Using home monitoring technology to study the effects of traumatic brain injury on older multimorbid adults: protocol for a feasibility study

Abstract

Introduction: The prevalence of traumatic brain injury (TBI) among older adults is increasing exponentially. The sequelae can be severe in older adults and interact with age-related conditions such as multimorbidity. Despite this, TBI research in older adults is sparse. Minder, an in-home monitoring system developed by the UK Dementia Research Institute Centre for Care Research and Technology, uses infrared sensors and a bed mat to passively collect sleep and activity data. Similar systems have been used to monitor the health of older adults living with dementia. We will assess the feasibility of using this system to study changes in the health status of older adults in the early period post-TBI.

Methods and analysis: The study will recruit 15 inpatients (>60 years) with a moderate-severe TBI, who will have their daily activity and sleep patterns monitored using passive and wearable sensors over 6 months. Participants will report on their health during weekly calls, which will be used to validate sensor data. Physical, functional and cognitive assessments will be conducted across the duration of the study. Activity levels and sleep patterns derived from sensor data will be calculated and visualised using activity maps. Within-participant analysis will be performed to determine if participants are deviating from their own routines. We will apply machine learning approaches to activity and sleep data to assess whether the changes in these data can predict clinical events. Qualitative analysis of interviews conducted with participants, carers and clinical staff will assess acceptability and utility of the system.

Ethics and dissemination: Ethical approval for this study has been granted by the London-Camberwell St Giles Research Ethics Committee (REC) (REC number: 17/LO/2066). Results will be submitted for publication in peer-reviewed journals, presented at conferences and inform the design of a larger trial assessing recovery after TBI.

Keywords: GERIATRIC MEDICINE; NEUROLOGY; Neurological injury; TRAUMA MANAGEMENT.

Figure 1

Schematic outlining study inclusion and exclusion criteria, study timeline, assessments and procedures. The Mayo criteria is chosen as it uses readily available positive clinical evidence of brain injury and impaired function, such as loss of consciousness and post-traumatic amnesia (PTA) and is felt to be a better predictor of long-term outcomes in comparison with pure imaging or GCS-based severity scoring criteria in TBI. Created with BioRender.com. BDI-II, Beck Depression Inventory; BP, blood pressure; CFS, Clinical Frailty Score; COMPASS31, Composite Autonomic Symptom Score-31; GCS, Glasgow Coma Scale; GI, gastrointestinal; GOSE, Extended Glasgow Outcome Scale; HADS, Hospital Anxiety and Depression Scale; IQCODE, Informant Questionnaire on Cognitive Decline in the Elderly; MOAS, Modified Overt Aggression Scale; MOCA, Montreal Cognitive Assessment; NOK, next of kin; PIR, passive infrared; QLIBRI, Quality of Life After Brain Injury; TBI, traumatic brain injury;4-AT, Alertness, Abbreviated Mental Test-4, Attention and Acute change or fluctuating course; EQ-5D, A standardised measure of health-related quality of life developed by the EuroQol Group to provide a simple, generic questionnaire for use in clinical and economic appraisal or population health status surveys;SF-36, 36-Item Short Form Survey.

Figure 2

Diagram showing pictures of sensors to be used in study and schematic illustrating how sensors may be placed in the participant’s home. The system will include five passive infrared (PIR) motion sensing units, four magnetic door sensors, two smart plugs and the Withings bed mat that communicates with a base unit. Door sensors record any opening or closing, and smart plugs record electrical use as a proxy for appliance use. The base unit receives binary data from the sensors via a wireless protocol and sends it to the cloud in real time. The PIR sensors measure light temperature and heat. They sense movement up to 9 m away from the sensor with a view angle of 45° up/down and left/right. In our study, we obtain maximum sensitivity at around 3 m and have set the ‘off-time’ to 30 s (sensors detect the presence or absence of motion every 30 s). The Withings bed mat passively captures minute-by-minute heart rate, respiratory rate and movement using pneumatic sensors. The bed mat is waterproof and is placed out of sight underneath the mattress. The mat was developed in collaboration with sleep physicians at Hôpital Béclère and validated against polysomnography.