1. technology and computing

Assisted Living
Technology
A market and technology review
Produced by: Life Sciences-Healthcare and
the Institute of Bio-Sensing Technology
for the Microelectronics and Biomedical iNets
March 2012
w:www.inets-sw.co.uk
e:[email protected]
i.
ABOUT THE AUTHORS
Dr Gugs Lushai - Director and Co-Founder of Life Sciences-Healthcare
Limited. Specialist in Business Development and Foreign Direct Investment and
New Market Entry – 20 years of Science and Innovation support for Private and
Public organisations. Promoting links to international markets. Former Head of
Bio Sciences for the UK Government and the South West of England Regional
Development Agency.
The Life Sciences-Healthcare Ltd Team has over 130 years of Life Sciences and
Healthcare experience to ensure accelerated business development success.
Our main foci include:
• Medical Technology, especially diagnostic platforms
• Pharmaceutical drug development through proof-of-concept and phase 1
development
• Biotechnology exploitation especially from marine resources
• Funding brokerage with a focus on government and international softlanding packages
Dr Tim Cox - Director of Research and Enterprise of the Institute of BioSensing Technology of the University of the West of England. He has over thirty
years experience in government, commercial and academic sectors as a
technical leader in the development of silicon based microsensor systems for a
wide range of applications.
The Institute of Bio-Sensing Technology, based at the University of the West of
England, Bristol, is a collaborative venture working with research groups and
industry in the UK and worldwide. Together we have a strong track record in
bio-sensing technology research, which has attracted significant funding from
industry, government, European Union and Funding Councils.
IMPORTANT NOTICE
This report has been prepared solely for the purpose of conducting an initial
evaluation of the proposed growth opportunities for the Assistive Living Technology
(“ALT”) markets on behalf of the South West of England Microelectronics and
Biomedical iNets.
The report does not purport to contain all the information that may be required for a
full evaluation of, or business planning for new and potential commercial growth
activity in this sector. Analysis and the market opportunity are from reputable
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ii. CONTENTS
IMPORTANT NOTICE
i. ABOUT THE AUTHORS
........................................................
This
report has been prepared solely for the purpose of conducting an initial evaluation of
2
the proposed growth opportunities for the Assistive Living Technology (“ALT”) markets on
ii. CONTENTS
behalf of the South West of England Microelectronics and Biomedical iNets.
........................................................
3 report does not purport to contain all the information that may be required for a full
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evaluation of, or business planning for new and potential commercial growth activity in
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1.0
INTRODUCTION
Assisted living is perceived differently in various parts of the world and
comprises various devices. The devices described by definition below form
the basis of the market analysis and revenue forecasting for ‘Assisted living
technologies’ (“ALT”) in this study. This study focuses only on the devices
“technology” market and briefly describes but does not quantify the services
market.
The macro-level landscape for ALT in Europe is against a back drop of
economies of Europe struggling to reconcile the demand for social care with
public funds available, especially after the onslaught of the continuing
recession. Therefore, Governments are keen to adopt affordable alternatives
that are innovative, technologically advanced and able to address the
problem using limited resources and reduced costs in healthcare services.
Europe is witnessing an explosion of an ageing population, and this is posing
a challenge for the policy makers in terms of social-security systems. Across
European countries, the retirement age is rising, putting higher pressure on
governments to provide the right living conditions for the elderly population
to facilitate the population’s independent living. Along with the increase in
life expectancy, there is an increase in the prevalence of mental and physical
health ailments among the ageing population. This demographic shift in
Europe paves the way for technological innovation to efficiently enhance the
living conditions of the aged and physically impaired.
Broadband communications, networking capacity, integration of devices and
services and other communication capabilities allow multimedia
communications between homes and community centres. However, there is a
difference in the usage of such technologies among various age groups of
end users. Hence, market demand impacts innovation and improvements of
technology and together these are an important stimulant for growth for ALT
in Europe.
It is against this socio-economically weighted background that the nascent
market of ALT is in its ascendency.
1.1
Top Level Definitions
Assisted Living Technologies has no specific definition and has different
meanings in different geographies. For the purposes of this report it implies
the use of instruments, apparatus, appliances, or materials, including the
software necessary that helps to assist the elderly (people aged above 65),
and those who are physically and cognitively impaired in fulfilling their daily
activities towards independent lives and an improved quality of life.
It is a nascent industry so application and technology is continually being
updated and has overlap in definition and implementation. In brief the
technology areas/types that are commonly associated with ALT include:
Telehealth devices that use information, communication and sensor
technologies to monitor and assist people who have conditions. Some
examples for these devices are blood pressure monitors and dementia
roaming systems.
Telecare is the use of information and communication and sensor
technologies to provide social care and support to people to help them live
independently away from the hospitals with settings consistent with their
needs.
Smart Homes retrofitted homes with automated building controls that are
integrated to facilitate least manual effort in domestic tasks, thereby
improving comfort and lifestyle, especially for the elderly and disabled.
Mobility/Orthopaedic aids to help users to walk or move from place to place.
Basic examples include crutches, canes, walkers, wheelchairs and motorized
scooters etc., whilst specialist surgical intervention includes dealing with
problems that develop in the bones, joints, and ligaments of the human body
impacting on the quality of life of the user.
It is important to note that a diversity of devices are used in the telecare,
telehealth, smart homes and mobility/orthopaedic markets, but only the
types that are used for monitoring, communicating and facilitating everyday
tasks, i.e. catering predominantly to the elderly population are described in
this report. Hence, many devices and surgical interventions including those
used for the young and physically impaired are not detailed here.
1.2
Who is the Report for
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The report is designed to provide:
•
An introduction to some of the patient conditions which may benefit
from ALT – current and future.
•
A description of some of the technologies currently available and
those under development which form the building blocks for ALT.
•
Users of and markets for assistive technology and the drivers behind
these markets.
•
A description of how a patient will be prescribed a particular aid and
how the technology will be paid for.
Therefore the report will be useful for senior managers considering how to
understand the assistive market and also technical, medical and nursing
practitioners at the working level.
In particular:
•
Companies considering deploying their technology from an existing
market, e.g. security, into the assistive market.
•
Companies wishing to understand the spectrum of issues, i.e. medical,
social, technical and commercial, involved in developing an assistive
product.
•
Medical and community healthcare workers who want to have an over
view of current and emerging assistive technologies.
•
Technical experts who want to appreciate how technology can fit into
the patient care pathway.
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1.3
Why do we need Assistive living
Ambient assistive living technology may be employed to improve the quality
of life for patients with a wide range of conditions which act as a barrier to
quality of life. Principal barriers may be classified as primarily cognitive or
physical in nature:
•
Physical barriers: loss of physical function, e.g. lack of mobility or
failing eyesight and hearing
•
Cognitive barriers: loss of cognitive function, e.g. memory loss in
Dementia.
These conditions may also be associated with psychological conditions such
as depression. Patients may often also be lonely and experience loss of
independence and control. Reductions in cognitive and physical functions
may arise from long term life limiting illnesses such as diabetes and
respiratory diseases such as chronic obstructive disease (COPD) and asthma.
Thus the control of such diseases is also a key part of the assistive
environment. Treatments for these conditions may also impact on physical
and cognitive abilities with some drug therapies giving rise to an increased
likelihood of falls.
Hence the total care package not only needs to address physical and
cognitive aspects but also other aspects such as medical treatment,
loneliness etc., whilst respecting the needs of the patient, i.e. their wish to
feel respected and in control.
Figure 1 Conditions may be represented as a combination of physical and
cognitive impairments of different severity
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We could represent a patient’s condition in terms of severity of impairment of
the cognitive and physical components (Figure 1). As an example, locked-insyndrome is a condition in which there could be a high level of cognitive
function but an inability to speak, for example as the result of a car accident
or stroke. Tracking the movement of the eyeballs is a technology which
allows one route, albeit slow, to communicate in the case of total locked-insyndrome.
Some of the common diseases of the aging population are represented in the
figure such as, Dementia. This is characterised by the development of
multiple cognitive deficits, including impaired problem solving, impaired
organisation skills and altered memory. The most common of these is
Dementia of the Alzheimer’s Type (DAT) which may have a gradual onset and
progressive decline. As the disease progresses, people with Alzheimer’s will
need more support and will eventually need help with all their daily activities.
The symptoms of Parkinson’s disease include tremor, rigidity and slowness
of movement. In the case of Lewy Body Dementia, symptoms include frequent
falls in the early stage. Other symptoms may include Parkinson’s type
tremors. The intensity of the symptoms may also fluctuate. Assistive aids are
being developed to overcome the effects of tremor, e.g. software is available
to remove the effect of tremor whilst controlling a computer mouse.
It is possible to represent the progress of a patient’s condition as a trajectory
in cognitive and physical space. The progress of Dementia could follow a
number of possible paths – three are shown in Figure 1. Alternatively a fall
victim could suddenly find themselves with a low level of physical mobility
whilst maintaining a high level of cognitive acuity. Assistive aids such as a
Zimmer frame, wheelchairs and devices to get in and out of a bath could be
used initially and then discarded after a recovery period. If the user does not
recover, then more permanent aids such as a mobility vehicle and stairlift
might also be necessary. The patient might also benefit from technology to
alert a carer to a fall or a change in stability of movement patterns. The use
of such an aid might also alleviate the fear of a second fall.
As described in section 5, the patient will often be assisted by a Team of
carers including family and healthcare carers and social services. Key
amongst this Team would be Occupational Therapists who are skilled in the
use of assistive aids. This Team would use assistive technologies as just one
of the toolsets available to support users.
The introduction of ALT is always undertaken with sensitivity and discussion.
The rapid deployment of an assistive aid might solve one problem whilst
emphasising a loss of function thereby leading to awareness of loss of
independence with associated depression.
As a consequence of the subtleties and diversities of Assistive Living, it is
being referred to as “Independent Living” (a term that will likely gain in
popularity as it implies release rather than dependence).
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2.0 MARKET
The European countries have underlined the importance of using information
and communication technology in healthcare primarily to tackle the growing
elderly population. Though assisted living is a niche market, it still holds
significant potential to grow. Acceptance of this market is high in countries like
the United Kingdom, Germany and Scandinavia, which are expected to be the
power houses of growth for the ALT market.
The current ALT market scenario is highlighted in Figure 2. It is a nascent
market in its ascendency, but it has many hurdles to overcome. Details of
market growth projections, drivers, challenges and opportunities are described
in this section.
Figure 2 Schematic of the overall ALT market scenario (2009)
2.1 Market Growth in Europe - special focus on the UK
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The ALT market in Europe is fragmented with skewed market competition
and high growth opportunity. The market was valued at $154.7 million in 2009
and is estimated to grow to $525.7 million by 2015. This growth will be
attributable to four major markets and these are respectively Germany, UK,
France and Scandinavia (see Figure 3).
Figure 3 Pie Chart describing ALT market segmentation (2009)
Germany and UK contributed more than $94.0 million with market shares of
32.9% and 27.8% respectively, whilst France and Scandinavia made a significant
contribution of $47.6 million with market shares of 16.0% and 14.7%. This
major contribution was mainly an outcome of high adoption rate and
receptiveness for such technologies the high percentage of an elderly
population. The other geographies (Italy, Spain and Benelux) made very limited
contribution, $13.3 million and market share of 8.6%. This was due to factors
such as low penetration of ALT and a relatively low population of the elderly
against the respective national totals.
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Table 1 European ALT market segmentation and projected growth
(2007-2015)
Country
% Market
Revenue (2007-2015) 2009 2007 2008 2009 2010 2011 2012 2013 2014 2015
Germany 32.9 $24.7 $36.4 $50.9 $65.5 $81.9 $100.3 $120.4 $142.8 $171.9
UK 27.8 $20.5 $30.4 $43.0 $55.5 $69.3 $84.7 $101.6 $120.4 $141.0
France 16 $13.8 $20.4 $24.7 $31.8 $39.7 $48.5 $58.3 $69.3 $85.8
Scandinavia 14.7 $7.8 $14.5 $22.8 $31.3 $40.6 $50.9 $62.1 $74.4 $90.9
Italy 4.1 $3.8 $4.9 $6.4 $7.8 $9.3 $10.9 $12.7 $14.7 $17.4
Spain 3 $2.6 $3.5 $4.6 $5.7 $6.8 $8.1 $9.4 $10.9 $12.9
Benelux 1.5 $1.5 $1.9 $2.3 $2.8 $3.3 $3.8 $4.4 $5.1 $5.8
100 $74.7 $112.0 $154.7 $200.4 $250.9 $307.2 $368.9 $437.6 $525.7
The market growth of ALT in Europe (see Table 1) mainly depends on the
adoption rate/market penetration rate of these technologies. This in turn is
influenced by factors such as receptiveness towards technology, price
affordability and product customisation. The market dynamics seem
favourable to ATL and are expected to influence a CAGR of 22.6 % between
2010 and 2015. A large number of opportunities are expected to attract new
market participants and aid in the market development. Most of the above
mentioned revenues are expected to come from countries like Germany, the
United Kingdom, France and Scandinavia, which are the big markets for
assisted living technologies in Europe.
ALT in institutions is widely prevalent due to the large number of community
centres in use. Many aged people living in community centres and social care
homes enjoy the benefits of personalised and regular care. The assisted living
technologies market in institutions was valued at $115.5 million in 2009 and is
expected to grow at an average rate of 20.2 % per annum between 2010 and
2015. The healthcare services of Germany, the United Kingdom, France and
Scandinavia are again leaders in this market (revenues in millions (market
share) respectively: $34.8 (30.1%), $35.1(30.4%), $18.2 (15.8%), $16.8 (14.5%)).
ALT in residences The assisted living technologies market is shifting its focus
towards home-based services and care. The assisted living technologies
market for residences was valued at $39.4 million in 2009. Together Germany,
UK, France and Scandinavia are again a huge market for home care assisted
living (revenues in millions (market share) respectively: $8.3 (21%), $15.8
(40%), $6.5 (16.6%), $6.0 (15.3%)). The ALT market for residences is expected
to grow at a CAGR of 28.5 % between 2009 and 2015 and reach a market size
of $177.2 million in 2015.
ALT market in the UK The United Kingdom is one of the fastest growing
markets in Europe for ALT, as the importance and advantages of these
technologies are already recognised by the Government. This has resulted in
significant improvement in the adoption rate of ALT in healthcare. The market
is expected to witness a CAGR of about 21.9 % from 2010 to 2015 and to
achieve revenues of $141.0 million in 2015. Comprehensive deployment of
pilot projects and government funding (see later) and the elder population
growth described in Box 1 below are together the reasons behind this market
growth, as the government recognises the need for such preventive care for
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Figure 4a,b,c (clock wise) describes the Medical Technology Industry sector segmentation by a)
companies and c) turnover in the UK (2009). The “stars” describe market segments closely associ
Figure 5a,b,c describing the Medical Technology Industry sector segmentation by UK regions: a
turnover (2009)
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Medical Technology (MT) sector in the UK by employees, companies and
turnover gives an indication of the place of the ALT segment in the overall MT
sector. As Invitro Diagnostics, Orthopaedic Devices, Ophthalmic Devices, ICT
+E-health, Mobility Access and Implantable Devices are all closely related to
ALT, the importance of size and scale for the ALT market segment is
demonstrable not only to the national but also the South West regional
economy.
The sector can be described by 21 industry segments (Figure 4) and 12
significant geographies (mapped by local government zones, Figure 5). In brief
an overview by employees, companies and turnover illustrates:
Employees: The total employment within the MT sector is just over 52,000,
which represents 13% of all EU medical technology employment, second to
Germany with 26%. The Top 5 segments for employment contain 41% of all
employees in the sector and these are; professional services, in-vitro
diagnostics, single use diagnostics, wound care and orthopaedic devices. The
ALT market is just after these and employs c. 3500.
The employment pattern across the UK geographies shows Yorkshire and
Humber as the largest employer within the MT sector, with 12% of the UK total.
The South West being described as the fifth, with just under 5000 employees.
Companies: There are 2,771 companies (mostly Small to Medium Enterprises,
(SMEs)) in the MT sector. The professional services and consultancy sector
contains the most companies followed by those providing products in ALT (c.
10% of all companies) and re-usable diagnostics equipment segments.
The West Midlands, followed by the East Midlands and the East of England have
the highest number of companies in the MT sector, with the South West being
7th in size. For ALT, the top five regions are in order of size: West Midlands,
Yorkshire and Humber, East Midlands, South East and the South West.
Turnover: The combined annual turnover based on the latest available
company information from these 2,771 companies is £10.6 billion (20094).
Wound care management, in-vitro diagnostics, orthopaedic devices and single
use technology are the largest by turnover, all with just over £1 billion in sales.
Between them, these four segments make up 40% of the total UK turnover.
According to these figures the ALT market is worth c. £500 million a factor of
ten greater than that described in Table 1.
Ranking the total turnover by regions shows that the South East and East of
England have high turnovers, together representing a third of the UK total. The
South West is ranked 6th, but this does not take into account the significant
turnovers from multinationals trading within the region.
2.2 Drivers
Market drivers are factors that induce the market growth in any region. These
factors could be anything, which yield a better market expansion and generate
high revenues.
Rising population of the elderly By 2015, there will be 75 million people
above 65 years of age living in Europe, putting enormous pressure on the
working and independent population. Assisted living technologies are identified
as the solution to reduce this social issue on the working population, which will
indirectly benefit the economic activities of the respective regions.
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Figure 6 Schematic of some of the market drivers for the ALT market2
The increasing elderly population is laying more emphasis on preventative
medicine and healthy living of the elderly, making the elderly population the
most important market driver for ALT in Europe. The increase in the elderly
population is likely to drive the need for customisation of product and
technology development.
Cost of providing healthcare A skewed demographic with an ever increasing
elderly population is impacting on the European Governments to invest into
affordable techniques that could provide practical solutions to the growing
population. These investments are helping bring in innovative techniques to the
elderly population that needs assistance with vital daily activities.
Low market penetration ALT has not penetrated deeply into the market and
low adoption rates are the evidence for this. Current levels of low adoption
show the untapped potential of this market making Europe the most lucrative
geography for ALT versus North America and Asia. With better marketing and a
clearer road map of what is out there and improvisations and customisation of
technology, there is an expected increase in the adoption rate.
Similarly, innovation in technology and simpler to use and common platforms
are likely to make the prices more affordable, which is expected to attract more
elderly users to adopt this technology. Current low market penetration levels,
due to the market being in the early stages of development, will offer huge
opportunities for the market participants. This growth in the market will take
place in parallel with the growth of the product development and innovation in
technology. The market participants are expected to leverage on this scarce
competition and low adoption levels to ensure a better market share in the
future.
Healthcare systems are being standardised across Europe through better
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Page 21 of 65
improvement of healthcare infrastructure
standards is driving the growth of ALT
market by rapidly increasing adoption rates among the elderly.
2.3 Challenges
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Industry challenges are issues, which influence the industry development and
business development of the industry participants. These challenges are
economic trends, end-user issues, government regulations, marketing
strategies, competitive structure, new opportunities, and market threats.
There is limited awareness about the benefits of using assisted living
technologies, as the target audience for these technologies is the elderly. There
has been no statistical evidence on the benefits of adoption of such technology,
making it a weak argument for the market users.
Increasing government participation and initial results from the pilot research
projects are likely to help the market participants in the future. Current market
conditions offer limited market or technology-specific knowledge and
information to the end users, making it unattractive for them to adapt to such
technology. Awareness levels are likely to improve in the future with improving
healthcare standards and reimbursement models.
Profit margins in the assisted living technologies markets are low, making it
unattractive for the market participants. Low adoption rates, unclear standards
and procedures and low growth rate due to the market being in the early
development stage are influencing the profitability of the technology and
product suppliers.
Figure 7 Schematic of some of the main market challenges for the ALT market2
The entire value chain will witness higher profits when the market develops into
a matured one and develops standards to ensure profitability for the suppliers.
This scenario is likely to change in the near future, with improved product
development and increasing adoption rates; the receptiveness towards such
technologies is expected to make positive projections for profits in this market.
High costs in delivering the products to the end user, supply chain management
and costs involved in innovation and customisation of products and services are
the main causes for low profitability of ALT.
Unclear reimbursement models and policies are reasons behind the low
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ALT.
This situation is likely to improve in the future, with improvement in healthcare
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2.4
Opportunities
Industry opportunities are aspects which will promote the accelerated
development of the industry and business development of the industry
participants.
Government policy and support are central to the accelerated establishment of
this new industry. And Europe has been coordinated in its approach with for
example the establishment of Ambient Assisted Living (“AAL”) - a joint
programme taken up by EU to enhance the quality of life for the elderly
through effective use of information and communication technology (ICT). The
increase in the elderly population is driving the funding for such initiative, as
it not only poses a challenge, but also provides new opportunities for social
and healthcare providers. This and national programmes of this type is giving
the boost towards investment in ALT and also helping the market to have
accelerated growth.
There are significant trends that will qualify the growth in this decade2. In brief
these are:
Market Driven Growth Increased private participation will lead to higher
competition, and the free market will drive the growth instead of governmentfunded projects.
Private funding will rapidly increase and overtake the government funds.
Diversification Strong market participants will expand into other lucrative
regions, and there will be large-scale plans under execution.
Interoperability Equipment is likely to become globally interoperable and will
use open platform software to enhance connectivity.
Reduction in Costs As an outcome of high demand, the cost of equipment is
likely to drop by 2020.
Shift in Demands There will be a vast expansion in product portfolio and the
aged population are likely to change their demands. There will be specific
suppliers for the variety of equipment.
Digital Communication The ALT market is likely to adopt c.100% digital
communication and infrastructure for effective services to the elderly.
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3.0
ASSISTIVE LIVING TECHNOLOGY
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In recent years, there have been significant advances in many aspects of the
technology base required to develop ALT. The drivers behind these major
advances have been primarily to address markets other than assistive living,
e.g. small sensors for the automotive industry, the detection of chemical and
biological entities for defence, lightweight functional materials for aerospace.
However, assistive living is now poised to exploit and to benefit from these
technologies.
The most significant of these include:
•
•
•
•
•
•
•
•
•
•
Lightweight materials with improved engineering properties relative to
traditional materials such as stainless steels, e.g. materials containing
carbon fibres and new materials containing carbon nanotubes
Smaller, cheaper and more sensitive sensors to measure a wide range
of physical parameters. For example, accelerometers and gyroscopes
developed partly for the automotive industry which are now appearing
in products such as the Apple i-phone 4 and Nintendo Wii
Imaging technologies, i.e. cameras which detect radiation not only in
the visible part of the spectrum but also at other wavelengths, e.g. in
the infra red parts of the spectrum to image in the dark and for
temperature measurements
Sensor devices to measure chemicals, i.e. small molecules, in either air
or liquid with increasing specificity and sensitivity, e.g. at the level of
sub parts per billion. In the medical field, the most all pervasive sensor
is that to measure glucose in blood for the management of diabetes
Sensors to measure biological entities, such as bacteria which might
cause infection, on surfaces and in blood and water, and also
biomarkers which are early indicators of disease, e.g. cancers
Sophisticated electronics to condition the signals from the sensors
Mathematical techniques such as signal processing and pattern
recognition to extract the maximum amount of useful information
from a range of sensors with a minimum volume and power overhead.
Also the fusion of data from a number of sensors to extract optimal
diagnostic information
Based on the above technologies, a range of actuators – devices that
do things are also possible. These range from the opening of a window
for environmental control to an implanted pump to deliver insulin for
the control of diabetes (section 3.2)
User friendly methods of interfacing between people and technology,
e.g. smartphones, haptic displays and voice recognition (section 3.3)
Wireless communications that offer wireless connectivity within the
home in the home, e.g. to a smart hub and communications
technologies to link the home to the outside world, e.g. to a carer or
healthcare professional. These include the internet and mobile phone
technology (section 3.4)
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The combination
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offers the possibility of closed loop control, either by the user, autonomously
or under the control of a remote carer or healthcare professional (section
3.5).
3.1
Sensor technology
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A sensor is a device which provides a useful output in response to a specified
measurand. Within the assistive environment, we may think of measurands
as either physical, chemical or biological in nature:
• Physical measurands include temperature, movement, pressure and
electrical fields.
• Chemical measurands include glucose in blood, blood gases and
volatile organic compounds in body fluids such as breath, urine or
faeces.
• Biological, e.g. the identity and number of bacteria present in a wound
and bio-markers in blood for a disease, e.g. biomarkers for cancer or
for a heart attack.
Some of the measurands of interest to the assistive environment are listed
below together with some of their applications in the assistive living market.
Sensors for physical measurands. There are now many commercially
available sensors for physical measurands. Many of these are MEMSbased
(Micro-Electro-Mechanical Systems). MEMS has evolved from the technology
used to manufacture silicon integrated circuits. The use of IC technology
allows three dimensional structures to be fashioned to tolerances of a few
nanometres in silicon and also in a wide range of other materials such as
metals for electrodes. MEMS technology now offers sensors for acceleration (3
axis), rotation, pressure and sound (e.g. the microphones currently used in
smart phones). The sensors are typically of dimension c. 100 microns (the
width of a human hair) and are available in small packages combined with
signal processing electronics for a cost of c. $1. The way in which
combinations of these sensors may be used to monitor daily activities such as
movement, cooking, washing, getting out of bed, exercising and sleeping are
reviewed by Hein et al.
Table 5 A selection of the physical measurands that may be used in assisted
living
Measurand Examples of use
Temperature Environmental control for comfort in a smart home; Human body core
temperature
Acceleration Fall monitor – rapid acceleration and a ‘crash’; Movement of limbs in
assistive living or for orthotics; Control of a powered wheelchair
Pressure
Blood pressure; Pressure pads under a bed to monitor movement
Rotation, orientationStability control system for mobility scooters; Fine control in
robotic systems
Electric fields / potential Implanted measurement of ECG for pacemakers;
Measurement of EEG and ECG from outside the body.
Sound / acoustic
Microphone to detect sound as a monitor and also for speech
input of commands; Microphone for cochlear implant
Optical radiation To measure light levels to decide when to turn on lights and
close curtains; To monitor movement, e.g. by interruption of a light beam
2D and 3D images Cameras are available for daylight and night time operation
(infrared); Machine vision systems can provide significant information ranging from
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simple movement
to anofanalysis
of facial
expressions.
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Sensors to measure chemical measurands. Some of the chemical
measurands of importance in the assistive living environment are listed
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3.2
Actuators – devices that do things
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Actuators are defined here as devices that do something – usually in response
to an electrical input. Within ALT, they traditionally comprise:
•
motors to open and close windows for environmental control in a
smart home
•
electrical motors as used to drive and control wheelchairs and for stair
lifts
•
relays to switch household appliances on and off
•
in robotics, a wide range of actuators are used to give movements to
give fine control of assistive devices, e.g. for self-feeding
New materials and devices are giving rise to new actuator technologies:
•
Piezoelectric materials which move in response to the application of a
voltage offer compact actuators, e.g. for haptic feedback and for vibroacoustic interfaces with the user. Early piezoelectric devices were
mostly made from rigid ceramic materials.
•
Electro-active polymers are flexible materials which change shape or
size in response to a voltage, e.g. polyvinylidene fluoride (PVDF). Such
materials are being developed to address the challenge of producing
artificial muscle type devices for assistive applications.
•
Micro-technology, e.g. based on MEMS, is spawning a range of microactuators such as pumps and valves. These are finding applications in
drug delivery systems, e.g. for insulin and complete miniaturised lab
on a chip systems (LOCs) for point of care diagnostics7.
•
LOCs offer the potential for complete micro-analysis systems to take in
a small sample and analyse it for a variety of analytes, such as biomarkers for a disease or infection.
Combining actuators with sensors offers a further level of sophistication in
actuator functions. Examples include:
•
Collision avoidance control for wheelchairs.
•
Measurement of acceleration and rotation of a wheelchair allows
control of actuators to stabilise any undesired movement. This
technology is also widely used in the automotive industry.
•
Measurement of bite pressure on a spoon for a feeding robot.
Electrical inputs to the human nervous system can also result in actuation of
muscles, e.g. for functional electrical stimulation (FES). In this way, the body’s
own actuators can be used, e.g. where neural pathways have been lost due to
a stroke or accident which caused a spinal cord injury. As examples, FES is
used to treat foot drop in neuro-prosthetic devices and also to restore
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function.
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3.3 System Integration: Man Machine Interface
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The user will need to interact with the assistive system to:
•
Input information and instructions
•
Receive feedback, instruction and social interaction.
The communications interfaces will need to be designed to match the cognitive
and physical skills of the individual user and the complexity and type of
information that is to be transferred.
Methods of input which are available and under development include:
•
Speech input: a microphone combined with signal conditioning and
speech recognition software is needed. This could either be for free
speech or for a defined set of instructions. The microphones could be
incorporated into sensor motes placed around the house or worn by the
patient
•
Non speech input, i.e. pre-defined sounds could also be used.
•
Gestures and movements – these could be recognised via camera
systems or by movement sensors, e.g. by a worn accelerometer.
•
For computer systems, input could be via a keyboard, mouse or touch
screen.
•
Handwriting recognition.
•
Tactile sensors which mirror the behaviour of the receptors within the
human hand
•
Haptic technology which gives feedback to the user. The touch of the
user is measured using e.g. pressure sensors. Feedback is then given via
actuators based on, for example, piezoelectric materials.
Some of the output methods include:
•
Visual displays on a screen
•
Acoustic outputs – these are preferred by many patients. These could be
either speech or non-speech.
•
Tactile – e.g. vibration of the skin to alert the patient to a forthcoming
event or as a reminder.
•
Light – patterns, intensity or hue are used to represent different results
or events. For example a reminder to take a medicine or that it is time to
eat or have a drink.
Video input and output can provide a very important level of social interaction
to alleviate a feeling of isolation and loneliness. Visual communications can
also be effective in a noisy environment. Boll et al describe the use of a range
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communicate
a reminder
to thewww.biosensingtech.co.uk
patient, e.g. to prepare a meal or
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to take a medicine. The techniques
include vibro-tactile devices, sound –
both speech and non-speech, and lighting effects.
3.4 Wireless Sensor Networks
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Advances in wireless communications combined with low power sensors have
in recent years led to the emergence of truly wireless networks of sensors. As
an example, Vergados discusses many of the issues in implementing such a
system in an assistive environment in the ‘INHOME’ project. The integration of
both sensors for health monitoring and sensors and actuators for the control of
appliances such as washing machines is discussed. A recent review by Bal et al
provides details and references to a number of projects developing smart home
technologies are A variety of communication hierarchies are also discussed.
Home sensor networks. Wireless technology allows sensors to be placed
anywhere in the home, including on moving objects such as exercise systems
based on Ninetodo’s Wii devices, and also to be worn by the patient as they
move around the home. A body area sensor network is also shown on the
patient which collects, processes and transmits data from wearable and
implanted sensors.
Figure 9 Schematic of a wireless sensor and actuator network in the home
The output from these sensors is routed wirelessly to a base station which in
turn may be connected to a PC which is then the gateway for onward
transmission outside the home, e.g. via the internet or via a wireless
communications technology. The information from the sensors may be
displayed in a form which is useful to the user via an appropriate graphical user
interface (GUI).
Actuators may also be present in the system and be wirelessly linked to the
base station. The actuators will be able to carry out operations as instructed via
a wireless link under the control of the PC.
The information may also be transmitted outside the home for consideration by
a healthcare professional, a carer or relative or via a monitoring service. This
may result in a decision to carry out a task via remote use of an actuator in the
home.
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www.biosensingtech.co.uk
Figure 9 depicts
a home
network Technology
and shows
three distinct types of sensors:
Page 37 of 65
• Sensor motes which are now available to measure a variety of physical
parameters.
3.5 Closed loop control systems
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The wide range of sensors, actuators and communications technologies can be
used in combination to provide a hierarchy of control loops of increasing levels
of intervention and sophistication as shown in the flow chart in figure 11.
Measurement only. The only component is a sensor(s) which takes the
measurement(s). The sensor could be under the control of the patient, e.g. a
blood glucose sensor, or be autonomous, e.g. a wireless mote. The output
from the sensor might be displayed for the patient to see or could be recorded
within the home for later analysis. The data could also be sent outside the
home for storage on the patient’s record or for assessment by a healthcare
professional or carer.
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Figure 11 Hierarchy
methodologies
within an assistive environment.
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3.6 The Design Process – Inclusive Design
Briefly two distinct approaches to producing assistive devices include:
•
The bespoke design of assistive devices for patients with particular
cognitive and physical impairments.
•
The inclusive design of mainstream products which are accessible to as
many users as possible.
Bespoke design. Important aspects to consider in the bespoke development of
assistive products include:
•
Involving the patients and users through the design, development and
trial process. The challenge to be addressed needs to be clearly defined
in conjunction with users at the outset. Information on this process can
be found on the Helen Hamblyn Centre for Design, Royal College of Art
website. Some products designed in this way are also described on the
Bath Institute of Medical Engineering (BIME) website.
•
Making assistive products attractive, so that the user is not immediately
labelled as disabled. Sometimes they can become fashion items in their
own right. As an example, the Novo Nordisk Novopensfor insulin
delivery come in a variety of attractive designs which are matched to a
spectrum of users.
Inclusive design. The British Standards Institute (2005) defines inclusive
design as "The design of mainstream products and/or services that are
accessible to, and usable by, as many people as reasonably possible ... without
the need for special adaptation or specialised design."
The inclusive design process thus involves understanding user diversity
variation in terms capabilities, i.e. physical and cognitive, and their needs.
Inclusive design will aim to understand and address as many of these aspects
as possible. The end product should be functional, usable and aesthetically
pleasing and also commercially viable. In this way mainstream products will
then become available which address some of the needs of an assistive living
environment. An inclusive design tool is available at reference to assist in
understanding this process.
3.7 Assistive Robotic Devices
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Robotic devices are being used increasingly to assist patients with impairments
across a significant part of physical / cognitive spectrum. Robots can in
particular provide:
•
•
Assistance with physical tasks – providing assistance particularly across
a wide spectrum of physical impairments.
A degree of social interaction.
Physically assistive robot. Assistive robotic arms (ARMs) are being developed
by many companies with six degrees of freedom with end grippers, for
example Exact Dynamics. ARMs can be mounted to the side of a wheelchair for
general manipulation. Control can be affected by an eye, mouse, shoulder
movements and an electromyography system, i.e. electrical signals produced
by skeletal muscles. Such devices can help with daily tasks such as washing,
cleaning teeth and feeding.
There are a number of feeding systems which can increase a patient’s
autonomy and can offer fine control to people with high tetraplegia, see for
example ‘My Spoon’.
Sophisticated wheelchairs are now available which respond to a variety of
controls including the use of a joystick, voice recognition and eyeball
movements (in development). On board sensors reduce the chance of
collisions. Wheelchairs are also available that can climb stairs.
Cameras on a robot can also be very useful – for monitoring exact details of
the patient interaction. It will be very important to be able to turn off the
camera for privacy reasons.
Social interaction. Robots can provide a level of interaction with feedback. For
example, AIST in Japan have developed a therapeutic seal which has tactile,
position, optical and acoustic sensors. It responds to being stroked and to
speech and sounds from the patient. It was shown to improve brain activity in
some patients with dementia.
Robots can provide personalised cognitive assistance and companionship, e.g.
to people with various forms of dementia. They can play games that stimulate
the mind and also suggest activities, e.g. physical exercise or that a meal or
drink should be taken.
3.8 Emerging Technologies
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Many emerging technologies have been described in the preceding sections. It
is, however, interesting to list here just a few of the most significant and
potentially disruptive new technologies and approaches from each section.
• Micro-sensors, e.g. MEMS, which can be widely deployed around the
home.
• Implanted or non-invasive sensors for glucose blood measurements and
interventions (See Figure 13)
• Small devices to measure biomarkers in the patient’s own home for early
disease diagnosis.
• Direct interfacing of sensors and transducers with the central nervous
system for both sensing and feedback applications
• Low powered wireless technology to link sensors and actuators
distributed around the home and also worn by the patient to a remote
site.
• Closed control loops allowing remote control of actuators based on
useful information from a range of sensors.
• A design methodology that puts the patient at the heart of the design
process.
• Robots to help with a wide range of daily tasks whilst maintaining
dignity.
• An integrated suite of technologies which can provide some level of
social interaction to address some of the issues of loneliness.
It is essential that all of these and other advances are viewed within a
sympathetic environment which puts the best interests of the patient at the
centre.
No section on disruptive technologies would be complete without a mention
smart phone and computer tablet technology (See Figure 13). As an example,
one group have used smart phones as an interface between wearable health
sensors in a smart garment and a health professional’s website. One author
reports that there are already in excess of 7,000 cases of smart phone medical
apps.
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3.9 Ethical Issues
The deployment of assistive technology should always be in the best interests
of the patient. It is not always straightforward to discern the best interests of
the patient, especially when they are not able to express an opinion through
either a cognitive or physical impairment. It is essential that a holistic approach
is taken to assessing the appropriateness of an assistive technology. Issues
that might affect the patient include:
•
The use of assistive technology, whilst helping with a physical or
cognitive challenge, might also lead to a feeling of inadequacy and
heighten the feeling of loss of a particular capability. There may be a
feeling that being seen with an aid, e.g. a stick or frame may cause
viewers to label the patient as old or inadequate. Such feelings might in
turn contribute to psychological conditions such as depression.
•
The patient should be involved in the decision process as much as
possible and their views should be paramount. They will want to feel in
control.
•
The technology may represent an invasion of privacy, e.g. the use of
cameras. The user will probably want to turn the sensors off and also
not to be monitored during some activities or in some rooms of the
house.
One of the issues is who makes the decision when the patient is not able to do
so themselves:
•
The Mental Capacity Act provides a framework to empower and protect
people who may lack capacity to make some decisions for themselves.
The Mental Capacity Act makes clear who can take decisions in which
situations, and how they should go about this. Anyone who works with
or cares for an adult who lacks capacity must comply with the MCA when
making decisions or acting for that person. Issues such as Deprivation of
Liberty may also need to be considered where appropriate.
•
Relatives and friends should also act in the best interests of the patient.
Security and access to any data that is generated should also be considered:
•
Patients and their carers should be informed what data is being
collected, how it will be stored and who will have access to it.
•
An appropriate level of encryption will be required for wireless and other
methods of data transmission.
3.1 Regulatory considerations
0
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Regulatory reforms. Regulations pertinent to ALT are undergoing significant
changes to make these comprehensive and effective to the end users.
Currently, the ALT market is mostly governed by regulations that were laid
down for the use of IT and communication in healthcare. These policies tend
to become obsolete for ALT as the market progresses into growth stage.
Regulatory assessment and amendments are currently in early stages of
development as the market growth is nascent. The main issues are that there is
a lack of clarity in policies and reimbursement models within organisations
such as the NHS. Notably, a robust combination of regulations is soon
expected to govern ALT market in Europe. There is also a sense of uniformity
that is likely to set in the region for assisted living techniques. Lack of
uniformity is likely to be removed by the developments such as joint
programmes being developed through EU programmes such as Ambient
Assisted Living (AAL) and national programmes such as DALLAS. This will
induce uniformity in the regulatory set up as well.
Devices in general may have four steps to consider before market entry:
MHRA approval: The Medicines and Healthcare products Regulatory Agency
(MHRA) regulates a wide range of materials from medicines and medical
devices to blood and therapeutic products/services that are derived from tissue
engineering. Assistive devices may be classed as medical devices in which case
the Medical Devices Directive (93/42/EEC (MDD)) will apply. Many of the ALT
devices will probably be classed as Class I devices: non-invasive devices for
which the regulations are the least stringent. The Active Implantable Medical
Devices Directive (0/385/EEC (AIMDD)) may also apply. For point of care
diagnostics devices, the In-vitro Diagnostics Directive ( 98/79/EC (IVDD)) will
apply. Manufacturers and distributors are licensed directly by MHRA. Medical
devices are approved by private sector organisations called 'Notified bodies'.
Their approval is needed before a CE mark can be put on the device, though
the manufacture of low risk devices is simply registered with the MHRA. The
MHRA audits the performance of Notified Bodies. However:
•
•
•
•
when a product is on the market and in use, there are more similarities than
differences in the ways medicines and devices are regulated
there are similar systems for receiving reports of problems with products
and similar ways of issuing warnings if problems are confirmed after
investigation
there are also similar systems for inspection of manufacture to ensure that
companies are complying with regulations, and similar ways of enforcing
the law if that proves necessary.
Further information on how we regulate medicines and medical devices is
available.
CE approval: Conformité Européenne, CE marking is a key indicator of a
product’s compliance with EU legislation and enables the free movement of
products within the European market. By affixing the CE marking on a product,
a manufacturer is declaring, on his sole responsibility, conformity with all of
the legal requirements to achieve CE marking and therefore ensuring validity
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for that product
to be of
sold
throughout
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Economic Area (EEA, the
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Iceland, Norway,
Liechtenstein), as well as Turkey. This also applies to products made in third
countries which are sold in the EEA and Turkey.
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4.0
FUNDING SOURCES FOR ALT DEVELOPMENT
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Opportunities range from small-scale single company projects through to
large-scale multi-year multiple partner collaborative projects.
A particularly useful source of information is the report from the Department
of Health: Research and development work relating to assistive technology
2010-2011. This provides a complete list of AT research and development
activities, together with a list of funding agencies and perspective
programmes. Foremost amongst these are:
•
•
•
•
EU Funding, e.g. via the Framework Programme
UK Government funding Department of Health (DoH):
o NHS funding via the National Institute for Health Research.
Department of Business Innovation and Skills (BIS):
o The Technology Strategy Board
o The Research Councils, in particular the EPSRC (Engineering and
Physical Sciences Research Council) and the ESRC (Economic and
Social Research Council); collaborative initiatives such as the
MRC’s LLHW (Life Long Health and Well Being) programme and
NDA (New Dynamics of Ageing Programme)
There is also a comprehensive list of organisations which fund assistive
technology on the FAST website. Calls currently open for funding are listed
elsewhere . Advice on assistive device development can also be obtained via
Devices for Dignity which provides awareness of the NHS, access to clinicians,
advice on regulatory issues and advice on applying for grants.
European Union Framework Programme Funding.
Information on EU calls can be found via the Cordis website. A good source
of information is the UK National Contact Points. Strategically, as mentioned
earlier there is Ambient Assisted Living (“AAL”). AAL is initially set up from
2008 to 2013. The programme´s planned total budget is €700 million, of
which c. 50% is public funding - from the AAL Partner States and the
European Commission - and c. 50% is private funding from participating
private organisations (e.g. enterprises).
For updates on these and further funding opportunities contact the
biomedical and microelectronics iNets who can direct you to stakeholders
supporting these programmes.
UK Government (DoH and BIS)
National Institute for Health Research (NIHR) ‘commission and fund NHS,
social care and public health research that is essential for delivering our
responsibilities in public, health and personal social services’. The routes to
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funding are
described on the NIHR website.
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For example the i4i Programme is an NIHR research programme that provides
investment in, and improved identification of, promising healthcare
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HOW ARE PRODUCTS CHOSEN, SPECIFIED AND PAID FOR
5.0
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The goal of this section is
•
To describe how a particular set of assistive aids is suggested for a
particular patient.
•
How the purchase and maintenance of the technology would be paid for
Figure 14 describes some assistive aids which can be used to address
challenges which arise during the progress of a disease resulting in the
progressive loss of physical and cognitive abilities.
Figure 14 Assistive aids to address the cognitive / physical spectrum.
The devices shown in the figure include:
•
•
•
•
•
•
Memory aids to remind the patient to undertake a particular task such as
to take a medicine - for patients with mild cognitive impairment.
Following sensors, e.g. pressure pads to track a patient with a higher
level of cognitive impairment.
Sensors to detect if the patient has had a fall.
Eye tracking devices for a patient with total locked in syndrome.
Assistive robots to help with tasks and with social interaction.
Electronic controllers which allow a patient with high cognitive acuity but
considerable physical impairment to operate television, telephone and
environmental controls such as windows, heating and curtains.
In addition to addressing cognitive and physical needs, technology is now
available and under development for the management of a range of medical
conditions in the patient’s own home.
These include:
•
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Cardiac
measurement
of blood
pressure and heart rate;
Theconditions:
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coagulation monitors for self-management
of anti-coagulation therapy,
biomarker measurement to warn of myocardial infarction, wearable
wireless ECG – in development,
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6.0
STRATEGIC COMPANIES
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Top five companies: The ALT market maybe nascent, but a number of well
established and new electronic precision engineering companies have been
able to develop products on engineering know how. These are described in
brief here (The Table overleaf lists more of the leading industry players).
A&D Medical / LifeSource manufacturers blood pressure monitors and other
home health care products for home and professional use. Models include
automatic, manual, ambulatory, kiosk style and accessories including
stethoscopes. The company has established itself as a leader in home health
monitoring technology through the development and introduction of a variety
of unique products. A&D’s LifeSource blood pressure monitor line has
garnered numerous industry awards. Recent product introductions include: the
LifeSource digital thermometers, personal scales, stethoscopes, and
Ambulatory Blood Pressure Monitors. A&D built its reputation by
manufacturing innovative and accurate measurement tools for business,
industry, education and health care.
Tunstall is a leading provider of telecare/telehealth solutions. Operating in
more than 30 countries and employing over 1,200 people, Tunstall supports
2.5 million people around the world. Tunstall's business philosophy is to
provide healthcare technology and services that enable anyone requiring
support and reassurance, such as older people or those with long term needs,
to lead an independent life with dignity and reassurance.
OBS Medical is a medical device company which supplies patient monitoring
and mobile-based software solutions to hospital wards, primary care practices,
and pharmaceutical companies running clinical trials. Originally a spin-out
from Oxford University, Oxford BioSignals Ltd, it developed a range of
monitoring algorithms across a variety of applications. In 2009, the industrial
arm of the business that arose from the broader implementation of the
technology was sold to Rolls Royce. In the same year, the company merged
with t+ Medical Ltd and to strengthen the technical capabilities and focus on
the development and expansion of their medical device products and services.
As a result of the merger, the company was renamed OBS Medical Ltd.
Tynetec has over 30 years’ experience in the design and manufacture of
Warden Call Systems, Telecare & Telehealth Solutions, Access Control Systems
and Wireless Nurse Call Products. Products and R&D design come from Blyth,
Northumberland. The company supplies equipment to hundreds of Local
Authorities and Housing Associations and now with the recent acquisition of
AidCall (Healthcare Division), the organisation is expanding its operation
through the sales of Wireless Nurse Call Systems into the Hospital and Care
Home Markets.
For the last 40 years of its 63-year history, Tanita's core business has been the
manufacturing of precision scales. Today, Tanita is looking beyond scales to
products that enable consumers to monitor their own health. Based on medical
evidence linking excess body fat to heart disease, diabetes and certain cancers,
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Tanita introduced
the world's first integrated body composition analyzer/scale
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to the professional markets in 1992.
Page 53Tanita
of 65 developed the world's first scale
plus body fat monitor for home use in 1994. Backed by extensive clinical
research and an independent medical advisory board, Tanita's accuracy,
Table 8 Some of the leading companies in ALT
Company Name Web Site
A&D Medical / LifeSource http://www.lifesourceonline.com
Tunstall Healthcare http://www.tunstallhealthcare.com
OBS Medical Ltdhttp://www.obsmedical.com
Tynetec http://www.tynetec.co.uk
Tanita http://www.tanita.com/en
CareTech AB
http://www.caretech.se
Robert Bosch Healthcare
www.bosch-telehealth.com
Chubb Community Care www.chubbcommunitycare.co.uk
Possum Ltd http://www.possum.co.uk/
Telbios http://www.telbios.it/en
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7.0 ROAD MAP
Regional Road map. It is only when you understand the sheer scale of the
problem that you start to see the need for ALT and the challenges involved in
implementation. The Health Innovation Education Cluster for the South West
(HIEC-SW) was asked to look at how to deliver self care and self management
at scale. It is estimated that up to 2 million people in the SW are living with a
long term condition.
They are not the only ones who can benefit from assistive technology; family
and informal carers also play a key role. There are perhaps 70,000 NHS staff
involved in providing care not to mention people involved in social care and
housing. In short this is a society and community issue affecting all of us.
Projects and services dealing with only a few hundred people, involving only a
few professional staff will never lead to a fundamental improvement in care.
The problem though is that most services are provided by relatively small
organisations and many of the good ideas and new services are emerging from
start ups and SME’s. There is not enough in the market place for consumers to
‘get it’ and get on with it. What we need is an environment where these
problems can be tackled.
The Technology Strategy Board (TSB) initiated a competition called Delivering
Assisted Living Lifestyles at Scale “DALLAS” (see BOX) as the culmination of a
£23 million, 5 year research and development programme to address these
issues. HIEC-SW entered the competition and has formed a team called
Community Solutions to create the environment where SME’s and statutory
and voluntary organisations can work together with citizens to create these
new services. We will know in May whether our efforts have been successful.
What is clear is that to be effective assistive technology needs to be considered
as part of overall service design. It needs to be conceived as a consumer
driven service that enables people to have choice, to feel connected and in
control of their life and to play a full role in their community. This means
thinking about the customer experience and business model at the same time
as the product and service offering. Many people have complex needs and
therefore want a coordinated and coherent approach and that is what we are
trying to engineer.
The role of the Government (through programmes such as DALLAS) and local
networks such as Biomedical and Microelectronic iNets and a new Medilink SW
will enable and support the accelerated growth of the application of ALT. From
a Community Solutions perspective HIEC –SW is committed to playing a part in
making ALT provision a scalable reality.
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Industry overview see Figure 16
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The ALT market place is a nascent market with high growth potential (CAGR
22.6%) and an estimated current value of about $310 million (2012). It is a
market where the patient or user needs alongside provider focus on medical
economy are driving growth.
Assistive Living may be more popularly called Independent Living and this
focus on quality and customer driven need will shape regulatory policy and
device uptake and establishment. One of the greatest barriers to growth will be
reimbursement models for market entry. The best opportunities for new
devices will be where they are not stand alone but are easily connected to
developed and standardised platforms.
It is more likely that standard platforms with a suite of applications will be
adopted either in service provider institutes or within the personal user space
(home or at work). This interoperability or “platform” approach will be central
to accelerated growth. Government focused funding and support has already
reviewed this issue and started to support activity that will help manage this
gap in the market. Regulatory provision and standards will work to make this
more important.
There is already a strong ALT product pipeline and continued R&D activity in
established high growth companies (most of which are of SME status) and
research establishments. Importantly the ease of use of ALT products and their
ability to be accessed, i.e. through new standardised platforms will be
important to development.
In the South West of England HIEC –SW and the “Community Solutions”
approach will help form a framework for engagement with support from TSB
and NHIR coordinated funding. Partnering through the iNets will allow access
to transitional research and innovation in the local geography and supported
by a new Medilink SW will be able to encourage local industry to collaborate.
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Figure 16 Schematic of Assistive Living Technology Industry Overview
8.0 RECOMMENDATIONS & CONCLUSIONS
There are many technologies emerging and under development to address
some of the many cognitive and physical challenges faced by patients who are
wanting to lead an independent life in their own homes. These technologies
will increasingly form part of a personalised care package to address the
complete spectrum of their needs.
When developing ALT products, it is important to appreciate that these must fit
into an integrated care package rather than regarding them as stand-alone
devices.
Recommendations. What is required to help current and emerging ALT
flourish is:
• Innovative business models to capitalize on business opportunities
• Development of a concrete market for assisted living services to
increase uptake
• Refrain from complexity for the benefit of the users
• It is important to show the cost benefits of ALT technologies to move
pilot programs to the mainstream – this will accelerate the transition
from pilots to commercially viability and help to attract large scale
investment. This is a gap being filled by TSB driven initiatives
• Service providers are continually trying to offer differentiated services
for the end users; technology solutions are fragmented and diverse,
these will need to become more integrated at the location of care and fit
for purpose. Interoperable platforms or better integrated platforms are
fundamental to successful uptake.
Conclusions. The ALT market is in its development phase and is likely to grow
rapidly (CGAR 22.6%). This growth will be attributed to factors that are
captured and well documented in this report (see summary in Figure 16).
Figure 17 below summarises the opportunity and challenges to overcome.
Figure 17 Overview of ALT market opportunity and trends2
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9.0 APPENDICES
9.1 References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
Here we define patients as the person with the condition and carers as anyone who is supporting the patient.
Carers include family and friends and healthcare professionals.
European markets for Assistive Living Technologies, Frost and Sullivan 2010.
Older people in the United Kingdom - Key facts and statistics, Age Concern’s Policy Unit, 2008.
Strength and Opportunity: The landscape of the medical technology, medical biotechnology and industrial
biotechnology enterprises in the UK, Her Majesty’s Government, 2009.
Eucomed Medical Technology Brief, May 2007
Fundamentals of microfabrication and nanotechnology , Marc J Madou (2011).
A Hein et al, Monitoring systems for the support of home care, Informatics for Health and Social Care, Vol 35, p
157 – 176 (2010).
http://pubs.rsc.org/en/journals/journalissues/lc
S Boll Development of a multimodal reminder system for older persons in their residential home, Informatics
for Health and Social Care, Vol 35, p 104 – 124 (2010).
C F Garcia-Hernandez et al, Wireless sensor networks and applications: a survey, Int. J. Comp Sci and Net Sci,
vol 7, p264 - 273 (2007).
D Vegados Service personalisation for assistive living in a mobile ambient healthcare-networked environment,
PersUbiquitComputVol 14, p 575-590 (2010).
M Bal et al Collaborative smart home technologies for senior independent living: a review, Proc of the 2011
15th international conference on computer supported cooperative work in design, p 481-488 (2011).
MEMSIC offer a range of MEMS sensors packaged into mote format (http://www.memsic.com/products/
wireless-sensor-networks.html - accessed 9 March 2012).
Medical applications of wireless body area networks, P. Khan et al, International Journal of Digital Content
Technology and its applications, Vol 3, p 181 – 193 (2009).
http://www.glysens.com/products/products.htm
http://designingwithpeople.rca.ac.uk/
http://www.bath.ac.uk/bime/
http://www.novonordisk.com/diabetes_care/insulin_pens_and_needles/novopen_4/default.asp
is www.inclusivedesigntoolkit.com – a number of inclusive designs are also described at this site. (accessed
March 14 2012).
S W Brose et al, The role of assistive robotics in the lives of people with disability, American Journal of Physical
Medicine and Rehabilitation, p 509 – 521 (2010)
http://www.exactdynamics.nl/site/
http://www.secom.co.jp/english/myspoon/ (accessed 14 March 2012).
www.parorobots.com
M Boulos et al, How smart phones are changing the face of mobile and participatory healthcare: an overview,
with example from e-CAALYX, Biomedical Engineering Online, 10:24 (2011).
Kailas A, From personal phones to personal wellness dashboards, IEEE Pulse vol. 1, 57-63 (2010)
http://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-act
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080718
http://www.mhra.gov.uk/Howweregulate/Devices/Registrationofmedicaldevices/index.htm
http://ec.europa.eu/enterprise/policies/single-marketgoods/cemarking/downloads/
further_information_en.pdf
http://www.bsigroup.com/en/Assessment-and-certification-services/
http://www.bsigroup.com/en/ProductServices/Medical/CE-marking-for-medical-devices/
http://www.fda.gov/medicaldevices/deviceregulationandguidance/howtomarketyourdevice/
premarketsubmissions/premarketnotification510k/default.htm
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127996.pdf
http://www.nihr.ac.uk/proposals/Lists/NIHR%20Calls%20for%20Proposals/Current%20Calls.aspx
http://www.innovateuk.org/competitions/competitionsearch/search.ashx
http://www.epsrc.ac.uk/funding/Pages/default.aspx
http://www.esrc.ac.uk/news-and-events/news/15706/funding-opportunities-for-201112.aspx
http://www.mrc.ac.uk/Ourresearch/ResearchInitiatives/LLHW/index.htm
http://www.newdynamics.group.shef.ac.uk/
http://www.fastuk.org/atcommunity/rdfunders.php
http://www.fastuk.org/research/fundingopportunities.php
http://www.devicesfordignity.org.uk/
https://connect.innovateuk.org/web/assisted-living-innovation-platform-alip
http://www.innovateuk.org/deliveringinnovation/collaborativeresearchanddevelopment.ashx
http://www.rcuk.ac.uk
http://www.nihr.ac.uk/research/Pages/default.aspx
http://www.ccf.nihr.ac.uk/I4I/Pages/Home.aspx
http://cordis.europa.eu/home_en.html
http://www.innovateuk.org/deliveringinnovation/internationalprogramme.ashx
http://www.aal-europe.eu
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
http://www.dh.gov.uk/health/category/policy-areas/nhs/personal-budgets/
Sasha Karakusevic, Director of Health Innovation Education Cluster SW (HIEC SW) www.hiecsw.org.uk
Life Sciences Healthcare Ltd www.lifesciences-healthcare.com
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9.2 Acknowledgments
The Authors would like to thank the following colleagues and contacts who
have been supportive in compiling this report and generating stimulating
discussions around the topic (listed in alphabetical order):
•
•
•
•
•
Dr. Praminda Caleb-Solly, UWE (assistive robots)
Mrs. Christine Fear, UWE (maintaining the health and well-being of older
people)
Dr. Sasha Karakusevic, Director of Health Innovation Education Cluster
SW
Dr. Mokhtar Nibouche, UWE (wireless networks)
Mrs. Sharon Webb (Occupational Therapist)
END
March 21st 2012
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