Leading dental care manufacturers are envisioning a world where daily oral health routine allows consumers to take care of health comprehensively. ACESO is paving part of the way by involving older adults and elderly along with their physicians in a co-creative approach to realize an integrated health and oral-care platform in which intelligent devices use data analytics for adaptable health and wellbeing. The uniqueness of the platform originates from its underlying intelligence and adaptability as well as from a holistic approach to physical and oral care. Our patient-centric approach brings clear benefits for the elderly while supporting professional caregivers (doctors, nurses, dentists, etc) to optimize their practice, improve their care and reach out to a larger number of patients even if living in remote areas.
The main functionalities of the ACESO platform are:
- i) monitoring physical health parameters and oral hygiene;
- ii) calendar reminders for users;
- iii) maintaining oral care through personalized brushing experience extracted from the user’s brushing behaviour;
- iv) assessment tools for caregivers who will be able to optimize care interventions and to coach their patients over time.
The target market is composed of three major groups:
- i) primary users are 60+ years old who suffers from modifications due to ageing regarding the whole body functionality (chronic cardiovascular diseases and diabetes are mainly considered);
- ii) secondary users, i.e. dentists and hygienists;
- iii) tertiary users: insurance companies which will be also considered for the business and exploitation aspects of the project.
Phase 1
Activity I.1 As part of this activity, we have comparatively studied 3 platforms for oral care, 2 platforms for health monitoring and 3 research projects relevant for the ACESO proposed devlopment and objectives. For example, mORAL is addressing oral health monitoring by proposing a platform with inertial sensors which are placed around the users’s wrist. In this way, the correct usage of the toothbrush is recorded and analysed. Another method proposed in the literature is using a manual toothbrush and a smartwatch to record the brushing movemnts on 16 tooth surfaces. The toothbrush is modified by attaching tiny magnets to it such that the movement and orientation of the brush is captured by the smartwatch. Yet another implementation is using an inertial sensor placed on the wrist and a normal, manual toothbrush. The system (Hygiea) is collecting three dimensional data and is analysing them using a smart phone.
Activity I.2 Within this activity, we have designed the ACESO platform architecture and have established the software tools for its implementation. The ACESO platform is composed of the following main subsystems: Core Subsystem (CSYS), Cloud Component (CCMP), and Helper Service (HSVC). The main design features are: (1) the platform is completely separated from the user’s home network and, as result of this separation communication between the components of the platform can be secured without limitations from the existent user’s WiFi network; (2) the platform can operate autonomously at the user premises without the need to transfer sensitive data outside the house for its operation; (3) communication between caregiver devices and ACESO Platform is direct, in a Peer-to-Peer (P2P) manner. Minimal external services are used to allow external clients to discover the platform over the internet due to dynamic IP allocation by the intenet provider (DDNS, Dynamic DNS).
Activity I.3 Several models which can be employed for the development of the business plan were considered and presented comparatively. The advantages and disadvantages of two canvas models were identified and compared. The Lean Canvas Model is more suitable for general business models of a company while the Business Model Canvas is more suitable for developing the business model of a specific product. We have also considered the Agile method and its implementation for business development.
Activity I.4 With the aim of classifying and recruiting the end-users for the ACESO pilots, we have performed initial tests to evaluate the salivary function of 20 elderly. The tests were performed in the dental clinic of the LSDM partner. Elderly above 60 years of age were selected, indpenedent on their oral health and general health conditions. Also younger persons were selected for comparison purposes.
Activity I.5 Emerging and innovative dental care practices will benefit from the use of mHealth instruments, data analytics and involving patients actively in maintaining their own health. By placing a higher importance on patient involvement and personalized care, healthcare providers will be able to offer the best care at the best moment in time. Various support software is alreadu in use. For example SNA (shade navigation app) which is helping with matching the color or Digital Smile Design which is supporting planification.
Activity I.6 Within this activity we have developed and made public the webpage of the ACESO project.
Phase 2
Activity II.1 In this activity, we have developed the following components: user interface and the ACESO smart toothbrush - a manual brush transformed into a smart brush that can acquire the movements made during brushing (data acquired from accelerometer and gyroscope), as well as the duration of brushing that will be analyzed using machine learning algorithms in order to identify the oral care model.
Activity II.2 In this activity the performance of the developed smart toothbrush was analysed. In the first phase the battery consumption connected to the microcontroller attached to the hand brush was optimized. Aspects related to data transmission between the ACESO tablet and the developed smart brush are also presented as part of our results. The implementation of the message transmission when longer than 23 characters (limitation of the BLE standard) was achieved by modifying the code and not by truncating the messages.
Activity II.3 In this activity the components of the ACESO platform were tested with 20 elderly people (over 60 yrs old) and 10 dental professionals. The physical health monitoring devices (blood pressure monitor, glucometer, thermometer) were found to be easy and comfortable to use. The smart brush developed within ACESO was considered useful by most patients. The Salipen device was well tolerated by patients who had no complaints or visible anxiety during its use. Salivary flow measurements increased, but not significantly, during intraoral operation of the device. Patients also reported an initial dry mouth sensation but very high salivary flow immediately after use. The flow persisted for a long period of time. A few hours later they still reported an increased salivary flow.
Activity II.4 In this activity we have researched the market for eHealth and ICT-based oral health products. Estimates of the market size, market predictors, etc. were identified. Manufacturers and products competitive with the solution proposed in ACESO were also identified.
Activity II.5 Two articles were published in ISI proceedings and the results of the project were presented in 3 scientific conferences. The project activities were also presented in events such as the "European Online Week of Active & Healthy Ageing" and seminar organised by FIT Europe ERASMUS+ and in the framework of COST action CA19136 - NET4Age-Friendly. Promotional materials were produced to be distributed at dissemination events. The web page in Romanian and English and also the web page of the whole project was maintained using the Wix platform.
Phase 3
Activity III.1 Contributions to the implementation of the integrated system: In the framework of this activity, we have made the steps to complete and optimize the integrated ACESO platform:
- ● the user interface has been extended by adding the necessary buttons to access the new functionalities integrated in the platform,
- ● the user interface has been extended by adding graphs allowing the visualization of parameters related to the daily monitoring activity,
- ● integration of the smart brush,
- ● integration of the SaliPen,
- ● calendar integration.
In terms of smart brush integration, the first version of the brush used a manual brush incorporated in a handle developed by CITST. However, the user could not change the toothbrush because it was glued into the handle. A new version of the handle has been designed that can be used with an interchangeable head from electric toothbrushes. To make the SaliPen smart, a 3D designed cup was developed which incorporates an electronic circuit to monitor the presence/absence of the device in the cup. An Android app was also developed to collect and transmit data related to the Salipen usage.
Activity III.2 Research on the laboratory performance of the integrated system and analysis of the collected data: Research on the operation of the platform under laboratory conditions revealed the need to improve the platform’s performance in the following areas: (1) how to package and transmit data from the smart brush; (2) how to adapt the shape of the cup for the SaliPen device so as to eliminate errors in detecting the use of the device; (3) extending the range of caps available for the smart brush and adapting the handle so that it does not slip out of the hand when wet; (4) modifying the brush cup so that it does not retain water drained after using the brush for washing and can be better fixed in place. Points 1 and 2 were addressed in this activity as they were considered essential for the correct functioning of the platform.
Activity III.3 Activities to involve end-users in the ACESO pilot studies: The ACESO platform was presented and tested under supervised conditions by 15 users. The purpose of the testing was to identify its strengths, but also the changes that elderly users would like to make to consider it functional and suitable for their needs. Following the presentation of the ACESO platform and the testing of its interface with related devices, users were asked to answer 16 questions. These were administered in the form of a questionnaire comprising 14 closed questions and 2 questions. The majority of respondents would not make significant changes to the ACESO platform. However, we obtained recommendations for optimisation of the tested prototype and have identified potential barriers that migh prevent adoption.
Activity III.4 Participation in scientific meetings, working visits, AAL forum: As part of this activity, we have published 1 article in a Q4 rated journal (BDI: Scopus), 1 article in ISI proceedings and the results of the project were presented at 2 scientific conferences. The project was also disseminated using promotional materials during events such as Techweek Bucharest 2022 and the AAL Forum. The results of the project were presented in discussions with manufacturers such as Alphasigma. Promotional materials were produced for distribution at dissemination events. The webpage in Romanian and English and also the webpage of the whole project was maintained using the Wix platform.
Phase 4
Activity IV.1 Optimization and testing of the integrated system by involving end-users: The optimization of the integrated system was carried out by involving end-users. Based on their feedback we have addressed the following issues to optimize the ACESO platform: (1) Modification of the shape of the brush handle so that it has an ergonomic appearance; after printing, the handle surface was post-processed by specific technologies in order to obtain a superior quality surface (visually and in terms of texture). (2) Modification of the brush cup by using magnets instead of the magnetic strip, in order to avoid its demagnetisation and the impossibility to use the cup (detection of the beginning and the end of the brushing). (3) Modification of the brush cup in order to be easily loaded. (4) Completion of the user interface implementation. (5) Implementation of the caregiver interface.
Activity IV.2 Contributions to the business plan: The ACESO project competes in a large and rapidly growing e-health market driven by technological advances, increased adoption of digital health solutions and the global response to the COVID-19 pandemic, which has accelerated the adoption of telemedicine and digital health services. The following aspects were analysed and assessed for the ACESO commercialisation: competitors, customers, value proposition, financial, regulatory and legal aspects.
Activity IV.3 Analysis of pilot study results: The pilot studies in Romania started in February 2023. LS DINTIIMEI SRL partners have previously selected the primary participants in Task 1.1 of the project. The same participants agreed to participate in Task 1.3. A total of 10 primary users and 5 secondary users (two dentists, one dental assistant, one orthodontist, one general practitioner) were enrolled in the Romanian pilot study. All of them met the inclusion and exclusion criteria presented in D1.1. There were 11 senior participants who completed the pre-questionnaires, their ages being between 64 and 85 years. The gender balance was very good, with 6 males and 5 females, and their level of education was relatively high, with the majority having higher education (university) or postgraduate studies. The participants benefited from the continuous support of CITST for any encountered problem. A good proportion of participants agreed that they felt very confident about using the system. Daily use and the possibility to consult the manual in case of problems are the main factors that give seniors confidence in terms of handling the system.
Activity IV.4 Dissemination: final project meeting: The closing meeting of the project took place in Krakow on 27.07.2023. It was attended by all partners (the meeting was hybrid). The agenda included the status of the pilot studies, deliverables and IA implementation as well as the planning of the project closure.
Scientific Dissemination: During this phase, we have prepared, together with our Polish partners, a chapter to be published in a monography. It will be published in the second part of September.
- ● Title of the monography: Oczekiwania wobec nauk biomedycznych - trendy, wyzwania i perspektywy (Expectations for biomedical science - trends, challenges and perspectives)
- ● Chapter title: Kierunki rozwoju telemedycyny w geriatrii (Directions of telemedicine development in geriatrics)
- ● Authors: Anna Rudzińska, Robert Kupis, Karolina Piotrowicz, Łukasz Malicki, Irina Mocanu, Oana Cramariuc, Ian Perera, Barbara Gryglewska, Jerzy Gąsowski
- ● ISBN: 978-83-67104-73-9
Dissemination Events:
- ● Presentation of the project in the Summer School of the COST Action Network on Privacy-Aware Audio- and Video-Based Applications for Active and Assisted Living (COST Action CA19121 GoodBrother), 13-16 June 2023: Intelligent systems in healthcare.
- ● Presentation of the ACESO project at the A-WEAR workshop at Tampere University in Finland. The workshop was attended by students and teachers from several countries.
- ● Presentation of the ACESO project at Nichita Stanescu High School in Bucharest (April 2023). The students of the 10th grade participated in the week with teachers of the school.
- ● Presentation of the project at the Centre of Excellence in Care for the Elderly and Prevention of Memory Disorders Vitalitas, July 2023.
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