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.
The objectives of the ACESO platform are:
- ● Monitoring of parameters related to physical health (blood pressure meter, glucose meter, etc) and activity- and sleep- monitoring sensors: e.g. FitBit, Xiaomi bracelets) and oral hygiene in an integrative manner which provides primary users with personalized and adaptive feedback extracted by the underlying AI engine;
- ● User-centric approach by actively involving users in maintaining their health (reminders for regular monitoring, timely medication and self-care) - personalized calendar;
- ● Improved oral care through personalized brushing experience extracted from the user’s brushing behaviour over time using smart toothbrushes (e.g. Philips DiamondClean Smart, Oral-B Genius series, Xiaomi Soocare X3) and salivary stimulation devices;
- ● Remote digital assessment tools for caregivers who will be able to optimize care interventions and to coach their patients over time, helping them to form better routines or recover from a treatment;
This work was supported by a grant of the European Commission through the Active and Assistive Living Program (AAL) and the Romanian Ministry of Education and Research, CCCDI - UEFISCDI, project number AAL-CP-AAL-2019-6-137-CP-ACESO.
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.
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.