This thesis addresses the hypothesis that a single, waist-mounted triaxial accelerometer (TA) can be used to monitor human movement patterns in unsupervised, freeliving subjects over extended periods, and that it can be used to quantitatively measure parameters that can provide clinical insight into the health status of the subject. A rigorous theoretical and experimental understanding of the signals obtained from a TA is developed. The effect of the placement of the TA device on the waist is explored and a model relating device position to TA signal is developed for a range of postures and activities. A classification framework for movement identification using the signals from a waist-mounted TA is presented. This framework is based on a hierarchical binary processing tree and is designed for real time use. An implementation of this framework for monitoring housebound patients is presented. Algorithms for detecting falls, distinguishing between activity and rest, classifiying transitions between different postural orientations, and for identifying periods of standing, sitting, lying and walking are developed. In evaluation studies performed in controlled laboratory conditions, every algorithm performed with better than 90% accuracy. Once movements are identified, movement-specific parameters sensitive to changes in functional status are extracted from the signal. A two stage methodology for employing the accelerometry system in monitoring free-living subjects is introduced. The first stage involved monitoring specific movements through a directed routine. The second stage involved monitoring of free movement. Signals obtained from the directed routine are used to extract clinically relevant, movement-specific parameters. Signals obtained from the period of free movement are monitored for falls and other abnormal events. General parameters of movement, including energy expenditure, are also measured. The system was evaluated in a series of field studies in laboratory and home environments, in supervised and unsupervised settings, using cohorts of healthy subjects. A pilot trial was conducted in which six healthy elderly subjects wore the TA device for a period of up to three months. The technical performance and useability of the system were evaluated. Clinically significant parameters were measured and the effects of age and health status on the measured parameters were evaluated.

The work presented in this dissertation was focused on developing an affordable, automated, upper extremity exercise system suitable for individuals with stroke and spinal cord injury (SCI). The three studies presented in this thesis demonstrated the efficacy of functional electrical stimulation-assisted exercise therapy (FES-ET). Furthermore a protocol was developed to implement FES-ET in participants homes via tele-rehabilitation. The protocol included the use of an improved version of the bionic glove, an FES device that enhanced hand grasp and release in SCI individuals in combination with a custom-built workstation that enabled task-oriented rehabilitation in the home setting, supervised over the Internet. In the course of these studies, an objective hand function assessment tool was developed to complement tele-supervised FES-ET and provide the therapist with an unbiased evaluation of the participants impairment. A major section of this dissertation is concerned with the development and testing of a novel exercise workstation named the ReJoyce (Rehabilitation Joystick for Computer Exercise), that can assess hand function electronically. The ReJoyce is an instrumented workstation that provides standardized upper extremity rehabilitation based on ADLs, in the guise of computer games played by manipulating attachments on the device. The three studies presented in this thesis focus on the scientific merits and the logistics of providing tele-supervised FES-ET with this workstation. The first study demonstrated the feasibility of treating and assessing individuals on the workstation who had recently suffered a stroke. The second study explored the relationship between the quantitative assessment of hand function with the workstation and two widely-used clinical tests. The last study involved daily, tele-supervised FES-ET or conventional exercises and therapeutic electrical stimulation (TES), maintained for 6 weeks, with SCI participants spread out over a large geographical area. FES-ET performed with the workstation resulted in statistically significant and clinically important improvements in hand function that were greater than those produced by the more conventional protocol. The results demonstrated the importance of including a range of exercises aimed at improving both strength and dexterity. It is concluded that tele-supervised FES-ET on a standardized workstation is feasible, effective and affordable in the current healthcare settin

Many devices are available on the market for the evaluation and rehabilitation of patients suffering from muscular disorders. Most of them are small, low-cost, passive devices based on the use of springs and resistive elements and exhibit very limited (or even not any) evaluation capabilities; extended muscular force evaluation is only possible on stationary, expensive, multi-purpose devices, available only in hospitals, which offer many exercise modes (e.g. isokinetic mode) that are not available on other devices. The objective of this thesis is to make the functionalities currently only implemented on bulky multi-purpose devices available at a lower cost and in a portable fashion, enabling their use by a large number of independent practitioners and patients, even at home (tele-medecine applications). In order to achieve this goal, a portable rehabilitation device, using a magneto-rheological fluid brake as actuator, has been designed. This particular technology was selected for its high level of compactness, simple mechanical design, high controllability, smooth and safe operation. The first part of this thesis is devoted to the design of MR-fluid brakes and their experimental validation. The second part is dedicated to the design of the rehabilitation device and the comparison of its performances with a commercial multi-purpose device (CYBEX).

To work and live in the same place where ones employer also is the landlord, can create a situation with many special requirements for the individual. Constrains regarding time, space and impact on social life is likely to appear. Based on theory and empirical research about the Boundaryless work and the Psychological contract the purpose of this report is to examine employees who live and work at the same place. This is done by studying the regulation regarding time and space factors and the psychological contracts in expectations and in violation of the psychological contract and the risks associated with this like Locked-in factors. The study includes interviews with managers and employees (n=9). The result shows the difficulties to set standards for the constrains of the factors concerning time and space. The expectations from both employees and the organization goes beyond what can be considered as formal work boundaries. The results are discussed in relation to the risks of stress, health and Lock-in.

This study utilizes a hypercube innovation model to analyze the changes in both healthcare informatics and medical related delivery processes based on the innovations from Tele-health care, E-health care, to M-health care. Further, the critical impacts of the E-health innovations on the stakeholders: healthcare customers, hospitals, healthcare complementary providers, and healthcare regulators are identified. These results indicate that the innovation from Tele-health care to E-health care is architectural for healthcare customers, radical for both hospitals and healthcare complementary providers, and architectural for healthcare regulators. From E-health care to M-health care, innovation is architectural for both healthcare customers and hospitals, racial for healthcare complementary providers, and modular for healthcare regulators. Thereafter, the critical capabilities and suggestions for adopting each innovation are discussed

Ένα εκπαιδευτικό λογισμικό κατασκευάζεται, προκειμένου με τη χρήση του να εκπληρωθούν συγκεκριμένοι μαθησιακοί στόχοι. Μπορεί να χρησιμοποιηθεί ως συμπληρωματικό μέσο διδασκαλίας από τον εκπαιδευτή ή ως υποστηρικτικό μέσο αυτοδιδασκαλίας από τον εκπαιδευόμενο. Αποτελεί μέσο αξιολόγησης ή αυτοαξιολόγησης του εκπαιδευόμενου, χωρίς βέβαια αυτό να αποτελεί κύριο σκοπό για την κατασκευή του. Οι σύγχρονες τεχνολογίες εκπαιδευτικού λογισμικού, που βασίζονται στις τεχνολογίες δικτύων υπολογιστών και των συστημάτων υπερμέσων, προσφέρουν την δυνατότητα να εξηγούνται, με παραστατικό τρόπο και πολλαπλά μέσα παρουσίασης, τα γνωστικά αντικείμενα, να διευκολύνεται η επικοινωνία και η συνεργασία μεταξύ εκπαιδευόμενων και εκπαιδευτών, να καταργείται η αποκλειστική χρήση μιας πηγής μαθησιακού υλικού, η οποία πολλές φορές περιέχει ξεπερασμένες πληροφορίες και, ως συνεπακόλουθο όλων αυτών, να μπορεί να αναπτύσσεται η κριτική σκέψη του υποκειμένου στην εκπαίδευση. Στην εργασία αυτή παρουσιάζουμε την συμβολή ενός τέτοιου προηγμένου συστήματος στην δημιουργία ενός μαθήματος για την Ακτινοπροστασία στους χώρους Υγείας. Για το σκοπό αυτό χρησιμοποιήσαμε μια εκπαιδευτική πλατφόρμα ικανή να παρουσιάζει προσαρμοστικά το περιεχόμενο, να προτείνει μαθησιακές δραστηριότητες ανάλογα με τον εκπαιδευόμενο, να προσφέρει διαφορετικούς τρόπους επικοινωνίας και συνεργασίας ανάλογα με το επίπεδο και τη διάθεση του μαθητή. Περιγράφουμε τους λόγους για τους οποίους τέτοια συστήματα μπορούν να προσφέρουν στην Ιατρική εκπαίδευση, καθώς και το πόσο απαραίτητο είναι το μάθημα της ακτινοπροστασίας για τα επαγγέλματα Υγείας. Παραθέτουμε την λειτουργικότητα των εργαλείων, τα οποία έχουν στη διάθεση εκπαιδευτές και εκπαιδευόμενοι, και τέλος αναφέρουμε τις τροποποιήσεις που κάναμε προκειμένου το σύστημα να διαθέτει ένα προσαρμοστικό τρόπο αξιολόγησης. Δίνουμε τα αποτελέσματα μιας πρώιμης αξιολόγησης του συστήματος-μαθήματος, από φοιτητές της Νοσηλευτικής του Τεχνολογικού Ινστιτούτου της Πάτρας. Τέλος αναφέρουμε μια συνοπτική περιγραφή της αρχιτεκτονικής και του τρόπου υλοποίησης του συστήματος. Η παρούσα εργασία αποτελεί ένα πρότυπο τόσο του πώς μια εκπαιδευτική πλατφόρμα μπορεί να χρησιμοποιηθεί για εκπαίδευση στους χώρους Υγείας, όσο και του πώς μια προϋπάρχουσα τέτοια εκπαιδευτική πλατφόρμα μπορεί να βελτιωθεί χρησιμοποιώντας τεχνολογίες τεχνητής νοημοσύνης. / -

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Undoubtedly one of the most significant developments to affect marketing worldwide in the 21st century has been the development of the Internet. As a communication tool the Internet is emerging as a new challenge to mass media advertising. As a result advertising agencies need to readdress their techniques, services and agency structure. Additionally, the shape and form of the traditional advertising agency will need to change along with the adoption and usage of this new interactive media channel. Agencies are now being forced to consider broadening their service offerings to clients. Apart from widening their service offerings, advertising agencies are being driven to invest in building and sustaining valuable client relationships to establish client loyalty, with profit and a healthy bottom-line being the ultimate objectives. Bush, Bush and Harris (1998) point out however, that whilst a growing number of companies are interested in developing an online presence, significant confusion remains about what this new medium will offer stakeholders in the advertising industry. The study undertaken in this thesis explores the relationship between two influential stakeholders in the advertising industry - advertising agencies and their clients. To explore this relationship, the study modified Parasuraman, Zeithamal and Berry's (1988) SERVQUAL model to explore whether gaps exist between agency-client expectations of the value of the Internet as a promotional tool. The SERVQUAL model, which was designed for measuring gaps between service expectations and perceptions, was adapted for use in the business-to-business environment (B2B). In the marketing literature there is little evidence of B2B research in relation to agency-client relationships, nor has there been significant scholarly work exploring the effect of the introduction of the Internet as a promotional tool on the agency-client relationship. The research undertaken in this study aims to respond to this gap in the marketing literature by addressing the broad research question: &quotHow will the introduction of the Internet as a promotional tool impact agency-client relationships?" Undertaking a review of agency-client expectations of the value of the Internet will ascertain whether gaps exist between agency and client expectations of the value of the Internet as a promotional tool. The discovery of gaps in the agency-client relationship in relation to Internet perceptions will indicate potential opportunities and challenges that need to be addressed by advertising agencies interested in extending their advertising services to embrace the Internet as a promotional tool. A major assumption in this inquiry was that gaps would exist between agency and client perceptions of Internet value. In particular, that advertising agencies would perceive the Internet to be a more valuable promotional tool than their clients. This assumption was informed from mass media and industry press, which indicated that advertising agencies were embracing new advertising creative in website design and strategic marketing activities using interactive media such as newsgroups and email to reach customers. However, the research of Bush et al. (1998) and Ducoffe (1996) suggests that little is known about the value of these Internet-based activities. Such thinking raises questions, such as: are advertisers feeling compelled to jump on the Internet bandwagon because of its popularity, or are businesses' desires to use Internet advertising a manifestation of Internet hype? To begin to answer these questions advertising industry stakeholders need to identify whether gaps do exist between agency and client perceptions of the value of the Internet as a promotional tool. The existence of such gaps could lead to tension in the agency-client relationship, which may ultimately mean a loss of client accounts for the advertising agency. Identifying and remedying such gaps could therefore aid in ensuring long-term and profitable working relationships with the agency's clients. To undertake this advertising industry research and respond to the research questions in this study an international advertising agency network, made up of 206 offices in 90 countries and a selection of their clients, were recruited to participate in the study. A two stage survey method approach was adopted because it was a time-efficient and affordable method for collecting detailed information from a dispersed network of professionals. The survey tool was a web-based questionnaire which was firstly submitted to a selection of advertising agencies within the international agency network. On completion of the questionnaire, agencies were asked to provide contact details for their top three billing clients. The second stage of the survey research involved the submission of a client questionnaire to the client contacts provided by the advertising agency. Both questionnaires used a modified SERVQUAL multi-item scale to measure service expectations. Discrete agency and client questions were also included in the respective questionnaires to situate the SERVQUAL analysis within the context of Internet usage, value perceptions and organisational characteristics (e.g. agency size, advertising spend, experience in using interactive media). The major finding of this study is that within the international advertising agency network there were no significant gaps in agency-client expectations concerning the value of the Internet as a promotional tool. Whilst several statistical analyses were undertaken, including bivariate and multivariate techniques such as Pearson's Chi-Square cross-tabulations, independent t-tests and ANOVAs, no statistically significant results are reported. In fact, it was found that advertising agencies and clients have similar expectations of the value of the Internet as a promotional tool. Gaps actually exist in relation to the clients who use the Internet as a promotional tool and agencies who supply Internet advertising services. Many agencies within this international agency network were found to be actively using the Internet, but their Internet advertising functions were not being provided by their traditional advertising agency. Descriptive analyses reported in the findings from this research study indicate that advertising agencies in this international network need to better understand their clients' Internet promotion needs. This will ensure the establishment of healthy, profitable and long-term agency-client relationships in the future. The research findings from this study offer advertising agencies worldwide insight into client expectations of the Internet, as well as other agency services. Furthermore, the findings reported contribute to the current small body of research in relation to B2B relationships in the advertising industry. The groundwork is set for future analysis of agency-client relationships in the advertising industry. In summary, while gaps between agency and client expectations of the value of the Internet as a promotional tool were expected, this research study found that agency and client expectations are quite similar. Analysis did reveal that one important factor, which influences the agency-client relationship, relates to the provision of Internet advertising services. Specifically, when an agency is not responsible for developing and maintaining clients' Internet advertising, these clients are utilising services from external providers of Internet services. These new stakeholders, who provide specialist services (i.e. graphic design houses, Internet advertising specialists and client's in-house Internet services), are changing the competitive environment of advertising services in the industry. Another interesting discovery, specific to the sample population, was that one third of agencies within the study did not provide Internet advertising services to current clients. However, these agencies have clients that use Internet advertising. On the one hand, this finding indicates that opportunities exist for these agencies to extend their service portfolio to embrace Internet advertising. However, it also raises an important question: that is, have these agencies created greater competition by not providing a full service communication portfolio for clients? These factors, and other methodological issues will inform directions for future research to explain the influential role of the Internet within the agency-client relationship in the advertising industry.

Cette recherche est née d'une réalité pratique d'un cabinet d'orthophonie situé au carrefour de déserts médicaux. C'est en partant de la problématique liée à la nécessité d’assurer une offre de soins équitable pour tous, et soucieux d'adapter ces offres en tirant bénéfice des évolutions technologiques et des évolutions des usages communautiques, que nous avons mené notre recherche dans une perspective exploratoire. Notre hypothèse principale est que le recours aux outils et services TIC, notamment aux dispositifs de e-learning, est une solution pour faire face aux difficultés organisationnelles et logistiques relatives à la mise en œuvre de soins pour tous.L'orthophonie est une profession de santé, et en ce sens, elle ne peut se résumer à une pratique pédagogique. Elle trouve sens dans la relation de soin qu'elle instaure avec le patient. La clinique amène l'orthophoniste à faire le choix d'un projet rééducatif qui s'articule autour d'une ligne de conduite plaçant le patient au cœur de la problématique, mais instrumenté par des méthodes pédagogiques, entre autres. C'est pourquoi, nous nous sommes interrogée sur les apports des recherches dans le domaine du e-learning dont nous pourrions bénéficier pour enrichir la pratique orthophonique.L'objectif est donc double: contribuer à enrichir la recherche scientifique propre au domaine de la télé-orthophonie et proposer des solutions à la demande grandissante de soins orthophoniques pour pallier une offre déficitaire dans certaines régions. Nous nous basons sur les visées et les enseignements de la FOAD, dans une optique de changement pédagogique qu'ils impliquent, sous l’hypothèse toutefois de la validité de ces apports pour la pratique de soin et de « rééducation » qu’est la clinique orthophonique.Dans un premier temps, pour situer le thème dans une perspective théorique, nous avons exposé la réalité de la pratique orthophonique en présentiel. Nous avons ensuite présenté les avantages des processus sollicités en FOAD. Nous avons également effectué une revue de littérature traitant de la télé-orthophonie et des diverses expérimentations réalisées. Du point de vue historique, nous avons abordé l'évolution de l'orthophonie en présentiel, des TICE ainsi que de la rééducation à distance. Nous avons également orienté notre travail vers un point de vue techno pédagogique, dans le domaine des sciences de l'éducation, avec le changement des rôles dans le rapport au savoir, impulsé par les avantages techniques proposés par les plates-formes FOAD, qui initient à la fois autonomie, interactivité, flexibilité, et socioconstructivisme. Sur le plan de la méthode, nous avons choisi de réaliser une recherche-action. Ainsi, notre recueil d‘informations s'est appuyé d'abord sur un questionnaire d’enquête prospectant sur les perceptions de la télé-orthophonie par les patients puis sur une expérimentation de pratique clinique présentée sous la forme de cas cliniques. Les résultats obtenus ont conclu à des perspectives d'enrichissement de la pratique clinique et des compétences orthophoniques. Ils nous ont également permis de faire quelques recommandations pour d‘autres recherches. Notre analyse a permis de confirmer l’hypothèse selon laquelle la Rééducation Orthophonique A Distance, peut relever les défis de la qualité de la pratique orthophonique tout en s'inscrivant dans l'évolution sociétale initiée par l'introduction des technologies de l'information. Ces dispositifs répondent de manière innovante à la demande grandissante de gage de qualité des soins et des compétences des praticiens, en se révélant des outils performants dans l'offre de soins, de formation et d'expertise. / This search arose from a practical reality of a cabinet of speech therapy located in the crossroads of medical deserts.Starting from the problem bound to the necessity of ensuring a fair offer of care for all and worried of adapting these offers by benefiting from technological evolutions and from evolutions of the social community uses, we led our search in an exploratory prospect Our main hypothesis is that the useof tools and ICTS services, especially e-learning, is a solution to face organizational and logistic difficulties concerning the implementation of care for all.Speech therapy is a health profession and by the way, it cannot be sum-up to an educational practice. The relation of care with the patient makes its sense. The practice brings the speech therapist to choose of a re-educational project which is articulated around a guideline locating the patient at the core of the problem, instrumented by educational methods. That is why, we wondered about the contributions of the researches in the field of the e-learning that could contribute to empower the speech therapy practice.The objective is thus double: To contribute to enrich the scientific research in the domain of the e-speech therapy and to propose solutions to the growing demand of care to counterbalance an insufficient offer in some regions.We base our approach on the perspectives and the teachings of the FOAD, in a project of educational change that under the hypothesis of the validity of these perspectives for the practice of care and "reeducation" that is the speech therapy practice.In a first step, to be in a theoretical perspective, we described the reality of speech-therapy practice as a face-to-face.Then, we have shown the benefits of the FOAD processes. We also conducted a literature review on e-speech therapy and the various experiments carried out.From a historical point of view, we have discussed the evolution of face to face speech-therapy, ICT and remote re-education.We have also oriented our work towards a techno-pedagogical point of view, in the field of educational sciences, with the changing roles in the relation to knowledge, driven by the technical advantages offered by the FOAD platforms, which initiate autonomy, interactivity, flexibility, and social constructivism.Concerning the method, we decided to carry out an action-research project.Thus, our collection of information was initially settled on a survey questionnaire exploring the feeling of patient of e-speech therapy and then on a clinical practice experiment presented in the form of clinical cases.The results led to perspectives of enrichment of the clinical practice and the speech-therapic skills.They also allowed us to make some recommendations for other researches.Our analysis confirmed the hypothesis according to which, e-reeducation, can meet the challenges of the quality of the speech-therapy practice while joining the societal evolution introduced by the e-technologies.However, if the reluctance to e-speech therapy are still existing, our vision of the future of the e-speech therapy converges on the conception of hybrid methods, mutualizing the skills and the offers of care, where both face-to-face and virtual modes will exist with other informal and social modes of reeducation, widely favored by the tools of Web 2.0.These approaches answer in an innovative way to the growing demand of quality security of the care and the skills of the practitioners by showing itself as successful tools in the offer of care, training and expertise.