing Combiner</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;">UBICOMSPL21</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Home Base License</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;">HOMEBASE</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Expert Support</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;">MANDS2</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Project Implmentation Services</td>
			<td style="width:71px;">Ubisense</td>
			<td style="width:119px;">PROJSERV</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Smart Factory</td>
			<td style="width:71px;">Ubisense&#160;</td>
			<td style="width:119px;"></td>
			<td>specialized software designed to manage the RTLS</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Server</td>
			<td style="width:71px;">Any</td>
			<td style="width:119px;"></td>
			<td>Laptop with at least 8MB RAM</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:344px;">Network Cabling</td>
			<td style="width:71px;">Any</td>
			<td style="width:119px;"></td>
			<td>3rd party or subcontract&#160;</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Tinetti Performance Oriented Mobility Assessment</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td>Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. The American journal of medicine. Mar 1986;80(3):429-434</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:344px;">The Montreal Cognitive Assessment</td>
			<td style="width:71px;"></td>
			<td style="width:119px;"></td>
			<td>https://www.mocatest.org</td>
		</tr>
	</tbody>
</table>

using a real-time locating system to measure walking activity associated with wandering behaviors among institutionalized older adults

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS&#39;s are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

RTLS raw data require smoothing to improve the location data&#39;s precision (see protocol step 9 under the section, &#34;Use the RTLS Tags to Locate and Track Residents in Real-Time&#34;). Though controlled with default settings in the power plot tab during installation and set-up (see step 1.6.3 in the associated protocol), without additional smoothing there will continue to be noise and jumps. With regard to noise, even when sedentary for several hours, the active RTLS tag continues to...

Watch this Scientific Journal Video about Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults at JoVE.com

Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

This paper discusses the use of a continuous and objective real-time locating system to measure walking activity associated with wandering behaviors, focusing on older adults with cognitive impairment. Walking activity is measured by walking distance, sustained walking distance, and sustained gait speed. Also assessed are gait quality and balance ability.

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for ...

Healthcare staff cannot distinguish between physical activity and wandering, and only identify wandering when a patient is at risk for leaving the facility. Changes in walking activity are associated with cognitive impairment, falls, wandering, and other poor health outcomes. The real-time locating system continuously and objectively tracks walking activity.This includes beneficial physical activity as well as wandering. Wandering is pattern walking that's associated with poor health outcomes. Before assigning a tag to a resident, open the Tag Association tab in the real-time locating system graphic use interface and assign a unique patient ID number to each consenting ambulatory or foot-propelled resident at random.Use the number provided on each tag to link a tag with each patient ID for wireless tracking, leaving the tag positions at origin and confirming that Allowed tag swaps is selected. Choose the type of tag, the mini tag, and click Save. In Location System Config, click View trace messages.Then, Get trace messages to make sure the system is recording events from the tags. Under the Sensor status tab, confirm that all of the sensors are running. In Location System Config, click Review location events.In the window, click Start listening to gather data in real time from tags. To turn on a tag, hold the magnet under the right side of the tag until the light begins to continuously blink. Then attach the activated tags to an area of the body of each resident with a small cross-sectional area for a more limited absorption of the radio frequency energy and to provide a better tracking accuracy.Once a day, visually check all of the sensor light indicators on the real-time location system sensors and tags and all of the system supplementary equipment, and confirm that the tags have not been submerged in water. Also daily, open the Map tab in the graphic user interface of the system and check that all of the tagged residents are visible and being tracked. To view more immediate events, use the Used last button in the Location System Config to adjust the amount of trace data.Set the time to the last 10 or fewer minutes, and click Start listening. When batteries are replaced, click on the associated tag and the Tag battery replaced button in the right-hand corner of the Smart Space Config. If a resident is missing from the tracking area and they are wearing an active tag, the report function can be used to determine the last time the resident was seen by the system by clicking on the daily, weekly, and monthly reports.Here, the travel of one resident over the course of a 24-hour period is shown. It is important to check that there are no jumps through walls and that all of the stationary activity is recorded without jumps. Given that the walking distance is a measure of all of the walking activity and that the sustained walking distance is measured only when the resident walks for at least 60 seconds, it is important to confirm that the walking distance mean data is higher than the sustained walking means for all of the tracked residents.Supplemental paper and pencil, cognitive, and getting balance tools can be used to further refine patient risk profiles. Real-time locating systems can provide continuous and objective measures of walking activity, predictive of falls, wandering, and other adverse events in high-risk patient populations.

using-real-time-locating-system-to-measure-walking-activity

Research

JoVE Journal

Behavior

How to Detect Amygdala Activity with Magnetoencephalography using Source Imaging

In trace fear conditioning a conditional stimulus (CS) predicts the occurrence of the unconditional stimulus (UCS), which is presented after a brief stimulus free period (trace interval)1. Because the CS and UCS do not co-occur temporally, the subject must maintain a representation of that CS during the trace interval. In humans, this type of learning requires awareness of the stimulus contingencies in order to bridge the trace interval2-4. However when a face is used as a CS, subjects can implicitly learn to fear the face even in the absence of explicit awareness*. This suggests that there may be additional neural mechanisms capable of maintaining certain types of "biologically-relevant" stimuli during a brief trace interval. Given that the amygdala is involved in trace conditioning, and is sensitive to faces, it is possible that this structure can maintain a representation of a face CS during a brief trace interval.
It is challenging to understand how the brain can associate an unperceived face with an aversive outcome, even though the two stimuli are separated in time. Furthermore investigations of this phenomenon are made difficult by two specific challenges. First, it is difficult to manipulate the subject's awareness of the visual stimuli. One common way to manipulate visual awareness is to use backward masking. In backward masking, a target stimulus is briefly presented (&lt; 30 msec) and immediately followed by a presentation of an overlapping masking stimulus5. The presentation of the mask renders the target invisible6-8. Second, masking requires very rapid and precise timing making it difficult to investigate neural responses evoked by masked stimuli using many common approaches. Blood-oxygenation level dependent (BOLD) responses resolve at a timescale too slow for this type of methodology, and real time recording techniques like electroencephalography (EEG) and magnetoencephalography (MEG) have difficulties recovering signal from deep sources.
However, there have been recent advances in the methods used to localize the neural sources of the MEG signal9-11. By collecting high-resolution MRI images of the subject's brain, it is possible to create a source model based on individual neural anatomy. Using this model to "image" the sources of the MEG signal, it is possible to recover signal from deep subcortical structures, like the amygdala and the hippocampus*.

This article describes how to record amygdala activity with magnetoencephalography (MEG). In addition this article will describe how to conduct trace fear conditioning without awareness, a task that activates the amygdala. It will cover 3 topics: 1) Designing a trace conditioning paradigm using backward masking to manipulate awareness. 2) Recording brain activity during the task using magnetoencephalography. 3) Using source imaging to recover signal from subcortical structures.

In trace fear conditioning a conditional  stimulus (CS) predicts the occurrence of the unconditional stimulus (UCS),  which is presented after a brief ...

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango&#8217;s demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson&#8217;s Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression.

Community-based Adapted Tango Dancing for Individuals with Parkinson&#039;s Disease and Older Adults

Adapted tango has demonstrated efficacy for improving mobility and balance. We describe the dissemination of adapted tango teaching methods to dance instructor trainees and the implementation of adapted tango by the trainees in the community for improving mobility and balance in older adults and individuals with Parkinson&#8217;s disease.

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple ...

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

Psychophysical Tracking Method to Measure Taste Preferences in Children and Adults

The Monell two-series, forced-choice, paired-comparison tracking method provides a reliable measure of sweet taste preferences from childhood to adulthood. The method, which is identical for children, adolescents, and adults, is of short duration (&#60; 15 min), does not rely on sustained attention or place demands on memory (which would yield spurious age differences), and minimizes the impact of language development, making this method amenable to the cognitive limitations of pediatric populations. In this whole-mouth tasting method, subjects are asked to taste (without swallowing) pairs of solutions of different sucrose concentrations and to point to the solution they prefer. Each subsequent pair contains the participant&#39;s preceding preferred concentration and an adjacent stimulus concentration. The procedure continues until the subject chooses either a given concentration of sucrose when paired with both a higher and a lower concentration, or the highest or lowest concentration two consecutive times. Subjects are prevented from reaching response criteria on the basis of first or second position bias by the two-series design of the method, which counterbalances the order of solution presentation within each pair between the series (the weaker concentration is presented first in Series 1, second in Series 2). The geometric mean of the two sucrose concentrations chosen in Series 1 and 2 is an estimate of the participant&#39;s most preferred level of sucrose. Sucrose preference as determined with this laboratory-based measure has been shown to be associated with preference for sugars in foods and beverages and with taste receptor genotype, family history of alcoholism, and race/ethnicity, as well as depressive symptomatology among pediatric populations. The method has real-world relevance and has been applied to determine most preferred level of other tastes (e.g., salt), making it a valuable psychophysical tool.

Sweet taste has powerful hedonic appeal among people of all ages, particularly children. Described herein is a reliable and valid method that can be used to determine the level of sweetness most preferred, making it a valuable psychophysical tool for scientists.

The Monell two-series, forced-choice, paired-comparison tracking method provides a reliable measure of sweet taste preferences from childhood to ...

Using the FishSim Animation Toolchain to Investigate Fish Behavior: A Case Study on Mate-Choice Copying In Sailfin Mollies

Over the last decade, employing computer animations for animal behavior research has increased due to its ability to non-invasively manipulate the appearance and behavior of visual stimuli, compared to manipulating live animals. Here, we present the FishSim Animation Toolchain, a software framework developed to provide researchers with an easy-to-use method for implementing 3D computer animations in behavioral experiments with fish. The toolchain offers templates to create virtual 3D stimuli of five different fish species. Stimuli are customizable in both appearance and size, based on photographs taken of live fish. Multiple stimuli can be animated by recording swimming paths in a virtual environment using a video game controller. To increase standardization of the simulated behavior, the prerecorded swimming path may be replayed with different stimuli. Multiple animations can later be organized into playlists and presented on monitors during experiments with live fish.
In a case study with sailfin mollies (Poecilia latipinna), we provide a protocol on how to conduct a mate-choice copying experiment with FishSim. We utilized this method to create and animate virtual males and virtual model females, and then presented these to live focal females in a binary choice experiment. Our results demonstrate that computer animation may be used to simulate virtual fish in a mate-choice copying experiment to investigate the role of female gravid spots as an indication of quality for a model female in mate-choice copying.
Applying this method is not limited to mate-choice copying experiments but can be used in various experimental designs. Still, its usability depends on the visual capabilities of the study species and first needs validation. Overall, computer animations offer a high degree of control and standardization in experiments and bear the potential to &#39;reduce&#39; and &#39;replace&#39; live stimulus animals as well as to &#39;refine&#39; experimental procedures.

Using the FishSim Animation Toolchain to Investigate Fish Behavior: A Case Study on Mate-Choice Copying In Sailfin Mollies

Using the novel FishSim Animation Toolchain, we present a protocol for non-invasive visual manipulation of public information in the context of mate-choice copying in sailfin mollies. FishSim Animation Toolchain provides an easy-to-use framework for the design, animation and presentation of computer-animated fish stimuli for behavioral experiments with live test fish.

Over the last decade, employing computer animations for animal behavior research has increased due to its ability to non-invasively manipulate the ...

Modified Blood Collection from Tail Veins of Non-anesthetized Mice with a Vacuum Blood Collection System and Eyeglass Magnifier

Blood sample collection is the basis of experimental animal research. It is of importance to obtain adequate blood samples for various research purposes. The tail veins of mice are small, and it is sometimes difficult to obtain the required blood volume by conventional puncture methods. This study investigates the superiority of repeated blood sample collection from tail veins of mice through use of a vacuum blood collection system and eyeglass magnifier (experimental group) compared to conventional blood sampling methods (conventional group), performed by beginners and experts, respectively. With the help of an eyeglass magnifier, a butterfly needle tip is inserted into the tail vein of each mouse in the experimental group. When the vein is penetrated successfully, a blood sample is collected in the vacuum collection tube by insertion of the rubber end of a butterfly needle into the vacuum blood collection tube. The plunger is then used to collect blood without the help of the eyeglass magnifier in the conventional group. Success rates of blood sample collection by the beginners and experts were shown to be 70% vs. 100% (p &#60; 0.01) in the experimental group and 35% vs. 85% (p &#60; 0.01) in the conventional group. For both beginners and experts, puncture times required for obtaining required blood sample were significantly lower in the experimental group compared to the conventional group (2.40 &#177; 0.75 vs. 2.90 &#177; 0.31, p &#60; 0.05; 1.15 &#177; 0.37 vs. 1.55 &#177; 0.76, p &#60; 0.05). In conclusion, the presented blood sampling technique is feasible and easy to practice and enables frequent sampling of adequate blood volumes from non-anesthetized mice.&#160;

This study reports blood sampling from tail vein in mice using a vacuum extraction tube system with eyeglass magnifier. Our method is easy to practice and could be used for repeat blood sampling in mice.

Blood sample collection is the basis of experimental animal research. It is of importance to obtain adequate blood samples for various research purposes. ...

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological cognitive decline. It is thus essential that cognitive tests and their administration are as fair as possible. However, an important source of bias during cognitive testing comes from negative aging stereotypes that can impair the memory performance of older adults and inflate age differences on cognitive tasks. The fear of confirming negative aging stereotypes creates an extra pressure among older adults which interferes with their intellectual functioning and leads them to perform below their true abilities. Here, we present a protocol that highlights simple but efficient interventions to alleviate this age-based stereotype threat effect. The first study showed that simply informing older participants about the presence of younger participants (threat condition) led older adults to underperform on a standardized memory test compared with younger participants, and that this performance difference was eliminated when the test was presented as age-fair (reduced-threat condition). The second study replicated these findings on short cognitive tests used to screen for predementia in clinical settings and showed that teaching older adults about stereotype threat inoculated them against its effects. These results provide useful recommendations about how to improve older adults' memory assessment both in Iab studies and in clinical settings.

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults&#039; Cognitive Testing

Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.

As life expectancy increases, aging has become a major health challenge, resulting in a huge effort to better discriminate between normal and pathological ...

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack

Recent studies have shown that an automated, lifespan-inclusive, transdiagnostic, and clinically based, individualized risk calculator provides a powerful system for supporting the early detection of individuals at-risk of psychosis at a large scale, by leveraging electronic health records (EHRs). This risk calculator has been externally validated twice and is undergoing feasibility testing for clinical implementation. Integration of this risk calculator in clinical routine should be facilitated by prospective feasibility studies, which are required to address pragmatic challenges, such as missing data, and the usability of this risk calculator in a real-world and routine clinical setting. Here, we present an approach for a prospective implementation of a real-time psychosis risk detection and alerting service in a real-world EHR system. This method leverages the CogStack platform, which is an open-source, lightweight, and distributed information retrieval and text extraction system. The CogStack platform incorporates a set of services that allow for full-text search of clinical data, lifespan-inclusive, real-time calculation of psychosis risk, early risk-alerting to clinicians, and the visual monitoring of patients over time. Our method includes: 1) ingestion and synchronization of data from multiple sources into the CogStack platform, 2) implementation of a risk calculator, whose algorithm was previously developed and validated, for timely computation of a patient&#39;s risk of psychosis, 3) creation of interactive visualizations and dashboards to monitor patients&#39; health status over time, and 4) building automated alerting systems to ensure that clinicians are notified of patients at-risk, so that appropriate actions can be pursued. This is the first ever study that has developed and implemented a similar detection and alerting system in clinical routine for early detection of psychosis.

We demonstrate how to deploy a real-time psychosis risk calculation and alerting system based on CogStack, an information retrieval and extraction platform for electronic health records.

Recent studies have shown that an automated, lifespan-inclusive, transdiagnostic, and clinically based, individualized risk calculator provides a powerful ...

Using a Virtual Reality Walking Simulator to Investigate Pedestrian Behavior

To cross a road successfully, individuals must coordinate their movements with moving vehicles. This paper describes use of a walking simulator in which people walk on a treadmill to intercept gaps between two moving vehicles in an immersive virtual environment. Virtual reality allows for a safe and ecologically varied investigation of gap crossing behavior. Manipulating the initial starting distance can further the understanding of a participant&#8217;s speed regulation while approaching a gap. The speed profile may be assessed for various gap crossing variables, such as initial distance, vehicle size, and gap size. Each walking simulation results in a position/time series that can inform how velocity is adjusted differently depending on the gap characteristics. This methodology can be used by researchers investigating pedestrian behavior and behavioral dynamics while employing human participants in a safe and realistic setting.

This protocol describes use of a walking simulator that serves as a safe and ecologically valid method to study pedestrian behavior in the presence of moving traffic.

To cross a road successfully, individuals must coordinate their movements with moving vehicles. This paper describes use of a walking simulator in which ...

Lower-Limb Biomechanical Characteristics Associated with Unplanned Gait Termination Under Different Walking Speeds

Gait termination caused by unexpected stimulus is a common occurrence in everyday life. This study presents a protocol to investigate the lower-limb biomechanical changes that occur during unplanned gait termination (UGT) under different walking speeds. Fifteen male participants were asked to perform UGT on a walkway at normal walking speed (NWS) and fast walking speed (FWS), respectively. A motion analysis system and plantar pressure platform were applied to collect lower-limb kinematic and plantar pressure data. Paired-sampled T-test was used to examine the differences in lower-limb kinematics and plantar pressure data between two walking speeds. The results showed larger range of motion in the hip, knee, and ankle joints in the sagittal plane as well as plantar pressure in forefoot and heel regions during UGT at FWS when compared with NWS. With the increase in walking speed, subjects exhibited different lower-limb biomechanical characteristics that show FWS associated with greater potential injury risks.

This study compared the biomechanical characteristics of the lower extremity during unplanned gait termination under different walking speeds. The lower-limb kinematic and kinetic data from fifteen subjects with normal and fast walking speeds were collected using a motion analysis system and plantar pressure platform.

Gait termination caused by unexpected stimulus is a common occurrence in everyday life. This study presents a protocol to investigate the lower-limb ...