• Ravi Bala

Exploring No-Touch Tech for Aging at Home

Updated: Apr 22

Empowered by AI and Edge Computing


We’ve seen many discussions of wearables, pendants and other devices that can be used to help Seniors age in place. While wearables are required for certain applications like Continuous Blood Glucose monitoring or EKG, non-wearables/invisibles /ambient sensors address the fact that for a variety of reasons 86% of people do not wear their devices 24-7! AI has enabled us to convert the tools that we are all familiar with into sensors of Digital Biomarkers that can enable amazing capabilities from downloadable Covid-19 screening to Activity Monitoring and COPD to Cardiac Health predictors. We call it No-Touch Health or the more clinical sounding Ambient Sensing.


Recently Google Health announced that Google Fit will soon use smartphone cameras to log heart rate and respiratory rate. The initial release will be for Pixel phones but the IOS version cannot be far behind. Why am I so excited about this?



Long before Covid-19, I’ve been focused on the emerging area of Ambient Sensing (No-Touch Health) to enable Aging at Home with no behavior change required on the part of the senior. My article on LinkedIn in January 2020 was an initial overview of these ambient sensing technologies. The product set in this area has only exploded in the last year. Let’s look at some of these innovative products and solutions that can be deployed in any senior living setting from CCRCs to Aging@Home.

The most exciting development for me is in Transdermal Optical Imaging (TOI), the technology that Google will use for their platform. The simplest explanation of TOI is a system that uses AI to detect the micro changes that occur in the reflected light from by the different layers of our skin to capture various Digital Biomarkers. Here are some of the leaders in this technology.



Binah.ai is an app on your phone (IOS, Android, Laptop)) that can provide real time, medical grade vital signs measurements, just by looking at the camera for a minute!

You can get your Heart Rate, Heart Rate Variability, Oxygen Saturation, Respiration Rate and your overall stress levels from your run of the mill smartphone camera. They claim that blood pressure measurement is in the works. Imagine being able to tell your residents to download a Pulsox device on their phone or laptop! Pair an IR thermometer and you have what you need for a no-touch Covid-19 assessment. The company says FDA approval is forthcoming.


On the question of privacy, I tested the app in airplane mode and with Wi-Fi turned off on my iPhone and it worked just fine; so, the claim of Edge AI by the company is justified and impressive. Binah’s business model is to license any partner an SDK, so that it can be

embedded into say an CVS Health/ Walmart / Walgreens Health or a HomeCare Agency app!


Anura is an equally impressive technology from Nuralogix that has some incredibly impressive capabilities. The Anura™ app is available on IOS and Android (and is also licensed as an SDK) and can provide Heart Rate, Blood Pressure, Stress, Cardiovascular Risk Assessment, Respiration, Heart Rate Variability and has a very impressive User Interface for presenting the results, with just a 30 second video sample.


I am sure 2021 will see the emergence of solutions that integrate visual AI and TOI to provide a level of digital biomarker capability that we could not have imagined a few years ago.

Imagine embedding these cameras in your bathroom mirror that automatically records your BP, Heart Rate, HRV, Breathing Rate and your general wellness score and only alerts your caregiver if the readings go out of range. The caregiver or physician can now access the historical data to see trends and head off problems before an ER visit.


VOICE / SOUND

Vocal Biomarkers are emerging as early indicators of a variety of conditions from cognitive disorders, emotional health, cardiac health and even for detection of Covid-19. These companies use AI to evaluate voice patterns such as pitch, tone, rhythm, volume and rate of speech to provide another weapon in the no-touch health arsenal.

Vocalis Health was formed with the merger of two brilliant Israeli startups BeyondVerbal

and Healthymize in 2019. The initial promise of Vocalis was to remotely detect deterioration in COPD patients who record a small vocal sample which is analyzed by the VocalisTrack AI engine. The alerts are sent to the physician with recommendations for action.


VocalisCheck uses the same technology to check for the Covid-19 biomarker. Since symptom onset can be delayed 1-2 weeks after infection, easy ubiquitous tests that can be administered on a smart phone are critical to fighting this epidemic.

SondeHealth is a Boston startup that can assess your Respiratory Health, Behavioral Health and risk of Congestive Heart Failure all with a Six -second voice sample. They launched a self-serve API that developers can use to integrate Sonde’s voice-enabled respiratory symptoms checker into custom IOS and Android apps.


SondeOne is a voice enabled Covid-19 screening tool, based on the same 6 second voice sample. The app combines voice analysis with a comprehensive COVID-19 questionnaire and user reported body temperature to give employees screening results within one minute.


Sensi.AI is another company from Israel that uses a device mounted on the wall to monitor and AI to analyze the quality of care to help both the homecare agency management and

provide peace of mind to the family. In an industry where the turnover could be as high as 80%, monitoring quality of service and the quality of the work experience could be critical to changing the economics of the business.


Every social engagement platform has now developed a voice front end, including K4Connect, CareMerge and Connected Living. Even Amazon recently announced Care Hub that connects family member and caregiver accounts with Seniors’ to help everyone keep better tabs from a distance, while respecting privacy.


Wi-Fi / RADAR

Sensors can use Wi-Fi or Radar, but the logic is the same: changes in radio signals caused by objects moving in a room are called Doppler Shifts. In context with history and environment, these shift patterns or Doppler Signatures can be interpreted as a fall, an activity or even a breathing pattern/ heart rate. Advances in Machine Learning / AI and Edge Computing (to enhance privacy), make this a viable technology to deploy in Eldercare today. Embedded Doppler signatures for walking, bending down, falling, etc. are used by sensors to automatically detect these activities. In combination with inexpensive motion detection sensors (using Infrared like to security systems today), there is a wealth of information that can be used for predicting potential health issues of seniors.


The first article I had seen on passive radar fall detection was in 2014, so the idea has been around for a few years. Viable solutions for the home and Senior Living facilities using this technology are finally emerging in the last year.


CVS Health just announced the Symphony Medical Alert System, as a comprehensive voice enabled Age in Place activity monitoring and fall monitoring solution. This is exciting because the solution white labels the award winning technology from Aloe Care Health and marries it to the size and stability of CVS Health (I also assume that Aetna will look at reimbursing this for MA customers). The wall mounted fall sensor uses radar doppler technology and voice. The solution can accommodate multiple radar detection units for fall detection across the entire home. The motion sensors use infrared and can be located across multiple rooms. The base unit also measures air quality and temperature and enables proactive voice check-in by the family. One of the strongest design features of the solution is that the app and the SmartHub are designed to enable multiple family caregivers to collaborate and easily handoff updates to each other and also proactively check in on the Elder.


Essence Smartcare announced their whole home radar-based fall detection capability last year. MDSense is a battery powered “peel and stick” sensor (part of the Essence Care@Home family) that can be located anywhere in the home. It is also water resistant and can be installed in the bathroom. It does not have a voice capability. Essence is a B2B white label solutions provider.


Linksys Aware is a software update that uses existing routers, IoT devices and Wi-Fi Doppler to provide motion sensing and activity. Linksys Wellness Pods were created in partnership with Origin Wireless and will use Wi-Fi doppler to monitor activity, motion sensing as well as falls and respiration rate! The specialized hardware samples at 50 times the rate of the standard Wi-Fi detection sensors.


The Vayyar Home sensor uses Radar Doppler and AI to monitor activity and falls. The base panel also has voice capabilities. It is continuously aware of how many people there are, their location, and whether they’re moving, standing, sitting, or lying on the floor. Vayyar Home can sense and display each person’s vital signs. It monitors activity patterns, breathing and health deterioration. The Vayyar Home base has a touch screen seems almost identical to the Aloe Care fall detection unit.


There are many emerging solutions that use these Radar and Wi-Fi Doppler imaging and the associated signatures to predict a range of safety, security, and health solutions, all without the need for any wearables or pendants.


Celeno is offering the CL8000 chipset family with the capability for Wi-Fi Doppler built in. In the next year or two, I would expect every Wi-Fi access point vendor to offer the Wi-Fi Doppler Imaging capability that can be used to provide safety, security, and health solutions. Other companies like VirtuSense VSTAlert and Cardi/o offer fall prediction and heart health vitals through similar radar doppler technologies.


I am pleased to see a number of these technologies use Edge AI to provide the most critical functions for Low Bandwidth or Disrupted Bandwidth usage. This enables a wider deployment of these solutions for rural and disadvantaged communities.


It is challenging to create a comprehensive snapshot in this rapidly evolving landscape but I am trying to maintain an online spreadsheet of companies and would welcome suggestions for additions. Please email me at balar**at** rbala **dot** info with any interesting discoveries.


Resources:

1. Digital Medicine: A Primer on Measurement: https://www.karger.com/Article/Pdf/500413

2. No-Touch Health Matrix – Work in Progress: https://drive.google.com/file/d/1UC6Zubf5DYhBNf3Cw13GS-eQ_J8DLltQ/view?usp=sharing

3. Laurie Orlov’s excellent report: Voice, Health and Wellbeing 2020: https://www.ageinplacetech.com/files/aip/Voice%20Health%20and%20Wellbeing%202020%20Final%20-%201-5-2020.pdf


Ravi Bala is an AgeTech Evangelist and a startup mentor in AgeTech and Remote Monitoring. He is a Co-Founder and former Board Member at HealthSignals, LLC, a leader in technology solutions for better senior living. An innovator and an expert in mobile health, conversational AI and digital strategy, he has a successful track record of creating and managing teams of independent thinkers.

He is currently Chair of the Capital for Good and board member for Girls First Fund – a global effort to end child marriage and is on the Advisory Board of CyberSeniors. He is also a mentor with the Silver Moonshots accelerator and a member of the Drexel University AgeWell Collaboratory. His latest passion is changing the model of eldercare with the aid of Conversational AI, Robotics and Passive Monitoring.


All images used in this article are associated with the products described here or the results of creative commons searches. If you find any images here that are in violation of usage rights, please inform me at balar**at**rbala**dot**info .

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