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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 10, NO. 1, JANUARY 2006

A Model for the Measurement of Patient Activity

in a Hospital Suite
Gael LeBellego, Norbert Noury, Member, IEEE, Gilles Virone, Mireille Mousseau, and Jacques Demongeot

AbstractAt the time of hospitalization, it is essential to evaluate the general health status of a patient and to follow up the
trends during therapy. Our work is focused on a set of tools for the
measurement of patient activity. In this paper, we propose a few
indicators of the patient activities of daily living, such as mobility,
agitation, repartitions of stays, and displacements. As a result of
this work, a diagnostic system was developed that could lead to a
deeper knowledge of human activity rhythms in normal situations.
Index TermsHospitalization, rhythms of activity, smart homes,
telehomecare.

I. INTRODUCTION
T IS WELL accepted that human activity follows a period of 24
h, directed by the common requirements of daily living (sleep
time, meals, etc.). Moreover, body temperature, weight, muscular strength and all biological functions follow such rhythms [1]
to ensure the global homeostasis of human metabolism. Therefore, the essential information revealed by these rhythms cannot
be ignored at the time of the diagnosis.
Currently, a set of manual scales is used to evaluate the health
status of the patients. The World Health Organization (WHO)
performance scale [2] and the Karnofsky scale [3], for example,
focus on patients ambulatory abilities and mental health. More
commonly, such scales intend to evaluate some or all Katzs
activities of daily living (ADL) [4] (e.g., dressing, eating, ambulating, transferring, hygiene). These evaluations, although performed by the clinical staff, depend on human subjectivity and
cannot be easily periodically updated. Therefore, the automatic
filling of such scales would be a real benefit for clinical evaluation. Moreover, it can benefit to home telecare for automatic
evaluation of the status of patients or elderly at home.
Most of the current works about telecare [5][8] are based
on sensor networks for a specific pathology or hazard (e.g.,
diabetes, high risks pregnancy, falls). The sensors become local
intelligent units operating on real time-critical situations [8], [9].
More recent works focus on the detections of slow changes in the
behavior (i.e., they involve greater observation periods). Some
other works deal with the fusion of the outputs of different
kind of sensors, such as cardiac rhythms, movements, postures,

Manuscript received December 2, 2004; revised May 11, 2005. This work
was accomplished within the OncologHIS, a joint project between the TIMCIMAG Laboratory and the Department of Medical Oncology of the Grenoble
University Hospital.
G. LeBellego, N. Noury, G. Virone, and J. Demongeot are with the TIMCIMAG Laboratory, UniversiteJoseph Fourier, Grenoble 38706, France (e-mail:
Gael.Le-Bellego@imag.fr; Norbert.Noury@imag.fr; Gilles.Virone@imag.fr;
Jacques.Demongeot@imag.fr).
M. Mousseau is with the Department of Medical Oncology, UniversiteJoseph
Fourier, Grenoble 38000, France (e-mail: mmousseau@chu-grenoble.fr).
Digital Object Identifier 10.1109/TITB.2005.856855

and agitation [9]. Another more recent work [10] proposes a

way to fit a model with the patient comportment through a data
discrimination process. Our current project [11] is centered on
the single analysis of displacements in a smart home [6], [8],
whereby patients displacements are monitored through a set of
basic sensors. The collected data are further analyzed for long
periods (e.g., weeks, months). Later, it may be completed by
data from wearable acetimeters [12].
The first telemonitoring smart home to measure mobility was
presented by Celler in 1994 [13]. This system recorded the
movements between each room using magnetic switches placed
on doors. It also identified the specific area of the room in which
the subject was present using infrared sensors (PIRs). Last, it
detected the type of activity using generic sound sensors.
Cameron et al. [14] designed a smart home that measured
mobility and gait speed along with other parameters to determine
the risk of falling in elderly patients. PIR sensors were also used
in this system to quantify motion within each room.
Chan [15] developed a system, also based on PIR and
magnetic switches, that not only detected a subjects absence/presence in a particular room, but also measured his or
her mobility in kilometers. An artificial neural network (ANN)
monitored the subjects mobility data for deviations from his
or her usual pattern. This system was based on the assumptions that the monitored subject lived alone and had repetitive
and identifiable habits. This system was tested for both shortterm (16 subjects monitored for an average of four nights) and
long-term durations (one subject monitored for 13 consecutive
nights), and good agreement was found between the system and
observations made by the nursing staff.
In this study, we propose more criteria to estimate the activity
status of a patient from presence detectors. We aim to design
a monitoring system for the natural environment of the patient
(i.e., at home), so the experimental set-up is based on commercially available PIR detectors, wireless communication, ease of
installation, and cost effectiveness, and we put effort into the
data analysis tools.
In this paper, we first present the tools used to monitor the
activity and the way in which we build our criteria. We then
discuss the results obtained on first experimental data. We finally
propose some further ameliorations and modifications to our
system.
II. MATERIALS AND METHODS
Our concept of health smart home, called Habitat Intelligent
pour la Sante (HIS), is based on a set of sensors networked in
the home to a local area network (LAN). A local PC collects
data for analysis and provides an access to a wide area network

1089-7771/$20.00 2006 IEEE

LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE

Fig. 1.

HIS and its sensor network.

93

(FSM), where the stable states are the rooms and the transitions are the sensors detections. The evolution of the FSM is
conditioned by the presence of the person; multiple detections
and abnormal cycles are detected and generate a confidence factor ([0 . . . 1]) associated with the information. The SmartCAN
finally transfers the data through a local CAN network to the
computer equipped with a LAN board (NiCAN, National Instruments, Austin, TX). There, it is analyzed with software that
performs many kinds of statistical analysis on large periods.
It can also launch some alarms according to the results of the
analysis. In the event of an emergency, an electronic message is
sent instantly.
B. Preliminary Data
Each detection is recorded with its date and time of occurrence. Information is stored in a XML-like file.
This file is loaded in the Matlab environment, where data are
stored in a preliminary matrix built with detection events (1).
Detection[Date][Hour][Sensor Number]
With
Date[Year][Month][Day]
Hour[H][M][S]
Sensor Number [1, 5].

Fig. 2. Albert Michallon Hospitals HIS (sensors and detections areas are
indicated).

(WAN). Automatic data acquisition allows the system to be as

transparent as possible to the occupant [11].
A. Tools
Our first HIS was settled inside the Faculty of Medicine,
Grenoble, France. It is used as an experimental platform (Fig. 1).
The second HIS (Fig. 2) was installed at the Department
of Oncology inside the Albert Michallon Hospital, Grenoble.
We divided the suit into five areas (including the entry), each
matching an area of interest (bedroom, entry, living room, toilets, shower). It provides us with data in true conditions from
frequent residents.
Most of the HIS sensors are working distantly from the patient
(ambient sensors): They detect movements or displacements
(door detectors, infrared sensors). Some other sensors embarked
on the patient (wearable sensors) are still under development and
will undergo further studies.
To make the telecare system as unobtrusive as possible for the
patient, the sensors must be intelligent units. Here, their intelligence is hosted in an electronic board (the SmartCAN) which
we specifically developed for this purpose. It can interface to a
CAN field bus any kind of sensor connected to its configurable
analog and digital inputs. It performs some local computing,
depending on the software uploaded into the program memory.
For instance, the SmartCAN connected to the presence sensors
(ACTICAN) runs a set of rules to filter the detections [16]: The
activity cycle of the person is seen as a finite state machine

(1)

Data are then formatted for further computations. Time is

converted into a discrete time dimension i; the best available resolution is in seconds. The date is replaced by a day
number j: the number of the day from the beginning of the observation. To apply standard digital signal processing, the data
are completed with zeros where no detections were recorded.
S(j, i) (2) describes sampled detections at regular instants.
S(j, i)
j [start day, end day]
i [1, 86400] : seconds
n [0, 5] : 1 to 5 = sensor number, 0 = no detection.
(2)
Graphic representation of S(j, i) shows discontinuities.
Therefore, we can hardly read or display it as is. Hence, we
replace each zero with a copy of the last valid detection. The
final S (j, i) signal (3) results from the application of this first
order Sample & Hold on S(j, i). We call this process rectangularization.
n = S (j, i)
j [start day, end day]
i [1, 86400] : seconds
n [0, 5] : 1 to 5 = sensor number.

(3)

The new graphic representation of the daily signal SJ (i) =

S (J, i) allows an immediate interpretation of localization,

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IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 10, NO. 1, JANUARY 2006

Fig. 3. S J (i): a rectangularized ambulatogram.

length, and behavior of daily activity and occupation. We call

this graphic representation an ambulatogram (Fig. 3).
C. Definition and Computing of Activity Criteria
We planned to evaluate the patients general health status
through the automatic processing of criteria on his or her activity.
Agitation outlines the frequency and repartition of events.
Mobility is our indicator for the patients displacements frequency and repartition. We first defined them as the mean number of daily detections [17] or daily displacements. However,
this did not carry sufficient information about the patients behavior during the day, as we could verify either on emulated
data or short time experimental data sets.
1) Profile for Agitation: We then defined a profile of agitation from the density repartition of events in the daily signal
SJ (i) = S(J, i) (for each day J). We started with an accumulation signal AJ (i) obtained from the accumulation of events
found in SJ (i) (4).


AJ (i) = 1, if SJ (i) = 0
(4)
0, if SJ (i) = 0.
To appraise patients behavior over a longer period, we then
sum up AJ (i) from day J = M to N (5).
AM N (i) =

N


AJ (i).

(5)

J =M

Eventually, we apply on signal AM N (i) a sliding observation

window Wa (i) (Bartlett, Hanning, Partzen, etc.). The window
height is unitary, and the width a is resizable (6).
a
a
t , 86400
2
2
P (i) = AM N (i) Wa (i) =

86400


AM N (k).Wa (i k) (6)

k =1

Through the profile for agitation P (i), we can easily estimate the evolution of daily agitation on different period lengths.
The instantaneous amplitude of P (i) is not interpretable, but
the relative amplitudes are significant. Actually, only profiles
computed on the same period lengths M N and with the same
window Wa can be compared (Fig. 4).
2) Definition of a Profile for Mobility: P (i) is computed in
the same way as the profile for agitation, although we accumulate the transitions between two successive different detections

Fig. 4. Example of the computation of a profile for agitation with a Hanning

window on the accumulation signal.

(hedges) found in SJ (i) = S (J, i) instead of the events.

 

 S J (i) 

1 if  i


 
AJ (i) =
 S J (i) 

0 if  i
<
With
= 0 a threshold
AM N (i) =
t

a
2

N


AJ (i)

J =M

, 86400

(7)
(8)

a
,
2

P (i) = AM N (i) Wa (i) =

86400


AM N (k).Wa (i k). (9)

k =1

3) Analysis of Occupation: The daily repartition of time

spent in each room was our first criterion. Though insufficient,
it is a good estimator of patients behavior. This new profile is
obtained nearly the same way as for the profiles of mobility and
agitation: we accumulate here the distinct occupation periods
lengths, centered on this period. This time, we have to compute
it for each room separately. We then build, from SJ (i), N J

signals BJ,n
(i) (with N the number of room and n the number

(i) describes the daily

associated with each room). Each BJ,n
occupation of each room (10).


BJ,n (i) : 1, if SJ (i) = n
0, if SJ (i) = n
with SJ (i) =

N


n BJ,n
(i).

(10)

n =1

Next, N tables are filled with the areas of each occupation

(i)(= 1) for each day. Each area is assoperiod found in BJ,n

ciated with its position (temporal center of the area). With this
table, we then build a discrete signal Occupations = J,n (i) for
each day J and room n. The signal is completed with zeros up
to 86400 samples (24 h). The occupation behavior is basically

LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE

95

represented by this raw data of the occupation. However, to

show something visually more accurate, we apply on J,n (i)
the same observation window as for mobility and agitation as in
M N ,n (i) =

N


J,n (i)

J =M

t
Pn (i)

a
2

, 86400

(11)
a
, n [1, N ]
2

= M N ,n (i) Wa (i)
=

86400


M N ,n (k) Wa (i k).

Fig. 5.
(2 h).

Mobility profile P (i) calculated with a Hanning window. a = 7200 s

(12)

k =1

Pn (i)

shows visually the patients activity at

The profile
precise periods within the day.
4) Estimation of Displacements Repartition: When studying mobility (i.e., displacements), we decided to look at their
repartitions. We now fill a matrix with the observed transitions
between rooms (i.e., edges). It includes the possibility that someone may be detected successively in the same room. This graph
obviously depends on the homes configuration. It describes the
relative frequencies of displacements among rooms. We can also
observe their daily evolution during the observation.
D. Validation for Preliminary Data
The validation process will be performed in three steps.
Simulation software was developed inside the team [18] to
provide us with simulated data of activity in the smart home.
Based on a Markovian model, it simulates pseudorandom data
for the daily activity. We will first run our algorithms on the
simulated data because in this case we know in advance the
expected results.
We will next use data obtained from the validation period
at the Grenoble Hospitals experimental home: It was obtained
under real conditions but with periods of observation that were
too short.
Eventually, we will validate the methods with data from an
observation in true conditions.

seconds) in 1 day, and the ordinates represent detections through

room number (here: 1door, 2living room, 3bedroom, 4
toilets/bathroom, 5shower). The ordinates unit is an arbitrary
unit. A few patients who were undergoing chemotherapy agreed
to be monitored after being informed about the experimentation.
They provided us with our first data taken in real conditions.
The first problem we encountered was the great computing
power needed for the calculation of our profiles within an observation window. As a consequence, we had to reduce the sliding
step p of Wa in (6), (9), and (12). This step p is now included
as a new parameter of the calculation of our profiles.
a
, p N +
2
2
P (i) = AM N (i) Wa (i)
t

a

, 86400

86400/p

AM N (p k) Wa (i p k)

(13)

k =1

P (i) = AM N (i) Wa (i)



86400/p

AM N (p k) Wa (i p k)

(14)

k =1

Pn (i) = M N ,n (i) Wa (i)



86400/p

M N ,n (p k) Wa (i p k).

(15)

k =1

III. RESULTS
We programmed our algorithms under the Matlab environment. A graphical user interface (GUI) was developed to easily
apply the matching processes to the activity data. Through this
GUI, we can automatically import data from the XML files to
S(j, i)) and display the ambulatograms SJ (i). It also provides
for some basic convenient functions, such as period selection
or the selection and/or modification of the parameters of most
of the algorithms (e.g., the width a of the window). Programming under Matlab also allows us to easily interfere with the
algorithms during their processing.
A. Evaluation of Algorithms on Preliminary Data
We worked with the results of successive detections of different sensors, each one matching a different volume (room). They
produce the ambulatograms: The abscissa represents the time (in

We commonly use a window step p = 86 (that corresponds

to 1% of a day). It is convenient for the computation and does
not introduce significant loss of precision on the resulting profiles. With different values for a in W a, daily activity can be
observed more or less precisely (granularity). A wide window,
for example, produces a global profile. A thinner one shows
smaller localized pattern in the activity (Figs. 5 and 6.).
The choice of the window may produce obviously significant
alteration of the profiles. For example, with a Gaussian or a
gate window, the extrema are difficult to localize (Fig. 7). Hanning, Hamming, triangular, or Bartlett windows allow an easier
exploitation with quite similar results. Of these different possible windows, we decided to keep the Hanning window, which
produces better results with lower side effects. This choice is
discussed later as a consequence of the clinical results of this
study.

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Fig. 6. Mobility profile P (i) calculated with a Hanning window on the same
data: a = 14 400 s (4 h).

Fig. 9. Profile for the global mobility (25 days) and overlaying of daily profiles
of the same period (a = 7200 s, 2 h).

Fig. 7. Profile for the global mobility (25 days) (a = 7200, 2 h) performed
with different windows.

Fig. 8.

Ambulatograms for the first two days (periods of absence are in gray).

B. Processing of the Data in Real Conditions

Our first data were produced in the home installed in the
Grenoble Hospital. A patient under chemotherapy provided his
consent for the monitoring during 1 mo. The 64-year-old male
patient was suffering from prostate cancer. He was aware where
the sensors were installed and how they worked.
1) Preliminary Visual Analysis: Ambulatograms provide us
with immediate information. First, we can detect when the home
is occupied (from May 21 to June 16). We can also localize the

concentration of activity (e.g., around 11 to 12 AM on Fig. 8). Absences (period between two successive detections at entrance)
are also easy to detect (grayed on Fig. 8). The analysis of the
repartition of events tells us that most of the activity happens
between bedroom (40%) and door (30%). Toilets (16%) and
living room (12%) also represent a nonnegligible part of the
detections. The analysis of time repartition confirmed that the
bedroom is the main room (70% of the day), but the entrance
area raises a surprising 20%. Eventually, the daily evolutions of
these repartitions show the global evolution of the activity and
behavior of the patient, although here we can hardly talk about
significant revelations.
2) Profiles for Mobility and Agitation: During this first
study, the ActiCAN software on the SmartCAN was running
a set of rules to remove successive identical detections. Then,
because we could not study the agitation, we focused on the
profile for mobility.
The profile for mobility were processed on long (several
days/weeks) and short periods (daily). We mainly compared
the global mobility (the whole observation) with the daily mobility. The global mobility characterizes global behavior. We
could point out regular periods of activity with significant peaks
(Fig. 5). We then compared daily activity. To confirm the regularity of the activity previously observed, we overlaid them
(Fig. 9). We finally verified that one can easily isolate short or
long periods of high or low activity within a day (Figs. 5 and 6).
3) Occupation Profile: This part aims at determining the
way the patient occupies the home space. The occupation profile
gives an estimation of the density of occupation of each room
within a typical day. The great proportion of time spent in the
bedroom in the repartition (Fig. 10) is confirmed here by the
high level of the matching occupation profile compared with
other rooms. We can also observe smaller patterns such as very
regular visits to the bathroom at 11 AM (Fig. 10).
4) Relative Frequencies of Displacements: Due to the filter
applied on successive detections, we were deprived of the possibility of studying relative frequencies of displacements to and
from the same room.

LEBELLEGO et al.: MODEL FOR THE MEASUREMENT OF PATIENT ACTIVITY IN A HOSPITAL SUITE

Fig. 10. Comparisons of occupation profiles for the different rooms

(a = 14400, 4 h).

We first observed that the activity of the patient seemed to be

almost predictable, that is, the relative frequencies of displacements from each room were quite regular (their standard deviation is 20% to 40%). It is less significant for the two smallest
rooms (bathroom and shower). However, this can be explained
by the lower amount of detections in those places compared
with the main ones.
IV. DISCUSSION
A. First Analysis of the Data
A few hypotheses have been drawn from singular observations in daily activity: A regular number of detections occur at
the entrance door during the night (on average, five or six). A
few of these are followed with bathroom detections, whereas
most seem to correspond to the regular passages of the medical
staff at night. The concentration of activity in toilets (around
11 AM) and the fact that it matches a high concentration of activity around the door, lead us to believe that the medical staff
is involved in the patients personal hygiene. (A detection in
toilets nearly always occurred during a great activity around the
main door). This provides us with important information about
the patients ability for personal hygiene.
The evolution of the events repartition shows a really significant correlation between entrance and bedroom activity
(Fig. 10). Moreover, there is a great amount of daily entrance
detections (an average of 100/day). They represent nearly 70%
of the amount of detections around the bed and 30% of all detections in the home. The hypotheses we made here is that most
of the activity in the home, especially the activity concentrated
around the bedroom, is the result of visitors. The comparison
between the amount of detections in the living room, those in
the bedroom, and the number of supposed visits (which equals
half the number of detections at the entrance), suggests that the
living room is mainly a transition room. We can then assume
that the patient mainly stayed in bed.
As a consequence for the great amount of entrance detections,
it is difficult to give a suitable interpretation for absences (periods between two successive door detections: see the grayed area

97

on Fig. 7). Absences observed on ambulatograms may match

the two following real cases: Patient really went out, and no
more activity was detected (no one entered the room), or one or
more visitor(s) entered the room and went out while the patient
was staying quiet (no detection of the patient).
In both cases, ambulatograms would show the same supposed
absences, and we cannot obviously say whether the patient really
went out. Previous observations led us to suppose that visitors
events are the main cause for those supposed absences.
Although these observations deprive us from information
about the single patients displacements behavior, they do inform us of the patients own abilities, such as the inability to
move or the inability for self-hygiene. If we were using the Organisation Modiale de la Sante (OMS) evaluation scale, which
gives a score 1 for a patient with a normal activity and a score
3 for a patient who stays in bed more than half of the day
time, our observation would give a score 3 for our patient.
This information may later inform an evaluation grid such as
the ADL [4].
B. Reflection on Proposed Criteria
The profile for mobility allows us to mainly characterize regular periods of greater or lower activity. We can focus now on the
study of common factors between regular peaks of great activity.
For example, a daily comparison study is being performed on
the data to find a recurrence factor about activity. Currently, we
are not able to perform significant results because of the noise
associated with the great amount of visitors/visits.
From a first analysis of relative frequencies, we believed our
patient, for a given room, had a globally predictable ambulatory
behavior. Despite the fact that the relative frequencies vary significantly (standard deviation is 20% to 40%), they apparently
follow a quite regular pattern of daily living. However, because
of the supposed great amount of visits, we can hardly distinguish the patient from his visitors. Moreover, we notice that the
portion of impossible displacements (successive detections in
noncontiguous rooms) is not negligible (from 1% to 41% from
a given room). We must finally consider the fact that the homes
configuration may be a significant point in those repartitions; for
example, someone who moves from bathroom to living room
must go through the bedroom first. Nonetheless, we can still say
that the activity inside the home is significantly regular. This is
probably due to the regular schedules inside the hospital and the
regularity of the external visits. However, we are still unable to
focus on the patient himself. A set of rules that filters the successive detections matching impossible displacements might
improve these analyses. Then, we would be able to separate
patient and visitor activities.
C. Comparison With the Medical Staff Observations
The study began without any additional information from the
medical staffs diary and without any nonprivate information
about the patient. This allowed us to draw our conclusions only
from our automatic data, not influenced by a priori knowledge.
This was necessary for the optimization of a future fully automatic telehomecare tool (i.e., without human intervention). The

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meetings with the medical staff were periodically programmed

to indicate whether our hypothesis was true. This also gave
us answers to some interrogations. Mainly, we verified the
hypothesis about the patients inability to move and to perform
his personal hygiene. Supposed regular activities were also
confirmed by the medical schedules. We also understood why
the living room was so little occupied. At the beginning of the
experiment, the living room was supposed to be the main room
in which the patient would stay, and for this reason, an armchair
had been placed facing the TV set. However, the patient asked
for the bed to be installed in front of the TV set so he could
stay in bed all day. This modification explains the low activity
in the living room, which turned into a transition room. This
also points out the necessity to adapt our system to the patients
comfort. This system must be transparent to the patient (i.e.,
it must not change his daily living patterns). This also points
out the need to lay out the home to fit the patients desires and
the need for accurate monitoring (i.e., making the living room
more comfortable so the patient will occupy it on his own).
Finally, the medical staff confirmed that the nocturnal entrance detections match the regular passage of the medical staff
at night. We again point out the difficulty of distinguishing the
patient from the visitor. However, visits are part of the patients
environment and may provide essential information about his
socialization ability.
The last pieces of information we received from the medical
staff completed our data about activity. Although we focus on automatic activity detection, analyzing these data may allow us to
verify some hypothesis we might develop about the patient. For
example, we could compare the OMS score we automatically
gave to the patient through our system with the one given by the
medical staff. An OMS score of 4 is quite easy to give because it
means the patient never moves from his bed. However, we also
hope to be able to rank patients ability to move according to
OMS scale: from 1 (normal) to 3 (patient stays in bed more than
half the day). These data may also collaborate in a later fusion of
multiple data for a monitored patient. The information we collected belong mainly to the medical information associated with
the patients hospitalization (e.g., cardiac rhythm, pulse, OMS
score, clinical examinations schedules). This information, for
example, explained some of the supposed absences we observed: Special medical examinations (outside the room) often
correspond to those absences. Through the comparison of real
and supposed absences, it is hoped that we are able to distinguish
between them, mainly due to wrong interpretations of visitors.

Occasionally, the homes areas may not match the hypothesis we made about their general purpose (e.g., someone may
go to the bathroom to pick up a forgotten item instead of performing personal hygiene). As a consequence, we now consider
setting specific rules to distinguish expected from unexpected
activities. This could be done using the time of day, time spent,
or the number of detections.
Actually, deeper exploitations of these criteria are not possible
as long as the occupant of the home cannot be distinguished
from visitors. To monitor one (or more) patient in a smart home,
this distinction is essential. We will thus focus on an intelligent
data acquisition process: in particular, we will develop sets of
rules [12] that will be applied to the detections in the SmartCAN
(e.g., if one detection occurs too shortly after another detection
in a noncontiguous room, it might be removed). Additional
sensors (contact and thermosensors) may also be placed on
some pieces of furniture (e.g., armchair, bed) for this purpose.
Finally, visitors could be differentiated from the patient with the
detection of the direction of passages at the door (e.g., through
a double sensor, pressure carpet, optical barrier sensor)
The analysis of incoming new data will allow a stronger validation of our tools and of the accuracy of our hypothesis. We
will also suppress the filter applied on successive identical detections to study agitation and the relative frequencies, including
the displacement to and from the same room. We will finally
review the homes configuration to fit the patients comfort and
monitoring needs. A new solution and perhaps a new structure
for our system will then be proposed.
The analysis of the patients agitation, in particular, will provide us with a new criterion for activity. This information is
essential when the patient remains in bed because agitation is
the only indicator left for his activity.
Current projects involving multiple types of sensors [5], [13],
or works on intelligent analysis of the activity [9] give us a
good prospective on the future of the monitoring and analysis
of activity. Specific projects such as AILISA [19] will also
produce new valid data, as well as the opportunity to monitor a
real patient at home. The expected future fusion of those works
and especially the multisensor fusion (e.g., fall, temperature, or
weight scale) will complete this study.
Obviously, it is hoped that this will be a new benefit for
the clinical diagnosis in hospitals and for the remote care of
patients healed at home. This work may also later contribute to
the rehabilitation of some patients who could be monitored at
home instead of in a hospital suite.

V. CONCLUSION

ACKNOWLEDGMENT

We showed in this study that our system could contribute to

evaluate three criteria of the five common ADL criteria: mobility, elimination, and personal hygiene. From these criteria, a
telehomecare system could provide long-term information about
a patients health status (e.g., an estimation of the trend of patients behavior could launch an alarm to the medical staff).
Because both physical and mental reasons (e.g., illness, depression, age) may be implied in the modification of the patients
behavior, further research is needed to interpret the observations.

The authors would like to thank S. Laetitia, and E. Mairesse

for their kind help. They also want to thank the ATRAL S.A.
Company for its support.
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99

Gael LeBellego was born in Marseille, France, in

1978. He received the B.Sc. degree in information
engineering from the Ecole Nationale dIngenieurs,
Brest, France, in 2002, and the M.Sc. degree in
Biomedical Engineering from the Universite Joseph
Fourier Grenoble (UJFG), in 2004.
His research project was in the field of
Telemedicine and technologies for health smart
homes.

Norbert Noury (M02) was born in Lyon, France,

in 1960. He received the B.Sc. degree in electronics
from the UniversiteJoseph Fourier Grenoble`(UJFG),
Grenoble, France, in 1985; the M.Sc. degree in electronics from the Polytechnic Institute of Grenoble, in
1989; and the Ph.D. degree in physics and instrumentation from UJFG in 1992.
From 1985 to 1993, he worked as an Electronic Engineer in various companies in the area of automation
and instrumentation. After writing his Ph.D. thesis on
telematics for home health care, he joined the UJFG
in 1993, where he is now an Assistant Professor at the University Institute of
Technology. He first worked in the Laboratoire dInstrumentation Microinformatique et Electronique, where he conducted research on the applications of
the piezo-polymer PVDF. In 1998, he joined the Traitement de lInformation,
Modelisation et Cognition, Institut des Mathematiques Appliquees de Grenoble}Institut des Mathematiques Appliquees de Grenoble, in the Faculty of
Medicine of Grenoble, where he initiated research on microsystems and smart
sensors for telemedicine applications. He now manages a research team and
several projects in the fields of home health care, health smart homes, and information systems for telemedicine. He is author or coauthor of approximately
100 articles, conferences, patents, and reports.
Gilles Virone was born in Grenoble, France, in 1974.
He received the M.Sc. in biomedical engineering
from the UJFG, in 1999, and the Ph. D. degree in
biomedical engineering from the UJFG, in 2003.
He works in the area of Telemedicine and technologies for Health Smart Homes.

Mireille Mousseau is an M.D. in the Unit of Oncology, A. Michallon Grenoble

Hospital.
Jacques Demongeot was born in Dijon, France, in
1946. He received the Ph.D. degree in mathematics
and the M.D. degree from the UJFG in 1975 and 1978
respectively.
He joined the UJFG as an Assistant in 1972, and
since 1985 he is a full Professor at the UJFG. He is the
Director of the laboratory TIMC-IMAG since 1983.
His major scientific contributions are in biomathematics and dynamic systems in medicine and biology.