Current Research Projects

Enhancing Cognitive Assessment Using Computer Game technology: The Western Ottawa Whack-a-mole (WOW) Pilot Study

Center of Pressure Characteristics During Bed Exit as Markers of Mobility

Driving Signature-working towards improved clinical decision making-distinguishing between drivers of shared vehicles

Mild Cognitive Impairment: Can Decline to Dementia be Monitored and Delayed by Computer-Based Games?

Monitoring Progression of Bed Transfer Abilities Using Pressure-Sensitive Mat Technology (CIHR Mobility Demo Project)


Completed Research Projects

Enhancing Cognitive Assessment Using Computer Game technology: The Western Ottawa Whack-a-mole (WOW) Pilot Study

Funding Angency: Age-Well Incentive

Grant Amount:

Investigators: Frank Knoefel, Rafik Goubran, Bruce Wallace, Eleni Stroulia, Victor Guana, Amanda Baker, Brianna Allard, Philippe Masson.

Details: Standard practice to monitor cognitive decline typically requires clinicians to use pen-and-paper tools, like the MMSE. However, these tools often cause patient stress and are less reliable in more advanced forms of dementia . Therefore, a “whack-a-mole” computer game was designed to monitor cognitive change over a 1-year period. We aimed to recruit 10 older adults with moderate dementia from an Ottawa Day Program. MMSE, Trails A and Ramparts testing was completed to help determine dementia severity. The game was designed to measure processing speed and inhibition by requiring participants to “whack a mole” but “ignore a bunny”. Fifteen rounds were played per session. As performance improved with each round, game difficulty increased. Accuracy, reaction time and level attained were monitored weekly.


Title: Center of Pressure Characteristics During Bed Exit as Markers of Mobility

Funding Agency: Bruyère Academic Medical Organization (BAMO) Incentive Funds

Grant Amount: $19,239

Term: 2014-2015

Investigators: Frank Knoefel (PI), Rafik Goubran, Martin Bilodeau, Jeff Jutai, Heidi Sveistrup

Details: Transfer characteristics of older adults change with fluctuations in strength and related to other medical conditions. For instance, asymetry before and after transfers is a common problem with transfers among the eldery. During rehabilitation, successful transfers are often taught by encouraging “nose over toes” as moving mass forward is essential for bed exit. Using a sub-set of data from the project, “Monitoring Progression of Bed Transfer Abilities Using Pressure-Sensitive Mat Technology” (M. Bilodeau, F. Knoefel, R. Goubran, H. Sveistrup, and J. Jutai), funded through the Canadian Institute for Health Research, the project aims to refine an algorithm and explore characteristics of center of pressure (such as forward movement of center of pressure, lateral deviation from midline patterns, etc.) for a sub-set of the community based patients with a focus on those patients discharged from the in-patient Geriatric Rehabilitation and out-patient Geriatric Day Hospital programs. Once potential characteristics have been identified, they will be compared to usual clinical outcomes, with the intent of being able to see if they are representative of mobility maintenance.

Title: Driving Signature-working towards improved clinical decision making-distinguishing between drivers of shared vehicles (2014-2015)

Funding Agency: Bruyère Academic Medical Organization (BAMO) Innovation Funds

Grant Amount: $69,000

Term: 2014-2015

Investigators: Frank Knoefel (PI), Bruce Wallace, Rafik Goubran, Shawn Marshall, Michelle Porter

Details: The incidence of chronic illness in Ontario is increasing and many of these illnesses have a significant impact on driving. Clinicians have a responsibility to report driving concerns to the Ministry of Transport, and yet there are no agreed upon standardized tests to determine driving risk. Recent work has suggested that car “black box” data be used to identify driving risk. However, many vehicles have multiple drivers making analysis of data for a specific driver difficult. This project explores the identification of a driving signature to distinguish between drivers and to provide a foundation for future analysis of driving signature change as a predictive tool of driving ability. The successful development of a driving signature leads to future benefits (beyond this proposal) as driving signature change may indicate issues that are the result of advancing cognitive or other impairment. These changes may provide an indication of driving ability, providing clinicians with additional information when assessing driving competence.

Title: Mild Cognitive Impairment: Can Decline to Dementia be Monitored and Delayed by Computer-Based Games?

Funding Agency: Bruyère Research Institute (BRI) Growth Fund and Mitacs (matching funds)

Grant Amount: $50,000 (BRI Growth Funds) + $44,000 (Mitacs matching funds)

Term: 2013-2015

Investigators: Frank Knoefel (PI), Vanessa Taler, Michael Breau, Lisa Sweet, Andrew Frank, Bruce Wallace, Rafik Goubran

Details: Over the last decade, there has been a growing literature on “brain plasticity” and the role of computer based games for brain health improvement. Most of the focus has been on healthy older adults. While there has been pharmacologic treatment available for dementia for decades, there is no accepted standard treatment for Mild Cognitive Impairment (MCI). This project aims to engage individuals with MCI in computer-based games that are programmed to 1) allow remote monitoring of improvement and/or decline and 2) strengthen cognitive function through improvement in game performance. The ultimate goal is improved patient outcomes, either by delaying decline to dementia, or by detecting decline earlier to allow timely treatment initiation. This study will also pilot the pre- and post- intervention measurements of a subset of participants using electroencephalography (EEG). The additional funding from the Mitacs-Accelerate Program has enabled an increase in the number of students working on the project and an expansion of the project scope. The team will do additional analysis and algorithm design, will expand the work on EEG and will do additional data analytics work (such as number of cues, mouse movements and timing).

Title: Monitoring Progression of Bed Transfer Abilities Using Pressure-Sensitive Mat Technology (CIHR Mobility Demo Project)

Funding Agency: Canadian Institutes of Health Research (CIHR)

Grant Amount: $499,165

Term: 2011-2014

Investigators: Martin Bilodeau (PI), Frank Knoefel, Jeffrey Jutai, Rafik Goubran, Heidi Sveistrup

Details: This study aims to build upon a previous pilot study (CIHR Seed Grant: Pressure Patterns of Bed Transfers in Older Adults with Different Levels of Mobility Skills) and confirm that progressive/evolving changes in transfer skills amongst older adults can be characterized by the pressure-sensitive mat (smart mat). Specifically, this study aims to:

Assess the smart mat’s ability to monitor progression in the transfer abilities of targeted groups of older individuals whose mobility status is evolving (i.e., community dwelling older adults and Geriatric Rehabilitation Unit (GRU) patients);

Compare changes in transfer patterns reflected in smart mat data and changes identified from performance-based mobility assessments using existing clinical tools (e.g., Berg Balance); and

Assess user acceptance of the smart mat technology.

Completed Research Projects

Title: Pressure-Sensitive Mat Technology: The Use of Bed Transfer Data in the Monitoring of Nocturia in Geriatric Day Hospital Patients

Funding Agency: Bruyère Academic Medical Organization (BAMO)

Grant Amount: $19,930

Term: 2010-2012

Investigators: Veronique French Merkley (PI), Frank Knoefel, Jeffrey Jutai, Rafik Goubran

Details: This project aims to facilitate the extraction of reliable patient data, using pressure-sensitive mat technology, to assist in the evaluation of nocturia. This mat technology has the potential to help home health care providers triage cases according to priority, as well as aid agencies such as the Community Care Access Centre who can better assess client needs if behavioural changes, such as the number of times one gets out of bed at night, are observed. If successful, this research could be added to the growing list of potential technologies that help older adults age in place.

Title: Healthcare Support through Information Technology Enhancements (hSITE)

Funding Agency: Natural Sciences and Engineering Research Council of Canada (NSERC)

Grant Amount: $50,000

Term: 2008-2013

Investigators: Frank Knoefel and Rafik Goubran

Details: The main focus of this project is home care for seniors and people with disabilities. It deals with improving home monitoring, including gathering, compressing and transmitting information through the use of sensor systems. Sensor systems, such as pressure sensitive mats that can be placed under the mattress of a bed in order to monitor the status of the bed occupant, microphone arrays that will monitor various sounds in the home and may be integrated with its phone system, and various other sensor systems that can track patients throughout the day, will be considered. It will also address the problem of data fusion from multiple sensors and monitoring devices in order to develop IT-centric decision support tools for home care based patients and providers.

Title: Integration of Biophysiological Information with Point-of-Care Decision Support Systems for Safer Patient Care

Funding Agency: Natural Sciences and Engineering Research Council of Canada (NSERC)

Grant Amount: $455,000

Term: 2008-2011

Investigators: Diane Doran (PI), Rafik Goubran, Frank Knoefel, Shawn Doherty, Andrew Dubrowski

Details: This study investigates the design and strategies for a technological system that will give home care clinicians innovative scheduling capabilities, allowing them to assess client activity in and out-of-home, and provide timely access to decision support. The study focuses on the integration of hand-held technologies, such as a cell phone-based GPS-supported monitoring system integrated with a Web-based software application for tracking client information. The system will be implemented in live home care settings for the purpose of determining the system’s feasibility and safety in the field. The study findings will provide valuable information about the effectiveness of integrating bio-physiological information obtained through non-intrusive monitoring with decision support technologies to support safer patient practices for seniors. As part of this study, the TAFETA research team will focus on the integration of pressure-sensitive mats, as well as data fusion and communication between multiple sensors.

Title: Smart Environments and Communications for the Independent Living of Seniors

Funding Agency: Natural Sciences and Engineering Research Council of Canada (NSERC)

Grant Amount: $372,000

Term: 2007-2010

Investigators: Rafik Goubran (PI), Frank Knoefel, Heidi Sveistrup

Details: This project aims to monitor the health and well-being of seniors using integrated smart sensor technologies and communicate this information to caregivers. Both the pressure-sensitive mat and e-nose technologies will be further developed as part of this study. Additionally, the team will look at new methods to further integrate smart sensor technologies and improve their communications/storage capabilities.

Title: Identification of Changes in Bed Pressure Patterns in the Pathological and Healthy Aging

Funding Agency: Canadian Institutes of Health Research (CIHR)

Grant Amount: $93,650

Term: 2008-2009

Investigators: Martin Bilodeau (PI), Heidi Sveistrup, Rafik Goubran, Frank Knoefel, Christine Yang

Details: This pilot study investigates bed transfers using pressure-sensitive mat technology. In this study, the research team will assess differences in pressure patterns between four initial groups of subjects with varying levels of mobility skills:

Young adults;

Community-dwelling older adults;

Older, frail adults post-hip fracture; and

Adults post-stroke.

The team hypothesizes that the different transfer patterns used by these four groups will lead to distinct bed pressure patterns measured using the pressure-sensitive mat technology. The data captured during the initial funding period is analyzed during the following year.

Title: Pressure-Sensitive Mat Technology: Studies in Palliative Care at Bruyère Continuing Care

Funding Agency: Kiwanis Medical Foundation

Grant Amount: $25,000

Term: 2009-2011

Investigators: Frank Knoefel (PI), Rafik Goubran, José Pereira

Details: This study investigates the viability of pressure-sensitive mat technology in the palliative care unit at Elisabeth Bruyère Hospital (Bruyère Continuing Care). Specifically, this study aims to:

Determine if the mat technology can identify end-of-life breathing patterns;

Identify any correlations between clinical sleep evaluations to the data obtained from the mats;

Identify any correlations between clinical delirium evaluations to the data obtained from the mats; and

Determine if the mats can identify changes in breathing and movement patterns based on changes in palliative sedation.

The Kiwanis Medical Foundation has generously donated funds to secure more equipment to advance this study.

Title: Feasibility of Smart Voice Technology to Improve Support in Affordable Seniors’ Housing

Funding Agency: Canadian Mortgage and Housing Corporation (CMHC)

Grant Amount: $20,100

Term: 2009-2010

Investigators: Frank Knoefel (PI) and Rafik Goubran

Details: The objective of this study is to install one smart fridge sensor in each of five units of an affordable seniors’ housing complex in the Ottawa area. The fridge sensors provide verbal cues that remind occupants that the fridge door is open and also track fridge status (open/closed door). Such information can be used to evaluate occupant activity related to the health of older individuals. During this one-year pilot study, the feasibility of installing multiple sensors in the homes of older adults will be assessed. In addition, the occupants’ acceptance of the technology will be evaluated.

Title: Can Pressure-Sensitive Mat Technology Identify Older Adults With Hip Fractures?

Funding Agency: Bruyère Academic Medical Organization (BAMO)

Grant Amount: $20,000

Term: 2009-2010

Investigators: Frank Knoefel (PI) and Rafik Goubran

Details: This study uses data captured in a prior study, entitled “Identification of Changes in Bed Pressure Patterns in the Pathological and Healthy Aging” to complete analyses aimed at evaluating the pressure-sensitive mat’s ability to identify transfer patterns amongst older healthy adults and older adults’ post-hip fractures.

Title: Can SmartCells® Flooring Reduce Falls Related Injuries?

Funding Agency: Bruyère Research Institute (BRI)

Grant Amount: $35,000

Term: 2006-2007

Investigators: Frank Knoefel (PI), Louise Patrick, Rafik Goubran

Details: This prospective study is being conducted at the Guest House, a respite care facility in Ottawa for patients with Alzheimer’s disease. The goal of the study is to verify the utility of the SmartCells® dual-stiffness flooring from SATECH Inc. as a potential technology to reduce morbidity related to falls in older adults

Title: Remote Pressure Monitoring Using Pressure-Sensitive Mats: 2006-2007

Funded by: Ontario Research Network for Electronic Commerce (ORNEC)

Details: This study advanced research focused on monitoring older adults remotely using pressure-sensitive mat technology from Tactex Controls Inc. As part of this study, a literature review of the use of pressure-sensitive mats in monitoring bed occupants was completed, and a literature survey of other sensors that may be used in the TAFETA Smart Apartment was finalized. In addition, signal processing tasks dealing with the pressure-sensitive mat were defined. These included: calibration and signal conditioning; signal enhancement; noise cancellation; interference cancellation; signal interpretation; feature extraction; pattern recognition; and classification. As a result of this activity, the team was able to analyze sleeping patterns and extract breathing information. This funding resulted in two publications and the completion of a Master’s thesis.

Title: SmartCells® Flooring Pilot Study: 2006

Funded by: Bruyère Research Institute (BRI) / Bruyère Continuing Care (BCC)

Details: In this study, SmartCells® flooring, developed by SATECH Inc., was integrated into the TAFETA Smart Apartment bathroom and a pilot project was completed to assess the product’s safety in a frail older population. The floor has been shown to reduce morbidity to falls in older adults.

Title: Magnetic Fridge Sensor Development: 2004

Funded by: Carleton University

Details: A simple magnetic sensor was developed by the Department of Systems and Computer Engineering at Carleton University to provide a verbal message to alert an older adult if the fridge has accidentally been left open. The sensor also alerts a caregiver if the fridge use is abnormal (i.e., has not been opened in several days). The sensor has been integrated into the TAFETA Smart Apartment.

Title: Blood Pressure Monitoring Project: 2004

Funded by: Industry Canada (Canarie Inc.)

Details: Using a remote blood pressure (BP) monitoring tool from a local high-tech company, a pilot study was completed to asses technology acceptance and the technology’s impact on blood pressure control. Seven nuns, aged 83-94, participated in the study. The results demonstrated that technology was not a barrier for a non-technologically savvy group.