Dans un contexte mondial de vieillissement de la population, de nombreuses recherches sont menées pour améliorer la qualité de vie des personnes âgées résidant en institution, mais peu de ces travaux développent une approche architecturale. Cette recherche a pour but de proposer de nouvelles manières d’aménager ces lieux de vie, en rupture avec les paradigmes dominants du soin et de l’hôtellerie. L’hypothèse générale est qu’un environnement architectural de type domestique (-homelike) permettra aux résidents de se sentir habitants, ce qui devrait favoriser leur bien-être, leur autonomie et le développement d’interactions sociales. Notre procédure s’est basée sur le concept de l’Evidence-Based Psychology (-psychologie fondée sur la preuve), avec un essai randomisé contrôlé. Elle a consisté à réaménager de manière domestique l’espace d’entrée de plusieurs établissements dits « standards », puis à évaluer selon les méthodes de comparaison avant vs après ; établissement réaménagé vs non réaménagé. L’étude a été multidimensionnelle et exploratoire dans ses outils de recherche ; échelles de qualité de vie, cartographie comportementale, entretiens qualitatifs. Ce travail s’inscrit dans le contexte d’un développement récent du doctorat en architecture en France et contribue de fait à la réflexion épistémologique qui l’accompagne. Il permet également pour de faire prendre conscience de l’importance du cadre bâti pour la qualité de vie et met en avant le rôle social de l’architecte. / In a global context of population ageing, many research are conducted to improve the quality of life of older people living in assisted living facilities, but few of these works develop an architectural approach. This research aims to propose new ways to design these places of life, breaking with the dominant hospital and/or hotel models. The general assumption is that an architectural environment with homelike characteristics will allow residents to feel inhabitants, which should promote their welfare, autonomy and the development of social interactions. Our procedure is based on the concept of Evidence Based Psychology, with a randomized controlled trial. The entrance hall of several facilities corresponding to standards were refurbished in a homelike way, and then we evaluated comparing before vs after; refurbished nursing home vs non refurbished. The study was multidimensional and exploratory in its research tools; quality of life scales, behavioral mapping, qualitative interviews. This work take place in the French context of recent emergence of PhD in architecture and contributes de facto to the epistemological reflection that goes with it. It also helps to raise awareness of the importance of the built environment to the quality of life and highlights the social role of architectes.

The population within the age group 80+ is increasing. At the same time retirement housing are limited. Which entails that a large portion of the elderly are in the main housing market, where there is a shortage of housing. An option to ease the problematic housing situation could be assisted living facilities. The problem with the assisted living facilities of today, is that they are often located within the city. The result of this is that many elderly people choose to remain in their current houses due to a fear of leaving the countryside and their social network behind.  The purpose of this thesis is to investigate the conditions of an assisted living facility on the countryside, define which aspects that the elderly appreciate in their home and everyday life, and finally design a visual suggestion of an assisted living facility. The applied methods were (i) literature study, (ii) area analysis and (iii) modeling of the assisted living facilities. The following questions were addressed:  -  What are the conditions for assisted living facilities? -  How do these conditions differ between urban and rural areas? -  What aspects create quality/well-being in their own home for elderly  people? -  How can these conditions and aspects be considered when designing  assisted living facilities on the countryside?  Based on the work's theoretical starting points and results, some conclusions could be made. An assisted living facility on the countryside would combine a harmonious environment and a quiet neighborhood. The form of housing would open housing opportunities for the younger generation on the countryside. Health, physical activities, and social interactions were deemed to give more well-being to the individual than the home's design. The main values of the design lay in its ability to allow the individual to live out their personality, and at the same time make the individual feel safe and secure in their home. The final result was a visual proposal for ten condominiums inspired by, among other things, Sweden's traditional one-room cottage.

Yes / Human activity recognition from sensor data is a critical research topic to achieve remote health monitoring and ambient assisted living (AAL). In AAL, sensors are integrated into conventional objects aimed to support targets capabilities through digital environments that are sensitive, responsive and adaptive to human activities. Emerging technological paradigms to support AAL within the home or community setting offers people the prospect of a more individually focused care and improved quality of living. In the present work, an ambient human activity classification framework that augments information from the received signal strength indicator (RSSI) of passive RFID tags to obtain detailed activity profiling is proposed. Key indices of position, orientation, mobility, and degree of activities which are critical to guide reliable clinical management decisions using 4 volunteers are employed to simulate the research objective. A two-layer, fully connected sequence long short-term memory recurrent neural network model (LSTM RNN) is employed. The LSTM RNN model extracts the feature of RSS from the sensor data and classifies the sampled activities using SoftMax. The performance of the LSTM model is evaluated for different data size and the hyper-parameters of the RNN are adjusted to optimal states, which results in an accuracy of 98.18%. The proposed framework suits well for smart health and smart homes which offers pervasive sensing environment for the elderly, persons with disability and chronic illness.

Due to the continuous ageing of our society, both the care and the health sector will encounter challenges in maintaining the quality of human care and health standards. While the number of people with diseases such as dementia and physical illness will be rising, we are simultaneously recording a lack of medical personnel such as caregivers and therapists. One possible approach that tackles the described problem is the employment of technical assistance systems that support both medical personnel and elderly living alone at home. This thesis presents approaches to provide assistance for these target groups. In this work, algorithms that are integrated in prototypical assistance systems for vision-based human daily activity, mobility and motion analysis have been developed. The developed algorithms process 3-D point clouds as well as skeleton joint positions to generate meta information concerning activities and the mobility of elderly persons living alone at home. Such type of information was not accessible so far and is now available for monitoring. By generating this meta information, a basis for the detection of long-term and short-term health changes has been created. Besides monitoring meta information, mobilisation for maintaining physical capabilities, either ambulatory or at home, is a further focus of this thesis. Algorithms for the qualitative assessment of physical exercises were therefore investigated. Thereby, motion sequences in the form of skeleton joint trajectories as well as the heat development in active muscles were considered. These algorithms enable an autonomous physical training under the supervision of a virtual therapist even at home. / Aufgrund der voranschreitenden Überalterung unserer Gesellschaft werden sowohl der Pflege- als auch der Gesundheitssektor vor enorme Herausforderungen gestellt. Während die Zahl an vorrangig altersbedingten Erkrankungen, wie Demenz oder physische Erkrankungen des Bewegungsapparates, weiterhin zunehmen wird, stagniert die Zahl an medizinischem Fachpersonal, wie Therapeuten und Pflegekräften. An dieser Stelle besteht das Ziel, die Qualität medizinischer Leistungen auf hohem Niveau zu halten und dabei die Einhaltung von Pflege- und Gesundheitsstandards sicherzustellen. Ein möglicher Ansatz hierfür ist der Einsatz technischer Assistenzsysteme, welche sowohl das medizinische Personal und Angehörige entlasten als auch ältere, insbesondere allein lebende Menschen zu Hause unterstützen können. Die vorliegende Arbeit stellt Ansätze zur Unterstützung der genannten Zielgruppen vor, die prototypisch in Assistenzsystemen zur visuellen, kamerabasierten Analyse von täglichen Aktivitäten, von Mobilität und von Bewegungen bei Trainingsübungen integriert sind. Die entwickelten Algorithmen verarbeiten dreidimensionale Punktwolken und Gelenkpositionen des menschlichen Skeletts, um sogenannte Meta-Daten über tägliche Aktivitäten und die Mobilität einer allein lebenden Person zu erhalten. Diese Informationen waren bis jetzt nicht verfügbar, können allerdings für den Patienten selbst, für medizinisches Personal und Angehörige aufschlussreich sein, denn diese Meta-Daten liefern die Grundlage für die Detektion kurz- und langfristiger Veränderungen im Verhalten oder in der Mobilität, die ansonsten wahrscheinlich unbemerkt geblieben wären. Neben der Erfassung solcher Meta-Informationen liegt ein weiterer Fokus der Arbeit in der Mobilisierung von Patienten durch angeleitetes Training, um ihre Mobilität und körperliche Verfassung zu stärken. Dabei wurden Algorithmen zur qualitativen Bewertung und Vermittlung von Korrekturhinweisen bei physischen Trainingsübungen entwickelt, die auf Trajektorien von Gelenkpositionen und der Wärmeentwicklung in Muskeln beruhen. Diese Algorithmen ermöglichen aufgrund der Nachahmung eines durch den Therapeuten gegebenen Feedbacks ein autonomes Training.

Este trabalho foi projetado a partir de experiência vivida no Instituto Nise da Silveira, Rio de Janeiro/RJ. Nesta instituição, como em outras, as mudanças estruturais efetuadas no contexto da Reforma Psiquiátrica se configuram como um dos maiores desafios colocados tanto para a assistência na área de saúde mental, quanto para a legislação que a regulamenta, considerando-se a imensa clientela de pacientes moradores das instituições psiquiátricas e os problemas que se apresentam às transformações empreendidas. No bojo das mudanças que afetam essa clientela despontam os serviços residenciais terapêuticos e o trabalho do cuidador profissional, figura de grande importância nas ações para o desmantelamento do aparato manicomial. Esta pesquisa objetiva analisar o processo do cuidado de pacientes psiquiátricos em moradias assistidas e residências terapêuticas, com atenção à formação e ao treinamento do profissional cuidador. Define-se como pesquisa qualitativa, que utiliza o método etnográfico e se apoia, teoricamente, na Antropologia Interpretativa para a análise dos significados das práticas e concepções relacionadas com o trabalho do cuidador nesses dispositivos residenciais. As técnicas utilizadas na pesquisa constituíram-se de observação direta e entrevistas semi-estruturadas. A pesquisa desenvolveu-se durante o segundo semestre de 2008 e primeiro semestre de 2009, nas moradias internas do Instituto Nise da Silveira, no Rio de Janeiro, e nas residências terapêuticas de seu entorno. Os sujeitos principais da pesquisa foram cuidadores (11) e os sujeitos secundários supervisores (4) que trabalham nos referidos espaços. Os dados coletados permitem refletir a respeito da importância do trabalho do cuidador profissional e sobre como ele se insere nas equipes de assistência em saúde mental, tendo como pano de fundo as novas regras que propõem a assistência para a clientela institucionalizada a partir da Reforma Psiquiátrica brasileira. Durante a realização da pesquisa, observou-se certa diversidade na compreensão do trabalho, tanto por parte de cuidadores como de supervisores. Esta diversidade, contudo, é mais reveladora dos desafios e da riqueza de ações de um trabalho ainda em construção do que de suas deficiências. As principais conclusões dizem respeito ao vínculo que se estabelece entre cuidadores e moradores, à possibilidade de discussão regular do trabalho em supervisão, ao impacto dos diferentes equipamentos de moradia no cotidiano de profissionais e pacientes, e às mudanças comportamentais observadas nos moradores, que permitem constatar o processo de reabilitação em curso. / This work was designed from experience at the Institute Nise da Silveira, in Rio de Janeiro / RJ. In this institution, as in others, structural changes that have been made, stand as one of the greatest challenges both for the assistance in the area of mental health, as for the legislation that regulates it; considering the huge clientele of patients who lives in psychiatric institutions and the problems that arise for transformations undertaken. In the midst of changes that affect these clients emerge the residential health care and the work of the professional caregiver, a figure of great importance in the actions for the dismantling of the asylum apparatus, foreseen in the new guidelines for psychiatric care in Brazil. This research aims to analyze the process of care of psychiatric patients in care homes and residential treatment, the formation and training of professional caregivers. It is defined as qualitative research that uses the ethnographic method and is based theoretically, in the Interpretative Anthropology for the analysis of the meanings of practices related to the work of the caregiver in these residential devices. The techniques used in the research were consisted of direct observation and semi-structured interviews. The search was conducted during the second half of 2008 and the first half of 2009, in the spaces of housing within Nise da Silveira Institute, in Rio de Janeiro, and in the therapeutic residences of its surroundings. The main subjects of the search were the caregivers (11) and the secondary subjects were the supervisors (4) who have worked in these spaces. The data collected allow us to reflect the importance of the work of the professional caregiver, and how he inserts into teams of mental health care, having as background the new rules which propose assistance for customers institutionalized as from Brazilian Psychiatric Reform. During the research, it was observed certain diversity on understanding the work, by both the caregivers and the supervisors. This diversity, in preliminary analysis, indicates mainly the challenges, and the richness of the actions of a work under development than the deficiencies. The main conclusions concern to the bond established between caregivers and residents, the possibility for a regular discussion under supervision, the impact of different equipments of the dwelling house in the everyday professionals and patients, and behavioral changes observed in residents that give us the possibility to check the rehabilitation process.

Les approches actuelles pour diagnostiquer les troubles du sommeil sont lourdes, intrusives et peuvent influer sur la qualité du sommeil du patient. Il y a donc un besoin crucial de systèmes moins encombrants pour diagnostiquer les problèmes liés au sommeil. Nous proposons d'utiliser un nouveau système de suivi du sommeil non intrusif basé sur un tapis à fibre optique à microflexion placée sous le matelas de lit. La qualité du sommeil est évaluée en fonction de différents paramètres, y compris la fréquence cardiaque, le rythme respiratoire, les mouvements du corps, l’heure du réveil, la durée du sommeil, le mouvement nocturne et l’heure du coucher. Le système proposé a été validé dans un environnement de santé et de bien-être, en plus d'un environnement clinique comme suit. Dans le premier cas, la fréquence cardiaque est mesurée à partir de signaux ballistocardiogramme bruités acquis de 50 volontaires en position assise à l'aide d'une chaise de massage. Les signaux sont recueillis discrètement à partir d'un capteur de fibre optique microflexible intégrée dans l'appui-tête de la chaise, puis transmis à un ordinateur par une connexion Bluetooth. La fréquence cardiaque est calculée à l'aide de l'analyse multi-résolution de la transformée discrète en ondelettes à chevauchement maximal. L'erreur entre la méthode proposée et électrocardiogramme de référence est estimée en battements par minute en utilisant l'erreur absolue moyenne où le système a obtenu des résultats relativement bons (10.12±4.69) malgré la quantité remarquable d'artefact de mouvement produit en raison des fréquents mouvements corporels et/ou vibrations de la chaise de massage pendant le massage de soulagement du stress. Contrairement à l'algorithme complet de décomposition du mode empirique de l'ensemble, précédemment utilisé pour l'estimation de la fréquence cardiaque, le système proposé est beaucoup plus rapide. Par conséquent, il peut être utilisé dans les applications temps réel. Dans ce dernier cas, nous avons évalué la capacité du capteur de fibre optique microflexible pour suivre la fréquence cardiaque et la respiration d’une manière discrète. En outre, nous avons testé la capacité du capteur dans la discrimination entre la respiration superficielle et pas de respiration. Le capteur proposé a été comparé à un dispositif de surveillance portatif à trois canaux (ApneaLink) dans un milieu clinique au cours d'une endoscopie sous anesthésie. Parmi les dix patients recrutés pour notre étude, le système a obtenu des résultats satisfaisants quant à la fréquence cardiaque moyenne et quant à la fréquence respiratoire moyenne avec une erreur de 0.55 ± 0.59 battements/minute et de 0.38 ± 0.32 respirations/minute, respectivement. De plus, le coefficient de corrélation Pearson entre le capteur proposé et le dispositif de référence était de 0.96 et 0.78 pour la fréquence cardiaque et la respiration, respectivement. Au contraire, le capteur proposé a fourni une très faible sensibilité (24.24 ± 12.81%) et une spécificité relativement élevée (85.88 ± 6.01%) pour la détection de l'apnée du sommeil. On s'attend à ce que cette recherche préliminaire ouvre la voie vers la détection discrète de l'apnée obstructive du sommeil en temps réel. Suite à la validation réussie du système proposé, nous avons déployé avec succès notre système de surveillance du sommeil pendant plus de 6 mois dans treize appartements habités principalement par les personnes âgées. Néanmoins, dans cette recherche, nous nous concentrons sur un déploiement d'un mois avec trois résidents seniors de sexe féminin. Le système proposé montre l’accord avec l’enquête utilisateur recueillie avant l'étude. En outre, le système est intégré dans une plate-forme d’autonomie assistée existante avec une interface conviviale pour rendre plus commode pour les aidants le suivi des paramètres de sommeil des résidents. / The current approaches for diagnosing sleep disorders are burdensome, intrusive, and can affect the patient’s sleep quality. As a result, there is a crucial need for less cumbersome systems to diagnose sleep-related problems. We propose to use a novel nonintrusive sleep monitoring system based on a microbend fiber-optic mat placed under the bed mattress. The sleep quality is assessed based on different parameters, including heart rate, breathing rate, body movements, wake up time, sleep time, night movement, and bedtime. The proposed system has been validated in a health and wellness environment in addition to a clinical environment as follows. In the former case, the heart rate is measured from noisy ballistocardiogram signals acquired from 50 human volunteers in a sitting position using a massage chair. The signals are unobtrusively collected from a microbend fiber optic sensor embedded within the headrest of the chair and then transmitted to a computer through a Bluetooth connection. The heart rate is computed using the multiresolution analysis of the maximal overlap discrete wavelet transform. The error between the proposed method and the reference ECG is estimated in beats per minute using the mean absolute error where the system achieved relatively good results (10.12 ± 4.69) despite the remarkable amount of motion artifact produced owing to the frequent body movements and/or vibrations of the massage chair during stress relief massage. Unlike the complete ensemble empirical mode decomposition algorithm, previously employed for heart rate estimation, the suggested system is much faster. Hence, it can be used in real-time applications. In the latter case, we evaluated the capacity of the microbend fiber optic sensor to monitor heart rate and respiration unobtrusively. In addition, we tested the capacity of the sensor in discriminating between shallow breathing and no breathing. The proposed sensor was compared to a three-channel portable monitoring device (ApneaLink) in a clinical setting during a drug-induced sleep endoscopy. Across all ten patients recruited for our study, the system achieved satisfactory results in the mean heart rate and the mean respiratory rate with an error of 0.55±0.59 beats/minute and 0.38 ± 0.32 breaths/minute, respectively. Besides, the Pearson correlation coefficient between the proposed sensor and the reference device was 0.96 and 0.78 for heart rate and respiration, respectively. On the contrary, the proposed sensor provided a very low sensitivity (24.24 ± 12.81%) and a relatively high specificity (85.88 ± 6.01%) for sleep apnea detection. It is expected that this preliminary research will pave the way toward unobtrusive detection of obstructive sleep apnea in real-time. Following successful validation of the proposed system, we have successfully deployed our sleep monitoring system in thirteen apartments with mainly senior residents over six months. Nevertheless, in this research, we concentrate on a one-month deployment with three senior female residents. The proposed system shows an agreement with a user’s survey collected before the study. Furthermore, the system is integrated within an existing ambient assisted living platform with a user-friendly interface to make it more convenient for the caregivers to follow-up the sleep parameters of the residents.

L'Assistance Ambiante est un domaine de recherche prometteur qui vise à utiliser les technologies de l'information pour venir en aide aux personnes dépendantes durant leur vie quotidienne. L'impact de ces recherches pourrait être déterminant pour de nombreux séniors ainsi que pour leurs proches. Cette discipline s'est développée régulièrement au cours des dernières années, mais tout de même plus lentement que la plupart des autres applications de l'internet des objets. Cela est dû à la complexité inhérente à l'Assistance Ambiante, qui nécessite une compréhension dynamique du contexte, ainsi que la mise en place de nombreux média de communication dans le lieu de vie de l'utilisateur. Plus précisément, les chercheurs rencontrent des difficultés avec l'étape déterminante de la reconnaissance d'activité, comme nous le montre la littérature.Mon équipe de recherche a déployé notre système dans plusieurs environnements, le plus récent consistant en une maison de retraite et trois maisons individuelles en France.Nous adoptons une approche centrée sur l'utilisateur, où l'utilisateur final définit ce qu'il attend, et nous fournit des réactions et conseils sur notre système.De cette manière, nous pouvons apprendre de nos déploiements, et obtenir des informations pour répondre aux défis de l'Assistance Ambiante, y compris la reconnaissance d'activité.Ainsi, la ligne directrice de cette thèse émerge des défis que nous avons rencontré durant nos déploiements.Au commencement de cette thèse, j'ai été confronté à la problématique concrète d'un déploiement réel de notre système.Je relate donc les besoins que nous avons vu émerger, par nos propres observations et par les retours des utilisateurs, ainsi que les problèmes techniques que nous avons rencontrés.Pour chacun de ces problèmes et besoins, je décris la solution que nous avons retenu et implémenté.Une fois le système installé, mon équipe et moi-même avons pu récolter de nombreuses données sur son fonctionnement.J'ai tout d'abord mis en place une plate-forme d'analyse de données en Assistance Ambiante, permettant un prototypage rapide lié à la reconnaissance d'activité.En tirant profit de cette plate-forme, j'ai observé le problème posé par la reconnaissance d'activité, qui est une étape critique, mais trop souvent inexacte dans ses conclusions.Pour faire face aux erreurs dans le raisonnement, je formalise la notion d'exactitude pour la reconnaissance d'activité, et fournit une méthode pour mesurer l'exactitude de notre moteur de raisonnement.Cela requiert d'abord d'observer une vérité terrain sur l'activité en cours, ou à défaut une estimation sur cette activité, d'une source autre que le raisonneur lui-même.Je cherche ensuite à améliorer la qualité de notre moteur de raisonnement.Pour y parvenir, je m'attache à regarder plus précisément certains raisonnements incorrects.J'y observe que les erreurs de raisonnement viennent parfois du fait que le raisonneur essaie d'être trop précis, ou qu'à l'inverse, il est parfois trop imprécis dans les activités qu'il infère.Je propose donc une méthode pour optimiser le moteur de raisonnement, de telle manière à ce qu'il conclue de la meilleure façon possible parmi plusieurs activités suspectées, en choisissant l'activité qui offre le meilleur compromis entre sa Précision et le risque d'Inexactitude de la part du moteur de raisonnement.Cette contribution me mène à introduire une hiérarchie entre les activités.En effet, en appliquant la méthode précédente sur un modèle hiérarchique d'activités, le raisonneur est calibré automatiquement, pour choisir à quel niveau de précision il pourra reconnaître une activité.Il va de soi que ces travaux sont validés formellement au sein de cette dissertation. / Ambient Assisted Living is a promising research area.It aims to use information technologies to assist dependent elderly people on their daily life.The impact of these technologies could be dramatic for millions of elderly people and for their caregivers.This research area has developed consistently over the past few years, although slower than most other applications of the Internet of Things.This is caused by the inner complexity of Ambient Assisted Living.Indeed, Ambient Assisted Living requires a dynamic understanding of the context, as well as the disposal of numerous communication media in the environment surrounding the end-user.More precisely, researchers face difficulties in recognizing end-users' activities, as we can observe in the literature.My research team have deployed our system in several environments, of which the most recent includes a nursing home and three houses in France.We adopt a user-centric approach, where end-users describe what they expect, and share with us their feedbacks and advices about our system.This approach guided me to identify activity recognition as a critical challenge that needs to be addressed for the usability and acceptability of Ambient Assisted Living solutions.Thus, the guiding line of this thesis work emerges naturally from the challenges we encountered during our deployments.In the beginning of this thesis, I have been facing the practical problem of putting into place an actual deployment of our system.In this document, I describe the needs that emerged from our own observations and from the users feedbacks, as well from as the technical problems we encountered.For each of these problems and needs, I describe the solution we have selected and implemented.From our deployments, my team and I were able to collect a large amount of operating data.I have created a platform to analyze Ambient Assisted Living data, also to allow rapid prototyping for activity recognition.By using this platform, I have observed problems with activity recognition, which is too often misleading and inaccurate.A first observation is that the sensor events are sometimes disturbed by multiuser situations, when several persons are active in the home.Activity recognition in these conditions is extremely difficult, and during this thesis my scope is solely focused on detecting multiuser situations, not recognizing activities in such situations.I then seek to improve the quality of our reasoning engine.To do so, I have looked more precisely at some incorrect reasoning.I observed that the errors in reasoning come from the fact that the reasoner tries to be too precise or that, conversely, it infers too imprecise activities.I therefore propose a method to optimize the reasoning engine, so that it concludes with the best possible activity among several possible activities, by choosing the one that offers the best compromise between Precision and the risk of Inaccuracy in activity recognition.It should be noted that this contribution is independent of the method used for activity recognition, and can work with any type of reasoning.I have formalized the concept of Accuracy, and provided a method to measure the Accuracy of a reasoning engine.This requires first to observe a ground-truth on the activity being performed.This contribution brought me to introduce a hierarchical model for activities.Indeed, by applying the method described above on a hierarchical model of activities, the reasoning engine can be calibrated automatically to choose how precise it should be at recognizing an activity.It goes without saying that these contributions are formally validated through this dissertation.

Este trabalho foi projetado a partir de experiência vivida no Instituto Nise da Silveira, Rio de Janeiro/RJ. Nesta instituição, como em outras, as mudanças estruturais efetuadas no contexto da Reforma Psiquiátrica se configuram como um dos maiores desafios colocados tanto para a assistência na área de saúde mental, quanto para a legislação que a regulamenta, considerando-se a imensa clientela de pacientes moradores das instituições psiquiátricas e os problemas que se apresentam às transformações empreendidas. No bojo das mudanças que afetam essa clientela despontam os serviços residenciais terapêuticos e o trabalho do cuidador profissional, figura de grande importância nas ações para o desmantelamento do aparato manicomial. Esta pesquisa objetiva analisar o processo do cuidado de pacientes psiquiátricos em moradias assistidas e residências terapêuticas, com atenção à formação e ao treinamento do profissional cuidador. Define-se como pesquisa qualitativa, que utiliza o método etnográfico e se apoia, teoricamente, na Antropologia Interpretativa para a análise dos significados das práticas e concepções relacionadas com o trabalho do cuidador nesses dispositivos residenciais. As técnicas utilizadas na pesquisa constituíram-se de observação direta e entrevistas semi-estruturadas. A pesquisa desenvolveu-se durante o segundo semestre de 2008 e primeiro semestre de 2009, nas moradias internas do Instituto Nise da Silveira, no Rio de Janeiro, e nas residências terapêuticas de seu entorno. Os sujeitos principais da pesquisa foram cuidadores (11) e os sujeitos secundários supervisores (4) que trabalham nos referidos espaços. Os dados coletados permitem refletir a respeito da importância do trabalho do cuidador profissional e sobre como ele se insere nas equipes de assistência em saúde mental, tendo como pano de fundo as novas regras que propõem a assistência para a clientela institucionalizada a partir da Reforma Psiquiátrica brasileira. Durante a realização da pesquisa, observou-se certa diversidade na compreensão do trabalho, tanto por parte de cuidadores como de supervisores. Esta diversidade, contudo, é mais reveladora dos desafios e da riqueza de ações de um trabalho ainda em construção do que de suas deficiências. As principais conclusões dizem respeito ao vínculo que se estabelece entre cuidadores e moradores, à possibilidade de discussão regular do trabalho em supervisão, ao impacto dos diferentes equipamentos de moradia no cotidiano de profissionais e pacientes, e às mudanças comportamentais observadas nos moradores, que permitem constatar o processo de reabilitação em curso. / This work was designed from experience at the Institute Nise da Silveira, in Rio de Janeiro / RJ. In this institution, as in others, structural changes that have been made, stand as one of the greatest challenges both for the assistance in the area of mental health, as for the legislation that regulates it; considering the huge clientele of patients who lives in psychiatric institutions and the problems that arise for transformations undertaken. In the midst of changes that affect these clients emerge the residential health care and the work of the professional caregiver, a figure of great importance in the actions for the dismantling of the asylum apparatus, foreseen in the new guidelines for psychiatric care in Brazil. This research aims to analyze the process of care of psychiatric patients in care homes and residential treatment, the formation and training of professional caregivers. It is defined as qualitative research that uses the ethnographic method and is based theoretically, in the Interpretative Anthropology for the analysis of the meanings of practices related to the work of the caregiver in these residential devices. The techniques used in the research were consisted of direct observation and semi-structured interviews. The search was conducted during the second half of 2008 and the first half of 2009, in the spaces of housing within Nise da Silveira Institute, in Rio de Janeiro, and in the therapeutic residences of its surroundings. The main subjects of the search were the caregivers (11) and the secondary subjects were the supervisors (4) who have worked in these spaces. The data collected allow us to reflect the importance of the work of the professional caregiver, and how he inserts into teams of mental health care, having as background the new rules which propose assistance for customers institutionalized as from Brazilian Psychiatric Reform. During the research, it was observed certain diversity on understanding the work, by both the caregivers and the supervisors. This diversity, in preliminary analysis, indicates mainly the challenges, and the richness of the actions of a work under development than the deficiencies. The main conclusions concern to the bond established between caregivers and residents, the possibility for a regular discussion under supervision, the impact of different equipments of the dwelling house in the everyday professionals and patients, and behavioral changes observed in residents that give us the possibility to check the rehabilitation process.

Comme les gens vieillissent, ils sont souvent confrontés à un certain degré de diminution des capacités cognitives ou de la force physique. Isolement de la vie sociale, mauvaise qualité de la vie, et risque accru de blessures en sont les principales conséquences. Ambient Assisted Living (AAL) est une vision de la façon dont les gens vivent leur vie dans leur propre maison, à mesure qu'ils vieillissent : handicaps ou limitations sont compensées par la technologie, là où le personnel de prestation de soins est rare ou des proches ne sont pas en mesure d'aider. Les personnes concernées sont assistés par la technologie. Le terme "ambiante" en AAL exprime, ce que cette technologie doit être, au- delà de l’assistance. Elle doit être intégrée dans l’environnement de manière à ce qu'elle ne soit pas reconnue en tant que tel. L'interaction avec les résidents doit être intuitive et naturelle. L'équipement technique doit être discret ct bien intégré. Les domaines d'application ciblés dans cette thèse sont le suivi de l’activité et la recherche de profils d'activités dans des appartements ou des petites maisons. L'acquisition d’informations concernant l’activité des résidents est vitale pour le succès de toute la technologie d’assistance. Dans de nombreux domaines de la vie quotidienne, ceci est déjà de la routine. L’état de l’art en matière de technologie de détection comprend des caméras, des barrières lumineuses, des capteurs RFID, la radiolocalisation de signal en utilisant des transpondeurs et des planchers sensibles à la pression. En raison de leurs principes de fonctionnement, ils ont malheureusement un impact important sur les environnements domestiques et de vie. Par conséquent, cette thèse est consacrée à la recherche de technologies d’acquisition d’informations de l’activité non-intrusive ayant un impact minimal sur la vie quotidienne. Deux technologies de base, la détection de présence passive sans dispositif et le suivi de charges de manière non-intrusive, sont prises en compte dans cette thèse. / As people grow older, they are often faced with some degree of decreasing cognitive abilities or physical strength. Isolation from social life, poor quality of life, and increased risk or injuries are the consequence. Ambient Assisted Living (AAL) is a vision for the way people live their life in their own home, as they grow older: disabilities or limitations are compensated for by technology, where care-giving personnel is scarce or relatives are unable to help. Affected people are assisted by technology. The term "Ambient" in AAL expresses, what this technology needs to be, beyond assistive. It needs to integrate into the living environment in such a way that it is not recognized as such any more. Interaction with residents needs to be intuitive and natural. Technical equipment should be unobtrusive and well integrated. The areas of application targeted in this thesis are activity monitoring and activity pattern discovery in apartments or small houses. The acquisition of information regarding the residents' activity is vital for the success of any assistive technology. In many areas of daily life, this is routine already. State-of-the-art sensing technology includes cameras, light barriers, RFID sensors, radio signal localization using transponders, and pressure sensitive Floors. Due to their operating principles, they have a big impact on home and living environments. Therefore, this thesis is dedicated to research for non-intrusive activity information acquisition technology, that has minimal impact on daily life. Two base technologies are taken into account in this thesis.

Internet des objets (IoT) est actuellement à notre portée. De nombreux domaines ont bénéficié de cette technologie. Cela va d'une application simple, comme l'identification d'un objet jusqu'à la gestion d'un système plus complexe. L'identification par radiofréquence (RFID) est l'une des technologies a une part importante dans l’IoT aujourd'hui. C’est une technologie embarqué, pas cher et ne nécessite aucune source d'alimentation supplémentaire dans le cas de tag passif. Avec sa fonctionnalité omniprésente, cette technologie permet de positionner un objet dans une zone spécifique. L’Assistance et l'Autonomie des personnes à Domicile (AAL) est l'un des nombreux domaines qui bénéficient de l'IoT. Il vise à aider les personnes âgées dans leurs routines quotidiennes en fournissant de nouveaux services d'assistance dans les maisons intelligentes (smart home). La présence de RFID dans une maison intelligente sont d'une grande aide pour une personne âgée et/ou déficiente, par exemple, pour l’aider à trouver un objet dans son environnement quotidien. Cependant, même avec tous ces avantages d’assistance dans notre vie, il est malheureusement à double tranchant où l'avantage qu'il apporte à un objet pourrait à son tour se tourner contre lui-même. En effet, pour pouvoir aider les personnes âgées à localiser un objet, le système nécessite certaines données relatives au positionnement de l'objet, tout au moins son identification. Étant donné que la couverture de l'étiquette RFID passive est très faible, une fois sa présence détectée, il est difficile de la cacher. La capacité de cette technologie à localiser des objets donne l'occasion à une tierce personne de profiter du système. Parallèlement au besoin persistant et constant de confidentialité par les utilisateurs, l'objectif de cette thèse consiste à améliorer la confidentialité dans la localisation d'un objet grâce à un nouveau protocole basé sur la deuxième génération de RFID passive. Le protocole proposé doit pouvoir empêcher un objet d'être identifié et localisé par des parties non autorisées ou par un lecteur malveillant. La première contribution de ce travail est l'évaluation de la gestion anti-collision RFID. Elle est réalisée par la création d'un modèle OMNET++, construit sur la base de la dernière norme RFID développée par GS1 et adaptée par ISO / IEC appelé Gen2V2 (RFID classe 2 Génération 2 Version 2). Dans cette norme une étiquette RFID passive ne nécessite aucune source d'alimentation interne. Il communique en utilisant la fréquence UHF. La norme Gen2V2 propose une liste de suites cryptographiques qui peuvent être utilisées comme méthodes pour authentifier une étiquette et un lecteur. Cette nouvelle génération d'étiquettes est soutenue par une alliance de fabricants appelée RAIN (RAdio frequency IdentifatioN) qui favorise l'adoption du Gen2V2. Nous évaluons les performances globales du protocole anti-collision et nous comparons ensuite quatre de ses suites cryptographiques, à savoir PRESENT80, XOR, AES128 et cryptoGPS pour garantir l’authentification lecteur/tag. Parmi les performances évaluées dans ce modèle, nous nous sommes intéressé au nombre de collisions et à la durée requise pour interroger un groupe d'étiquettes. Nous avons intégré en fonctionnalité de localisation dans le modèle en s’appuyant sur les messages échangés avant l’authentification, ce qui peut conduire à une localisation malveillante d'un objet. Pour augmenter la confidentialité de la localisation au sein des applications AAL, nous proposons donc une deuxième contribution qui est une nouvelle méthode de localisation basée sur les échanges standard Gen2V2 en anonymisant l'identité de l'étiquette. / Internet of things (IoT) is currently on our doorsteps. Numerous domains have beneted from this technology. It ranges from a simple application such as identifying an object up to handling a more complex system. The Radio Frequency IDentication (RFID) is one of the enabling technologies that drive the IoT to its position today. It is small, cheap and does not require any additional power sources. Along with its ubiquitous functionality, this technology enables the positioning of an object within a specic area. Ambient Assisted Living (AAL) is one of the many domains that benet from the IoT. It aims at assisting elderly people in their daily routines by providing new assistive services in smart homes for instance. RFIDs in a smart home come as a great help to an elderly person, for example, to nd an object that they misplaced. However, even with all its benets in simplifying our lives, it is unfortunately double-edged where the advantage that it brings to an object could in turn go against itself. Indeed to be able to help the older adults to locate an object, the system requires certain data in relation to the positioning of the object and its identication. As the passive RFID tag coverage is very small, once its presence is detected, it is dicult to hide it. The ability of this technology in localizing objects gives an opportunity to a third person to take an advantage of the system. In parallel with the persistent and constant need of privacy and secrecy by the users, the objective of this thesis consists of improving the privacy in localizing an object through a new protocol based on the latest version of the RFID second generation passive tag. The proposed protocol must be able to prevent an object from being identied and located by unauthorized parties or a malicious reader. The rst contribution of this work is the assessment of the RFID anti collision management. It is performed through the creation of an OMNET++ framework, modelled and built based on the latest RFID standard developed by GS1 and incorporated by ISO/IEC called Gen2V2 (RFID class 2 Generation 2 Version 2). It is a passive RFID tag that does not require any internal power sources to operate. It communicates using the UHF frequency. The Gen2V2 standard provides a list of cryptographical suites that can be used as a method to authenticate a tag and a reader. This new generation of tags is supported by an alliance of manufacturers called RAIN (RAdio frequency IdenticatioN) that promotes the adoption of the Gen2V2. The anti collision management overall performance is then compared with its theoretical value and four of its cryptographical suites namely PRESENT80, XOR, AES128 and cryptoGPS. Among the performances evaluated within the framework is the number of collisions and the duration required to interrogate a group of tags. Note that an addition of a localization functionality within the framework reveals that exchanged messages through wireless channel prior to the authentication can lead to a malicious localization of an object. To increase the localization privacy within AAL application, we propose therefore a second contribution which is a new localization method that is based on the current Gen2V2 standard exchanges by anonymizing the tag identity.