MS, University of Cincinnati, 2016, Engineering and Applied Science: Mechanical Engineering

The continuous development in medical and healthcare sector has led the human civilization to have an increased life expectancy which in turn will lead to a higher than ever before population of elder people soon. This concept of world aging has spurred the development of healthcare services and facilities for the elderly population. There are a lot of daily activity and behavior monitoring systems that are built to promote independent living in people of age and aid in terms of health care to perform the basic activities of daily living. However, it has been observed that most of these systems uses either people or care takers to monitor the health and make their own judgements based on their own experience and intellect, or use sensors that are too complex, expensive, intrusive and/or unreliable. These problems have obstructed a lot for achieving convincible results in the healthcare monitoring applications. To deal with this issue, the proposed research designs a systematic framework of an intelligent mechanism that is low-cost, flexible, easy to install, robust and accurate for monitoring basic activities of daily living of elderly and assess their health status. Additionally, this model doesn't raise concerns related to security, privacy and legal aspects which is a cause for growing concern these days. The model in this research focuses on monitoring functional health of the elderly based on the Katz index of ADL. It has been established that functional health is the dominant health classification because it depends on all mental health, physical health as well as the quality of life. A practical data acquisition strategy is established from sensor to collect data for appliance usage. The collected data is then analyzed and inference were drawn based on the habits and preferences of the occupant of the house (subject). A preliminary work plan for behavioral deviation detection and psychometric property testing is proposed. This research provides a guid (open full item for complete abstract)

Committee: Samuel Huang Ph.D. (Committee Chair); Sam Anand Ph.D. (Committee Member); David Thompson Ph.D. (Committee Member) Subjects: Health Care

Doctor of Philosophy, Case Western Reserve University, 2023, Clinical Translational Science

A fundamental gap exists in the ecologically valid assessment of functional decline in neurological disease. Functional decline is characterized by difficulty with performance of instrumental activities of daily living, like shopping and medication management. Traditional assessments of IADLs rely on self-report questionnaires or resource-intensive performance-based tests. Virtual adaptations of performance-based tests offer advantages but neglect to incorporate the motor components inherent in everyday IADL tasks. Dual-task conditions requiring simultaneous cognitive and motor function impact performance, particularly among the aging and neurological populations; therefore, ecological IADL assessments must include both the mental and physical aspects of daily tasks. By combining immersive virtual reality with an omnidirectional walking platform, the Cleveland Clinic Virtual Reality Shopping (CC-VRS) application replicates all aspects of everyday grocery shopping and provides objective outcome measures to quantify performance. We hypothesized that CC-VRS outcomes would display convergent validity with neuropsychological tests and would discriminate performance of young adults, older adults, and individuals with Parkinson's disease (PD). The omnidirectional platform utilized by the CC-VRS was first evaluated to investigate the relationship between overground walking and omni-platform walking (Chapter Two). Omni-platform walking was characterized by slow gait speed and short step; otherwise, relationships between biomechanical outcomes resembled those of natural gait during forward walking but differed during turning tasks. Next, the conceptualization, development, and protocol of the CC-VRS were detailed (Chapter Three). Preliminary results from PD participants provided evidence for the feasibility and usability of the CC-VRS system among individuals with neurological disease. Primary outcomes of the CC-VRS discriminated older adults from younger adults ( (open full item for complete abstract)

Committee: Jay Alberts (Advisor); Jill Barnholtz-Sloan (Committee Chair); Xin Xin Yu (Committee Chair); Michael Fu (Committee Member); Mark Lowe (Committee Member); James Spilsbury (Committee Member) Subjects: Biomedical Research; Neurosciences

MA, Kent State University, 2023, College of Arts and Sciences / Department of Psychological Sciences

The increased demands that arise with dementia progression can make caregiving challenging, leading to an onset of burden in the caregiver. Although burden is often associated with caregiving, the role of the caregiver is linked to beneficial outcomes as well. Because individuals who report many positive aspects of caregiving tend to exhibit lower burden relative to those reporting few positive aspects of caregiving, caregiver burden and positive aspects of caregiving are often viewed as mutually exclusive constructs. The present study is a retrospective review of medical records from an outpatient memory clinic, with the goals of better understanding whether and how these constructs coexist within the individual caregiver and exploring potential contributors to caregiver profiles that emerge. A total of 225 patient-caregiver dyads were included in analyses. Results suggested a three-cluster solution with a highly burdened group, a group with low-moderate burden and positive experiences, and a group with high positive experiences. Presence of greater neuropsychiatric symptoms predicted assignment to the higher burden cluster, and greater care recipient dependence predicted assignment to the cluster with higher positive experiences. Future research should investigate other potential contributors to the experience of burden and positive aspects of caregiving.

Committee: Mary Beth Spitznagel (Advisor) Subjects: Clinical Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2022, Psychology

Nearly 43% of individuals aged 60 and older experience loneliness (Perissinotto et al., 2012), which is associated with an increased risk of cognitive impairment (Cacioppo & Hawkley, 2009; Gow et al., 2007) and impairment in performance of activities of daily living (Ferreira-Alves et al., 2014; Holmen et al., 1992; Perissinotto et al., 2012). The present study examined cognition as a moderator of the relationship between loneliness and both basic and instrumental activities of daily living (ADLs; IADLs) amongst older adults. It was hypothesized that cognitive functioning would moderate the relationship between loneliness and ADLs/IADLs, such that higher cognition would lessen the impact of loneliness on ADL/IADL performance, whereas lower cognition would not afford a buffering effect. Participants (N = 106) were community and non-community dwelling adults 65 years and older who completed a series of self-report questionnaires. Hierarchical regression analyses revealed that cognition moderated the relationship between loneliness and instrumental ADLs. Follow-up simple slope analyses uncovered that loneliness had a greater impact on IADL performance amongst participants with lower cognition, but still exerted significant influence on IADL performance among participants with higher cognition. It is conceivable that exposure to chronic stress and loneliness owing to the COVID-19 pandemic has negatively impacted older adults' functioning, over and above the protective effects afforded by their higher cognition. Further study implications, future research and limitations are discussed, including the recruitment of a small, homogeneous sample and the limited generalizability of findings.

Committee: Cynthia Dulaney Ph.D. (Committee Chair); Tammy L. Sonnentag Ph.D. (Committee Member); Reneé A. Zucchero Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy (PhD), Wright State University, 2022, Computer Science and Engineering PhD

Activities of Daily Living (ADL's) are the activities that people perform every day in their home as part of their typical routine. The in-home, automated monitoring of ADL's has broad utility for intelligent systems that enable independent living for the elderly and mentally or physically disabled individuals. With rising interest in electronic health (e-Health) and mobile health (m-Health) technology, opportunities abound for the integration of activity monitoring systems into these newer forms of healthcare. In this dissertation we propose a novel system for describing 's based on video collected from a wearable camera. Most in-home activities are naturally defined by interaction with objects. We leverage these object-centric activity definitions to develop a set of rules for a Fuzzy Inference System (FIS) that uses video features and the identification of objects to identify and classify activities. Further, we demonstrate that the use of FIS enhances the reliability of the system and provides enhanced explainability and interpretability of results over popular machine-learning classifiers due to the linguistic nature of fuzzy systems.

Committee: Tanvi Banerjee Ph.D. (Advisor); Yong Pei Ph.D. (Committee Member); Michael Riley Ph.D. (Committee Member); Mateen Rizki Ph.D. (Committee Member); Thomas Wischgoll Ph.D. (Committee Member) Subjects: Computer Science

MS, University of Cincinnati, 2019, Engineering and Applied Science: Computer Science

The increasing population of elderly people has been one of the characteristics of this modern century. This ever-increasing population of elderly people is predicted to outnumber the population of youths and caregivers in a few years' time. Old age is mostly associated with a number of problems like memory issues, cognitive disabilities, disorganized behavior and many more, quite often leading to Mild Cognitive Impairment (MCI) and other forms of disabilities which cause problems for elderly people to accomplish their daily routine activities. This increased need for healthcare and daily care services that is associated with old age, causes a huge burden on the world economy to sustain and meet the needs of elderly people worldwide. To ensure that these varying needs of elderly people arising from their differing diversities are met, and they have a better quality of life, it is essential for modern day technologies to adapt according to the specific needs of individual users and develop an assisted living environment that can improve both physical and mental wellbeing and foster independent living of older adults in the context of their day to day goals and tasks. The integration of Affect Aware Technologies with Activity Centric Computing in the context of Human-Computer Interaction and Internet of Things (IoT)-based technologies holds immense potential to act as a long-term solution to address these ever-increasing needs for elderly care. This serves as the primary interest for this research work. In this work, a Framework for a Context Aware Adaptive Intelligent Assistant for Activities of Daily Living (ADLs) has been proposed. This framework integrates methodologies for complex activity recognition, user performance augmentation for respective activities and complex activity recommendation, based on the users affective state and daily routine. The ability of this framework to adapt according to the dynamic needs of specific users and (open full item for complete abstract)

Committee: Chia Han Ph.D. (Committee Chair); Wen-Ben Jone Ph.D. (Committee Member); Nan Niu Ph.D. (Committee Member) Subjects: Computer Science

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

Adherence to a prescribed plan of care in chronically ill patient populations of all ages is a global challenge. Failure to adhere to prescribed medications, treatments, and recommended self-care behaviors can lead to poor health outcomes and increased health care costs. Pediatric oncology, immunodeficiency, and hematopoietic stem cell transplant (HSCT) patients are at increased risk of developing treatment-related toxicities including infections, oral complications, and deconditioning, especially when they are non-adherent to prescribed self-care behaviors. Evidence indicates the risk for these toxicities can be reduced by participation in key activities of daily living (ADL), including daily bathing with chlorhexidine gluconate (CHG), physical activity and oral hygiene, known as ADL 1-2-3. Despite this evidence, many patients fail to perform these important ADL during their inpatient treatment, when they are most susceptible. Pilot testing of a paper token economy system demonstrated increased engagement in ADL 1-2-3 in a small group of inpatient pediatric HSCT patients who had a history of non-adherence with these self-care behaviors. The results of the pilot study suggested furthering this effort through the design and building of a digital token economy system. The primary DNP scholarly project aim is to improve overall adherence to ADL 1-2-3, as well as compare adherence between one group of patients receiving the current standard of care and a second group of patients receiving a novel digitalized token economy intervention in addition to the current standard of care. The DNP project serves as a feasibility study for a larger scale randomized controlled trial and therefore includes measurement of intervention fidelity in support of this National Institute of Health grant funded research.

Committee: Elizabeth Bragg PhD, RN (Committee Chair); Susan Allen PhD, RN-BC (Committee Member) Subjects: Medicine; Nursing; Psychology

Master of Arts, The Ohio State University, 2015, Educational Studies

Individuals with intellectual and developmental disabilities (IDD) often need to be explicitly taught activities of daily living (ADLs) that will lead to a more independent lifestyle. Research indicates that the earlier interventions begin, the bigger impact they may have on the individual. Video prompting is one way that has been shown to be effective in teaching individuals with IDD ADLs. This study used a multiple probe across tasks design to determine whether two preschoolers with IDD would acquire ADLs with video prompting. Imitation skills were also assessed to determine if skill acquisition using video prompting was impacted by imitation skills. Results indicate that video prompting with error correction was successful in teaching one participant ADLs. The second participant did not acquire the skills with video prompting and error correction alone. When vivo teaching was implemented, minor increases were made, but mastery was not reached with the second participant. Results of the imitation assessment show that the participant who acquired ADLs with video prompting had a high level of imitation skills prior to the intervention. The student who did not acquire the skills had a low level of imitation skills. This indicates that imitation could be a possible indicator of the effectiveness of video prompting as an intervention for individuals with IDD. The paper will discuss further procedures of generalization, limitations, and areas for future research.

Committee: Helen Malone Dr. (Advisor); Matthew Brock Dr. (Committee Member) Subjects: Behavioral Sciences; Early Childhood Education; Special Education

MA, Kent State University, 2014, College of Arts and Sciences / Department of Psychological Sciences

Heart failure (HF) is a progressive chronic illness associated with significant functional impairment as well as many medical and psychiatric comorbidities. HF patients often require assistance in completing activities of daily living (ADL) and also frequently have poor treatment adherence. In addition, cognitive impairment and depression (both known contributors to functional impairment) are common in this population. Little work has been done to investigate whether the co-occurrence of depressive symptoms and cognitive impairment is more detrimental to daily functioning than either condition alone. Older adults with HF (N=107) completed a neuropsychological test battery and self-report measures at baseline and 12-month follow-up. Linear regression analyses controlling for sex, age, and HF severity indicated baseline depressive symptoms and scores across several cognitive domains were independently related to ADLs at 12-month follow-up. However, the interaction of cognition and depressive symptoms did not predict later ADLs or adherence. These results indicate monitoring of depressive and cognitive changes is important, as it may serve as a marker for later decline in daily functioning and could be used to prompt early intervention in HF patients.

Committee: John Gunstad Ph.D (Advisor); Mary Beth Spitznagel Ph.D (Committee Member); Jeff Ciesla Ph.D (Committee Member); John Dunlosky Ph.D (Committee Member) Subjects: Psychology

Master of Science in Applied Behavior Analysis, Youngstown State University, 2011, Department of Psychological Sciences and Counseling

As we age, certain predictable but avoidable changes occur. One change being that older adults come to rely on others for more and more of their daily care. Maintaining functional independence, to the extent that it's desirable, increases life satisfaction. The goal of this study was to increase independent dressing behavior for six residents diagnosed with cognitive impairments. A multiple baseline design was used to evaluate the effects of a brief training procedure for nursing staff in an assisted living facility to implement the System of Least Prompts (SLP) procedure. Generalization of independent behavior to an untargeted ADL was also assessed. A significant increase in independent dressing behavior and generalization of independent behavior to an untrained ADL was evident. Notably, resident dressing time did not increase following implementation of the SLP procedure. These results provide evidence of the effectiveness and efficiency of SLP in increasing independent behavior for older adults with cognitive impairments.

Committee: Michael Clayton PhD (Advisor); Rocio Rosales PhD (Committee Member); Jane Kestner PhD (Committee Member); Julie Boron PhD (Committee Member) Subjects: Aging; Behavioral Sciences; Gerontology; Health Care; Inservice Training; Nursing; Occupational Therapy; Psychology; Rehabilitation

PhD, University of Cincinnati, 2011, Engineering and Applied Science: Biomedical Engineering

The long term goal of this research is to protect knee joint surfaces after knee surgery, thereby reducing the incidence of osteoarthritis. The objective of this dissertation was to determine if the ovine stifle joint is a suitable preclinical biomechanical model for the human knee. Using a 6 degree of freedom (DOF) robot, we applied simulated human and ovine in vivo motions to human knee and ovine stifle joints to measure the 3D joint and ACL kinetics. In addition, we investigated the biomechanical contributions of the other major knee structures. The in vivo studies were designed to determine the effect of surgically implanting motion and force sensors on ovine gait by monitoring the vertical ground reaction forces (VGRFs). Following surgery, we simultaneously measured VGRFs, knee kinematics, and the output from an arthroscopically implantable force probe (AIFP) which was implanted into the ACL. The kinematics were then simulated and applied to the operated joints, while measuring the 3D joint forces and moments. The AIFP output was used to validate the reproduced motions. Finally, we determined the effect of perturbing a simulated in vivo motion on 3D joint and ACL kinetics, which allowed us to investigate the potential effect of motion recording and reproduction errors on force and moment measurements. Applying simulated human and ovine in vivo motions to human knee and ovine stifle joints resulted in few significant kinetic differences between the human and ovine intact joints and ACLs. For a simulated 6 DOF ovine motion applied to the ovine stifle joint, the bony interaction and medial meniscus were the major restraints during the stance phase of gait, whereas the MCL and ACL were the key restraints during the swing phase. The contributions of the ovine structures for a simulated 6 DOF in vivo motion are similar to the roles previously reported for the human. The in vivo studies revealed that surgery to implant motion and force sensors decreased average and (open full item for complete abstract)

Committee: Jason Shearn PhD (Committee Chair); David Butler PhD (Committee Member); Donita Bylski-Austrow PhD (Committee Member); Marepalli Rao PhD (Committee Member) Subjects: Biomedical Research

Doctor of Philosophy, Case Western Reserve University, 2005, Epidemiology and Biostatistics

Quality research in home health care is complex since no gold standard exists for measuring adverse outcomes and the patient and clinician populations are heterogeneous. Furthermore, mortality, the outcome often used for quality research in institutionalized settings is not appropriate for home health care as unexpected death is too rare. This study evaluated three indices of functional decline. The first index is defined by the Centers for Medicare and Medicaid Services' (CMS) as ‘substantial decline in three or more activities of daily living' (ADLs). Substantial is considered a minimum two-unit decline and the ADLs evaluated were grooming, toileting, bathing, ambulation, and transferring. Alternative indices were developed with frequencies of 783 (1.58%) for ‘substantial declines in two or more ADLs' (Index Two) and 4 271 (8.64%) for ‘substantial declines in one or more ADLs' (Index One). This dissertation evaluated the predictive validity of all three indices. The CMS index (Index Three) was so rare it rendered statistical analyses meaningless (n=212). Index Two had the best predictive validity with c-statistics above 0.70, non-significant Hosmer-Lemeshow X2 indicating reasonable model fit, and moderate covariate consistency. These results were validated with follow-up data. Index One had reasonable model fit and moderate covariate consistency, however it consistently had lower c-statistics as compared to Index Two. Index Two was used in a two-stage approach using an ordinary least squares (OLS) unbiased model incorporating team fixed effects. These risk-adjusted team fixed effects scores were regressed against eighteen objective organizational factors. Core nurses (a measure of nursing concentration) had an inverse relationship (estimate= -0.48, t= -2.29); average number of years worked at the agency per team was also inversely associated (estimate=-0.75, t= -2.36); the number of different licensed home health aide agencies employed had a positive association ( (open full item for complete abstract)

Committee: Natalie Colabianchi (Advisor) Subjects:

MA, Kent State University, 2013, College of Arts and Sciences / Department of Psychological Sciences

Impairments in cognitive function are common among older adults with heart failure (HF) and associated with reduced quality of life and increased mortality risk. Executive function has been identified as a significant contributor to instrumental activities of daily living (ADL) performance among various medical populations, though this has yet to be fully examined in a HF population. The current study examined whether executive function mediates the relationship between HF severity and performance of instrumental ADLs. The current sample consisted of 120 persons with HF (67.71 ± 9.17 years of age, 33.3% female). Participants completed a brief neuropsychological battery, a series of psychosocial self-report measures, and impedance cardiography was conducted to quantify cardiac index. Executive dysfunction and reduced instrumental ADL performance was common in the current sample. Bivariate correlations revealed that cardiac index was not significantly associated with executive function or total instrumental ADLs (p > .05 for both) and thus mediation analyses were not conducted. Post-hoc analyses revealed a trend between executive function and total instrumental ADLs (¿F(1,118) = 3.02, ¿R2 = .02, p = .085), with better executive function associated with increased ability to perform instrumental ADLs. Partial correlation analyses also revealed reduced executive function was associated with decreased physical quality of life, mental quality of life, and basic ADL performance (p < .05 for all). In sum, the current findings do not support executive function as a mediator between the relationship of cardiac index and instrumental ADLs. However, our findings suggest a possible role for executive function in the performance of instrumental ADLS and prospective studies should further explore this link.

Committee: John Gunstad (Advisor); Mary Beth Spitznagel (Committee Member); Hughes Joel (Committee Member); Merriman William (Committee Member) Subjects: Clinical Psychology; Neurosciences; Psychology