La plupart des travaux réalisés dans le domaine de l'assistance à l'autonomie à domicile (AAL) reposent sur l'utilisation de capteurs visuels et audio tels que des caméras. Or, ces capteurs sont souvent rejetés par le patient à cause de leur caractère invasif. Des approches alternatives requièrent l'utilisation de capteurs embarqués sur la personne (GPS, bracelets électroniques ou puces RFID dans les vêtements...), et leur pertinence est donc ramenée à l'hypothèse que les personnes les portent effectivement, sans jamais les rejeter ni les oublier. Pour ces raisons, dans cette thèse, nous trouvons plus pertinentes les approches uniquement basées sur l'utilisation de capteurs binaires intégrés dans l'habitat, tels que les détecteurs de mouvements, les tapis sensitifs ou les barrières optiques. Dans un tel contexte technologique, il devient intéressant d'utiliser les paradigmes, les modèles et les outils des systèmes à événement Discrets (SED), initialement plutôt développés pour la modélisation, l'analyse et la commande des systèmes industriels complexes. Dans ces travaux de thèse, l'objectif est de construire une approche pour la modélisation et le suivi des habitudes de vie, basée sur les modèles et les paradigmes des SED et répondant à une problématique qui s'énonce de la manière suivante : L'objectif est de développer un cadre global pour découvrir et reconnaître les activités de la vie quotidienne d'un habitant vivant seul dans une maison intelligente. Cette maison intelligente doit être équipée uniquement de capteurs binaires, l'étiquetage par des experts des activités observées ne doit pas être nécessaire et les activités peuvent être représentées par des modèles probabilistes. La première méthode présentée dans cette thèse permet, à partir d'une base de données d'apprentissage et d'une description experte des activités à modéliser listées par des médecins, de construire pour chaque activité un modèle sous la forme d'un automate à état-fini probabiliste (PFA). La seconde méthode développée lors de cette thèse permet d'estimer en temps réel, à partir des seules données observées par les capteurs ambiants, quelle activité la personne observée réalise effectivement. Les méthodes décrites dans cette thèse sont illustrées en utilisant les données générées localement via l'utilisation d'un appartement prêté par ENS Paris-Saclay équipé pour répondre aux besoins expérimentaux de cette thèse. / Most of the work done in the field of ambient assisted living (AAL) is based on the use of visual and audio sensors such as cameras. However, these sensors are often rejected by the patient because of their invasiveness. Alternative approaches require the use of sensors embedded on the person (GPS, electronic wristbands or RFID chips in clothing ...), and their relevance is therefore reduced to the assumption that people actually wear them, without rejecting nor forgetting them. For these reasons, in this thesis, we find more relevant the approaches based on the use of binary sensors integrated into the habitat only, such as motion detectors, sensory mats or optical barriers. In such a technological context, it becomes interesting to use paradigms, models and tools of Discrete Event Systems (DES), initially developed for modeling, analysis and control of complex industrial systems. In this thesis work, the goal is to build an activity of daily living modeling and monitoring approach, based on the models and the paradigm of the DES and answering a problem that is expressed as follows:The objective is to develop a global framework to discover and recognise activities of daily living of an inhabitant living alone in a smart home. This smart home have to be equipped with binary sensors only, expert labeling of activities should not be needed and activities can be represented by probabilistic models. The first method presented in this thesis allows to build a probabilistic finite-state automata (PFA) from a learning database and an expert description of the activities to be modeled given by the medical staff. The second method developed during this thesis estimates, according to the observations, the activity performed by the monitored inhabitant. The methods described in this thesis are applied on data generated using an apartment lent by ENS Paris-Saclay and equipped according the experimental needs of this thesis. / La maggior parte dei lavori nel settore dell’Ambient Assisted Living (AAL) si basasull’uso di sensori visivi e audio come le telecamere. Tuttavia, questi sensori sonospesso rifiutati dal paziente a causa della loro natura invasiva. Gli approcci alternativi richiedono l’uso di sensori integrati nella persona (GPS, bracciali elettronici o chipRFID...), e la loro rilevanza è quindi ridotta all’ipotesi che le persone li indossino effettivamente, senza mai rifiutarli o dimenticarli.Per questi motivi, in questa tesi, troviamo approcci più rilevanti basati esclusivamente sull’uso di sensori binari integrati nell’habitat, come rilevatori di movimento,tappeti sensoriali o barriere fotoelettriche.In tale contesto tecnologico, diventa interessante utilizzare i paradigmi, i modelli egli strumenti dei sistemi ad eventi discreti (SED), inizialmente sviluppati per la modellazione, l’analisi e il controllo di sistemi industriali complessi.In questo lavoro di tesi, l’obiettivo è quello di presentare un metodo per la modellazione e il monitoraggio delle abitudini di vita, basato sui modelli e paradigmi di SEDe rispondendo ad un problema che si esprime come segue : L’obiettivo è quello di sviluppare un quadro globale per rivelare e riconoscere le attività della vita quotidiana di una persona che abita da sola in una smart home chedovrebbe essere dotata solo di sensori binari. Inoltre si suppone che non sia necessarial’etichettatura delle attività osservate da parte di un esperto e tali attività sono rappresentate da modelli probabilistici.Il primo metodo presentato in questa tesi permette di costruire un modello probabilistico di automa a stati finiti (PFA) ottenuto da un database di apprendimento e unadescrizione delle attività da parte di medici. Il secondo metodo sviluppato in questa tesi stima, alla luce delle osservazioni, qualeattività svolge la persona osservata. I metodi descritti sono illustrati utilizzando dati generati localmente attraverso l’usodi un appartamento messo a disposizione da ENS Paris-Saclay e attrezzato per soddisfarele esigenze sperimentali di questa tesi.

Many long-term wheelchair users find themselves unable to accomplish their former daily routines due to fatigue and weakness caused by cardiopulmonary decompensation (CPD). This study showed that long-term survivors of quadriplegia can improve stamina and strength, and therefore participation in daily life occupations, through participation in a regular exercise program using equipment specifically designed for them. Increased aerobic capacity, achieved through regular exercise, has proven with many populations to increase stamina and strength, thereby increasing participation in daily occupations. Whether decompensated survivors of quadriplegia could achieve this was unknown. Until recently there was no way to increase their aerobic capacity due to limited bodily function and lack of accessible fitness equipment. In this study, UPPERTONE, a recently designed fitness system for quadriplegics, was used by six veterans who had survived C-5–C-7 quadriplegia for between 18 and 48 years. They exercised for approximately 45 minutes three times a week for 36 sessions. Baseline level of exercise intensity (weight hefted and number of repetitions as tolerated) and heart rate were recorded and changes were recorded throughout the program. Subjects were interviewed regarding past and present daily life activities. They kept a daily log of activities throughout the study. Using the Canadian Occupational Performance Measure (COPM), subjects were pre-tested, rating their importance of self-identified problems with daily occupations caused by CPD and their performance in and satisfaction with those problem activities. Post-testing showed changes as a result of study participation. Subjects improved COPM scores an average of 7.4 points (greatest 17 points and least 1.5 points), reflecting satisfaction with their ability to perform identified daily activities with less fatigue. Weight hefted increased from an initial average of 22.35 lb. to 52.5 lb. Exercise heart rate increased from an average of 84.8 to 95.2. Subjects were enthusiastic regarding ability to use UPPERTONE independently and their improved quality of life. Clinicians and long-term wheelchair users with a variety of disabilities should understand CPD, its ramifications and the benefits of exercise to this population. Clients who regain ability to care for themselves will enjoy improved quality of life and have less need for long-term care.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18858号 / 医博第3969号 / 新制||医||1008(附属図書館) / 31809 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 古川 壽亮, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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The purpose of this study was to summarize the effects of physical activity (PA) as a nonpharmacological preventative measure in people at risk of Alzheimer's disease (AD) or all-cause dementia. It was hypothesized that persons at risk of AD or all-cause dementia who engage in sustained and continuous PA would fare better in terms of physical health, cognition, and activities of daily living (ADLs). A systematic literature review was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) using 12 keywords. Studies were included if they were randomized controlled trials with people at risk of AD or all-cause dementia reporting outcomes of PA on three domains, namely: physical health, cognition, or ADLs. Data was extracted using the Matrix Method and results were summarized using applied thematic analyses. Out of 55 records screened, eight met the inclusion criteria for data extraction. Findings indicate statistically significant improvement in four [HLC1] metrics of physical health such as balance, strength, stamina, and oxygenation. Findings also showed statistically significant improvement in four measures of cognition (short-term memory, lucidity, executive function, and language ability). Two studies reported statistically significant improvement in two measures of ADLs (less assistance to complete daily tasks and execution of instrumental activities). Overall, studies showed that physical health, cognition, and two measures of ADLs of people at risk of AD and all-cause dementia improve with sustained and continuous PA, although the interventions and measures were extremely heterogeneous. Future research and intervention efforts should align PA efforts with current universal recommendations to improve outcomes in the general population and in those at risk of AD and all-cause dementia.

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There is evidence that a person’s financial situation is associated with their wellbeing now and in the future. However, financial stress is present in many adults’ lives, impacting their role and participation in different occupational domains such as work, health management, and instrumental activities of daily living. Financial stress is consistently one of the top three causes of stress in the United States (APA, 2015). Financial stress is associated with cumulative effects that have a negative impact on a person’s physical health (Gallo et al., 2011; Kahn & Pearlin, 2006; Sturgeon et al., 2016) and mental health (Fitch et al., 2011; Mucci et al., 2016). Improving a person’s financial wellbeing is one way to mitigate financial stress. This project focused on the factors affecting a person’s financial decision-making skills and behavior, leading to financial stress or financial wellbeing. The evidence literature and current approaches were reviewed and contributed to the development of Financially Wiser, a theory-driven evidence-based approach for developing financial literacy and positive financial management behavior that leads to improved financial wellbeing. Financially Wiser is designed as a community-based financial management education program facilitated by an occupational therapist. A pre-test post-test evaluation will be conducted to determine participant satisfaction and the degree to which the program goals were achieved.

Background: In the next thirty years, the world’s elderly population will double which will lead to an increase in patients with cancer in need of palliative care at home. There is limited knowledge about the patient’s perspective of receiving palliative care at home and with the increase of patients in need, the home is likely to become a regular environment for care. It is therefore crucial that we know what aspects of care the patients perceive as contributing to their quality of life. Aim: In this study authors explored and identified the experiences of patients with cancer receiving palliative care at home. Method: This study was based on a qualitative literature study with Friberg’s (2017a) five-step analysis of ten scientific articles. Literature research was done in the databases Cinahl, PsycInfo and Pubmed. Results: Two major themes emerged; home as an environment of care and the nurses’ professional care. The patient experienced their home as a caring and familiar environment anda facilitator of life together with their close relatives and freedom to live as they choose. The nurse was also key in fulfilling the patient’s’ wishes with her competence in professional care and cooperation with close relatives. Conclusion: This study found that to achieve well-being and quality of life in a patients’ last time of their life it is important that the nurse sees the entire person together with close relatives.