Information Society and Health Care Services for Elders. The Naviga Platform.

The R+D+i Project NAVIGA described in this paper is partially funded by the Center for Industrial Technological Development (CDTI) as part of the "Subprograma Interempresas Internacional” (CIIP-20091007).

The concept of the information society is now a common one, as opposed to the industrial society that dominated the economy during the last years.  It is assumed that all sectors should have access to information and reap its benefits. Elder people are, in this respect, a major challenge, due to their lack of interest in technological progress and their lack of knowledge regarding the potential benefits that information society technologies might have on their lives. The Naviga Project (An Open and Adaptable Platform for the Elder people and Persons with Disability to Access the Information Society) is an  European effort,  whose main goal is to design and develop a technological platform allowing elder people and persons with disability to access the Internet and the Information Society.  NAVIGA also allows the creation of services targeted to social networks, mind training and personalized health care.


1. Introduction

Today, developed countries have great difficulties with effective health services and quality of care in a context marked by the population’s ageing.  This trend, as seen in Figure 1, has dramatic effects on both public and private health systems, as well as on emergency medical services,   mainly due to an increase in costs and a higher demand for more and improved benefits for users, as well as for increased person’s mobility.

This demographic change will lead to significant and interrelated changes in the health care sector and technologies promoting independence for the elderly. As representative data, approximately 64% of the European population is made up of 20 to 64 year olds, while the 65 and over group covers 17%. Thus, there are some 4 working employees to every pensioner. On the other hand, it is estimated that the 20 to 64 year old group will decrease to 55% and the over 65 will increase to 28% by the year 2050, making the proportion 1 to 2 instead of 1 to 4. Spending on pensions, health and long-term care is expected to increase by 4-8% of the GDP in the coming decades, with total expenditures tripling by 2050.

Figure 1: Demographic change according to the foresight of the United Nations, (access: 06/12/2010)

People live longer in developed countries as a result. For example, in North America only 4.5 % of population over 65 years old lives in nursing homes, a percentage that has decreased in recent years. The elder population is constantly prepared for a better aging due to a decrease in disability, resulting in the elderly being more active in their daily lives. Despite the improvement in conditions for coping with ageing and an increasingly active lifestyle, there are obvious changes that occur in behaviours and skills during the latter part of life.

These changes may include decreases in social relations and physical abilities, loss of memory, comprehensive and cognitive functions. Previous studies have shown that the ageing process is accompanied by a decrease in neuro-motor and cognitive functions. Compared to young people, the elderly demonstrate poor performance on tests, including reaction times, motor coordination, short-term and complex or abstract conceptualization. In general, these changes result in a decline in the quality of life for the elderly.

Another important impact that can be seen particularly in persons living in nursing homes is boredom.  Participation in social activities does not necessarily improve this feeling and sometimes creates negative attitudes in participants, although activities based on individual preferences can have positive effects and help to overcome boredom, increasing the quality of life for elderly. It is a challenge to find innovative activities that involve the elderly and encourage them to keep practicing with the activity. An adequate understanding of the disuse of motor and cognitive functions can help to prevent the decline in these skills and participation in activities based on individual preferences can reduce boredom. There is a real need for activities that address these two concepts, and these activities may be none other than for example mental exercises and social networks specially designed for elderly.

The current trend is to improve the quality of life of elderly people, not only by extending their lifetime. The "gerontechnology" [1] is a very active discipline focused on improving the lives of elderly, considered as a special group of users whose particular skills and needs in social and cognitive levels should be taken into account during the design process of any technology solution focused on this group. We must also consider that older people often do not feel comfortable in handling a computer and the use of technological devices seems complicated for them. This problem may be worse considering the decline in cognitive, visual or motor abilities.

The Naviga project (2009-2012) is an European initiative funded by the Eurostar [2] R&D program and whose main objective is to provide these collective tools, devices of better living and health conditions and methods to enjoy personal autonomy and a better quality of life. To accomplish this, within the project we are developing an integrated technology platform to provide Internet access through a computer or TV. In addition, the proposed platform will facilitate the incorporation of  elderly and people with different functional capacity to the Information Society through the use of special input devices, an adaptable Web Navigator, social networks, applications to improve the cognitive ability (serious games) or personalized health services.

The consortium comprises five SMEs conducting research (investment min. 20% of annual turnover in R & D), and a university.

2. Objectives in Naviga Project

The Naviga project, through the use of information and communications technology, intends to cover a range of social and health objectives aimed to improve the access to Information Society by the elderly and people with disabilities. Within Naviga we will develop an open platform and adaptive technology for various purposes detailed in the following subsections.

2.1 Technological Oriented Objectives

On the one hand, the development of an adaptive communication interface between user and computer or television, to facilitate the understanding of Internet and new technologies to people with a low-tech profile, while encouraging its use by providing a simple and friendly human machine interface. Also, this interface takes into account the integration with different support products on the market to ensure that users can use those techniques.

 Furthermore, the development of a platform that allows rapid creation of services and applications specifically for the elderly and disabled people with a common API.

2.2 Social Oriented Objectives

In this case, the main social objectives lie in the attempt to bridge the gap that prevents the elderly and people with disabilities from accessing to the Information Society. To do this, we are developing simple mechanisms for interaction between technical elements (computer, television or special input devices as pulsers in place of keyboard), and people; for example an accessible Web browser to improve usability through the use of alternative hardware to keyboard or for example voice commands. Also, the browser will be compatible with common support and aid products for elder people. We are also developing a social network among people with the same disability, where users can find people with common interests and concerns, and share information, experiences and advices.

2.3 Health Oriented Objectives

Similarly, the project will provide a range of health-oriented goals that will help elderly to keep active through mental training exercises, and otherwise assist staff medical (hospitals, health centres) in monitoring the treatment of these people from homes, in this case trough developing services and games that allow mental training (mind training), suggesting exercises to keep the mind active, and getting people to communicate and participate to a greater extent in their social community.  This will prevent premature degeneration of mental activity, and will improve the mood of elderly with functional diversity by increasing the feeling of being useful to society around them.

Although little is known about the perceived benefits of mental games for the elderly, there is a small but growing body of research evidence in support of the notion that brain exercises can have a significant positive impact on the elderly mental and physical health and wellbeing [3] as for example a better information processing, reading, comprehension, memory, self-image, etc.

Development of personalized health services is also part of the Naviga’s objectives, such as warning and reminder system for medication adherence through an automatic smart pill dispenser or home rehabilitation physiotherapy through virtual reality applications. In the latter case, the main goal is to recover the functionality of the hand of patients using a glove that makes measurements of the angles of each phalanxes up to 22 degrees of freedom with high accuracy. The device uses a strain sensing technology that transforms the movement of the hand and fingers to digital data in real time.

3. Architecture of technological platform

Among the initial services of the platform, there are technical difficulties related to the application area. For example, the development of an accessible Web browser must be multimodal and interoperable in order to take into account the needs of all members of the group, which greatly complicates the solution due the diversity of users. Also, the use they make of the social network can be very different. Both, use objectives (social relationships, share experiences, recommend support products) and access to services, must provide simple user interfaces, easy to use and highly adaptability to the preferences and characteristics of each person.

Naviga platform provides an open system based on SOA (Service Oriented Architecture) that enables and facilitates the development of new applications and services that seamlessly integrate with existing modules without need of an expert knowledge of the lower layers architectures and languages. Also, open source implementation based on Java EE and scripting languages like JavaScript, and compliance with accessibility standards of the ISO and the recommendations of the WAI, ensure continuity of service and support the development of the platform.

The technology platform we are developing within the Naviga Project, see Figure 2, must solve two major technical challenges:

Figure 2. Naviga's Technology Platform

Firstly, the connection to the platform in an interoperable way of different support products  and communication interfaces, integrating health monitoring devices that generate medical alerts, fall detection systems and security alarms, and devices that enable accessibility to users with motor or cognitive disabilities to  information and entertainment services.  The number of support products available in the market is very high, but often not compatible with each other or have the same degree of utility to different users who share a disability. It is therefore necessary to develop a common multi-modal interface that simplifies the integration between computer and any specific support product. It should also be taken into account the need for multi-channel access, allowing Internet navigation through the computer, television or mobile devices.

Second, the development of a set of tools for creating and deploying services and applications to ensure compatibility and rapid integration of new services and devices on the platform, while providing a common adaptive and easy to customize interface for user interaction, that is the function of Common Access Platform (CAP), see Figure 3, a shell running in place of the Microsoft Windows Operating System that implements several modules as for example for Short Message Commands (SMC), Web File Download (WFD), Text-to Speech Conversion (TTS), etc. and all elements to manage future applications and services to be included in the platform.

The main module inside the CAP is the so called “PANORAMA” which implements the user GUI and has a behaviour similar to the Windows desktop, but with some innovative characteristics that allow meets the specific 65+ user requirements (size of icons, colors, etc.) and including also key aspects of advanced user interfaces.

A special feature of the CAP is that it must be able to speak and perform voiceovers at the request of any other module or plug-in in the platform. This ability to speak is performed by the TTS module (Text to Speech), which will be able to interpret instructions to carry out a phrase, change of speaker or speed, volume, etc. This module is capable of pronouncing aloud the name of the icon over which the user is, or allowing the CAP to alert the user of events or errors via voice messages.  This means that any module, plug-in or Naviga service must be able to communicate with the user using phrases.

Figure 3. A detailed High Level view of the Common Access Platform

4. Virtual reality Hand rehabilitation. An example of Naviga’s health service

Virtual Reality (VR) is a human-computer interface technology that allows the user to experience and interact with virtual environments. The three-dimensional graphics and the possibility to interact with the environment give the participant the feeling that he is part of this world, immersion is the professional term for this. Also stereo sound may contribute to the immersion.

Virtual Reality is used in medicine for surgical simulation training, three-dimensional anatomy and surgery planning. Also, Virtual Reality is successfully used in the treatment of phobias. Virtual environments are safe, controlled environments and therefore attractive environments for the treatment of phobias. Besides the feelings of safety the patient has when experiencing the virtual environment as real, the user has to feel a part of it in order to conquer the fear.  From these studies it is concluded that it is possible to create a virtual environment that it is experienced as real and immersive. After the successful treatments of phobias with Virtual Reality more and more interest arises for Virtual Reality in cognitive and physical rehabilitation.

In the frame of Naviga project, we have chosen a health service for hand rehabilitation based on Virtual Reality for the improvement of the patient’s outcome.  This service is fully integrated within Naviga Platform allowing users to do rehabilitation exercises at hospital under professional supervision. In a future stage, patients will be able to perform their exercises under remote supervision.

Subjects that have taken part of the rehabilitation therapy are mainly patients who had a traumatic hand injury or surgery due to disease. Patients after brain injury and with cognitive and mobility handicap are not often taking part of this rehabilitation sessions, although sometimes they are included and can represent also a challenging task for the therapists.

Rehabilitation sessions are based on exercises involving actions related to an object: Reaching, grasping and manipulation. More specifically

  • Reaching objects at different heights and positions.
  • Grasping objects of different shapes and sizes.
  • Functional manipulation of objects.

The service is based on a CyberGlove® equipment. This data glove is a lightweight, comfortable, fully instrumented glove that provides up to 22 high-accuracy joint-angle measurements. It uses proprietary resistive bend­sensing technology to transform, with high accuracy, hand and finger motions into real-time digital joint-angle data. An option to the glove, the CyberTouch system provides vibrotactile feedback to the fingers and palm.

The VR-Hand Rehabilitation Service enclosed within Naviga can be defined as observed in the  figure 4.

As we can observe from the diagram, the interaction between Naviga and the service is mainly through the CAP and it is important to remark that the interface between CAP and the service is designed as lying on an xml interface. This means, every module in the service is launched though a defined xml file, but in general all modules interact with the local database. The VR-Service will take profit of other CAP Services (TTS, Video Player, etc) as well. 

The software developed within the VR- Hand-Rehabilitation service it composed of the following modules:

Figure 4. Naviga – VR-Hand-Rehabilitation Service. Blue blocks are representing the interfaces involved in this service

  • Module 1.  Database Configuration of the system.
  • Module 2. DataGlove Initialization.
  • Module 3. DataGlove Calibration.
  • Module 4. DataGlove Re-Calibration.
  • Module 5. Real-Time VR System Application.
  • Module 6. Offline Session Reconstruction.

These modules cover from the Initial Local Database and DataGlove Configuration to the execution of a rehabilitation session and further analysis.  The  figure 5 shows the DataGlove Initialization module.

 5. Expected Results

As mentioned above, from the point of view of development, the project's expected results are: 

  • A hardware interface device adaptable to all seniors and people with disabilities enabling the interaction with computer or television.
  • A framework (tools and methods) for creating and deploying services and applications.
  • The development of services including a Web browser that allows access for elderly’s and disabled people to the Internet.
  • Two technology demonstrators in the field of e-Health and entertainment.
  • An analysis of business opportunities and business requirements (identifying their strengths and weaknesses) for the successful commercialization of project results.

During the running of Naviga project two case studies/scenarios are being implemented to demonstrate the functionality of the framework developed. One dealing with rehabilitation at hospital based on virtual reality, while another scenario will be developed and evaluated in a care centre for elderly’s and people with disabilities aiming their access to the Information Society through the adaptable Web browser and in particular social networks and mental training. The scenarios will have real participation of end users to validate the technological advances.

Figure 5. Data Glove Initialization subsystem

6. References

  • Burdick, DC, and Kwon, S. Gerotechnology: Research and Practice in Technology and Aging.New York: Springer Publishing Company. 2004 program Eurostar website. /. 2010
  • Gamberini, L., Barresi, G., Mager, A., Scarpertta, F. A Game of a Day Keeps the Doctor Away: A Short Review of Computer Games in Mental Healthcare. Journal of CyberTherapy and Rehabilitation, 1(2), 127–145. 2008
  • Griffiths, M. The therapeutic value of video games. In Raessens, J & Goldstein, J. (Eds.) Handbook of Computer Games Studies (pp. 161-171). Cambridge, MA: The MIT Press. 2005
  • RM-ODP Web site. 2010
  • Gartner, "Gartner Reveals Five Social Software Predictions for 2010 and Beyond," 2010.:
  • Griffiths, M. The Therapeutic value of video games.In Raessens, J & Goldstein, J.               (Eds.) Handbook of Computer Games Studies (pp. 161-171). Cambridge, MA: T he MIT Press. 2005
  • Jimison HB, Pavel, M., McKanna, J., Pavel, J. Unobtrusive Monitoring of Computer Interactions to Detect Cognitive Status in Elders, IEEE Transactions on Information Technology in Biomedicine, Vol 8, No. 3, pp.248-252. 2004.
  • Czaja, SJ, & Lee, CC "Information technology and Older Adults. " In JA Jacko & A. Sears (Eds.), The human-computer interaction handbook (2nd ed.).New York.  Erlbaum. 2007.

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