Marjorie Skubic

• PhD
• Managing Director at University of Missouri

Background Falls and fall-related injuries are significant public health issues for adults 65 years of age and older. The annual direct medical costs in the US as a result of falls are estimated to exceed $50 billion, and this estimate does not include the indirect costs of disability, dependence, and decreased quality of life. This project targets...

Ballistocardiograms (BCG) is a passive, non-contact heart rate detection technology that requires no action on the part of the individual. However, during the BCG signal acquisition process, the surface pressure generated by cardiac contraction is easily disturbed by external factors, and as people's health deteriorates, the j-peak (the main peak o...

Longitudinal monitoring of heart rate (HR) and heart rate variability (HRV) can aid in tracking cardiovascular diseases (CVDs), sleep quality, sleep disorders, and reflect autonomic nervous system activity, stress levels, and overall well-being. These metrics are valuable in both clinical and everyday settings. In this paper, we present a transform...

Background Amyotrophic lateral sclerosis (ALS) leads to rapid physiological and functional decline before causing untimely death. Current best-practice approaches to interdisciplinary care are unable to provide adequate monitoring of patients’ health. Passive in-home sensor systems enable 24×7 health monitoring. Combining sensor data with outcomes...

BACKGROUND Amyotrophic lateral sclerosis (ALS) leads to rapid physiological and functional decline before causing untimely death. Current best-practice approaches to interdisciplinary care are unable to provide adequate monitoring of patients’ health. Passive in-home sensor systems enable 24×7 health monitoring. Combining sensor data with outcomes...

Importance: Stroke is the leading cause of long-term disability in the United States. Providers have no robust tools to objectively and accurately measure the activity of people with stroke living at home. Objective: To explore the integration of validated upper extremity assessments poststroke within an activity recognition system. Design: Explora...

Falls and fall‐related injuries are significant public health issues for adults 65 years of age and older. Over a third of older adults (OA) fall each year and 10‐20% of falls result in serious injuries such as fractures and head trauma. Cognitive impairment is a leading risk factor for falls in OA. Over 60% of OA with MCI fall annually – two to th...

Falls and fall-related injuries are significant public health issues for adults 65 years of age and older. Over a third of older adults (OA) fall each year and 10-20% of falls result in serious injuries. Cognitive impairment has been identified as a leading risk factor with over 60% of OA living with mild cognitive impairment (MCI) falling annually...

Exercise programs have great potential to help keep older adults active and independent in their homes. However, barriers to participation in a virtual coaching exercise program aimed at fall prevention is not well understood. This qualitative descriptive study with a conventional content analysis examined older adults’ perceptions of what interfer...

In this study, anatomical and functional differences between men and women in their cardiovascular systems and how these differences manifest in blood circulation are theoretically and experimentally investigated. A validated mathematical model of the cardiovascular system is used as a virtual laboratory to simulate and compare multiple scenarios w...

Those who survive the initial incidence of a stroke experience impacts on daily function. As a part of the rehabilitation process, it is essential for clinicians to monitor patients’ health status and recovery progress accurately and consistently; however, little is known about how patients function in their own homes. Therefore, the goal of this s...

Continuous noninvasive cuffless blood pressure (BP) monitoring is essential for early detection and treatment of hypertension. In this paper, we provide an overview of the recent advancements in cuffless BP sensors. These include contact wearable sensors such as electrocardiography (ECG), photoplethysmography (PPG), contact non-wearable sensors suc...

Falls and fall-related injuries are significant public health issues for adults 65 years of age and older. Fall-related injuries are among the most expensive medical conditions. Mild cognitive impairment (MCI) and housing conditions are each independent risk factors for multiple falls among older adults and there is increasing evidence of the adver...

In-home, sensor technologies can promote chronic disease self-management and independence among older adults. However, the translation of these technologies from assistive living/long-term care to community-dwelling older adults is lacking. This study aimed to tailor such technologies for private use by older adults, and gather feedback about adopt...

With the enormous amount of data collected by unobtrusive sensors, the potential of utilizing these data and applying various multi-modal advanced analytics on them is numerous and promising. However, taking advantage of the ever-growing data requires high-performance data-handling systems to enable high data scalability and easy data accessibility...

Introduction Automated measurement of digital range of motion (ROM) may improve the accuracy of reporting and increase clinical efficiency. We hypothesize that a 3-D camera on a custom gantry will produce ROM measurements similar to those obtained with a manual goniometer. Methods A 3-D camera mounted on a custom gantry, was mechanized to rotate 2...

Older adults aged 65 and above are at higher risk of falls. Predicting fall risk early can provide caregivers time to provide interventions, which could reduce the risk, potentially avoiding a possible fall. In this paper, we present an analysis of 6-month fall risk prediction in older adults using geriatric assessments, GAITRite measurements, and...

Older adults have experienced greater isolation and mental health concerns during the COVID-19 pandemic. In long-term care (LTC) settings, residents have been particularly impacted due to strict lockdown policies. Little is known about how these policies have impacted older adults. This study leveraged existing research with embedded sensors instal...

Older adults age 65 and above are at higher risk of falls. In this research, we explored an analysis of 6-month fall risk prediction in older adults using geriatric assessments, GAITRite measurements, and fall history. We used the SHAP (SHapley Additive exPlanations) approach to explain our model predictions to understand which predictor variables...

Left ventricular (LV) catheterization provides LV pressure-volume (P-V) loops and it represents the gold standard for cardiac function monitoring. This technique, however, is invasive and this limits its applicability in clinical and in-home settings. Ballistocardiography (BCG) is a good candidate for non-invasive cardiac monitoring, as it is based...

Purpose: This study proposes a novel approach to obtain personalized estimates of cardiovascular parameters by combining (i) electrocardiography and ballistocardiography for noninvasive cardiovascular monitoring, (ii) a physiology-based mathematical model for predicting personalized cardiovascular variables, and (iii) an evolutionary algorithm (EA)...

Background For individuals post-stroke, home-based programs are necessary to deliver additional hours of therapy outside of the limited time in the clinic. Virtual reality (VR)-based approaches show modest outcomes in improving client function when delivered in the home. The movement sensors used in these VR-based approaches, such as the Microsoft...

Older adults have experienced greater isolation and mental health concerns during the COVID-19 pandemic. In long-term care (LTC) settings, residents have been particularly impacted due to strict lockdown policies. Little is known about how these policies have impacted older adults. This study leveraged existing research with embedded sensors instal...

The Center for Eldercare and Rehabilitation Technology, at University of Missouri, has researched the use of smart, unobtrusive sensors for older adult residents' health monitoring and alerting in aging-in-place communities for many years. Sensors placed in the apartments of older adult residents generate a deluge of daily data that is automaticall...

The time interval between the peaks in the electroccardiogram (ECG) and ballistocardiogram (BCG) waveforms, TEB, has been associated with the pre-ejection period (PEP), which is an important marker of ventricular contractility. However, the applicability of BCG-related markers in clinical practice is limited by the difficulty to obtain a replicable...

Research Objectives To test an initial algorithm for recognizing and classifying daily activities of individuals with stroke in an unstructured home environment using a depth sensor. Design This study was a developmental, iterative design, completed in three phases. Setting In Phase 1, the algorithm was trained in a kitchen. In Phase 2, the train...

The rapid aging of the population worldwide requires increased attention from healthcare providers and the entire society. For the elderly to live independently, many health issues related to old age, such as frailty and risk of falling, need increased attention and monitoring. When monitoring daily routines for older adults, it is desirable to det...

Objectives From the view of everyday practices and the socio-technical coordination lens, we analyzed the gap between creators' intention and the users’ implementation (mainly nursing staff and social workers) of an alert system in assisted living communities. Methods Qualitative methods were employed by way of five user interviews and focus group...

Non-invasive heart rate estimation is of great importance in daily monitoring of cardiovascular diseases. In this paper, a bidirectional long short term memory (bi-LSTM) regression network is developed for non-invasive heart rate estimation from the ballistocardiograms (BCG) signals. The proposed deep regression model provides an effective solution...

Balance impairment due to vestibular feedback loss is considered a significant disabling factor. While older adults are more often impacted by this impairment, unfortunate events and infections can cause a similar impairment in younger adults as well. This paper reports the design evolution of a prototype wearable system proposed to help reduce the...

Falls are widespread among older adults causing serious injuries and threatening their quality of life. An approach to estimate fall risk, and to prevent falls, is the Timed-Up-and-Go (TUG) test. The TUG test has established validity and reliability. However, as a clinical test, it is not accessible for personal use. To enhance its reach, the autho...

Loss of vestibular feedback is considered a significant disabling factor among older adults. Studies show that prosthetic vestibular feedback in the forms of electro- and vibrotactile mechanisms expedite the treatment and recovery of vestibular feedback loss. We propose an alternative vibrotactile system in a hat that provides vestibular feedback t...

In-home monitoring has the potential to track health changes for older adults with chronic health conditions, thereby making early treatment possible when exacerbations arise. A recliner chair is often used by older adults for sleeping at night, especially by those with breathing difficulty, neck and back problems. Here, we present a sensor system...

With the current increase in cardiovascular disease and the complexities they create, especially for aging seniors, we are working on in-home and non-invasive techniques to monitor vital signs for early detection of health conditions. Ballistocardiography has shown to be useful for long-term evaluation of myocardial strength. We have previously rep...

Presents a missing funding acknowledgment for Dr. Mihail Popescu in the above named paper.

Connected health supporting environments, such as smart-sensor enabled long-term care facilities are saturated in ambient sensor data. Despite the wealth of data being collected, facilitating scalable storage and efficient access to the data for analytics continues to be a challenge. This is especially true when streams of data need to be associate...

Date Presented 03/26/20 This research provides an exploration into the use of virtual reality–based tools for assessment in stroke. As these tools become more widely used in practice, it is imperative that OT practitioners are able to utilize data effectively in clinical decision-making. Primary Author and Speaker: Rachel Proffitt Contributing Auth...

Date Presented 03/27/20 Current assessments of activity poststroke occur in clinical settings. Researchers have attempted to use wearable activity monitors to assess activity in natural environments, but they are unable to distinguish between activities. We have developed an algorithm within a depth sensor that is able to distinguish between activi...

Electronic health records (EHR) are complex and contain both structured (e.g. physiological measures) and unstructured (e.g. nursing notes) health data. Studies show that EHR nursing notes contain critical health information, including fall risk factors in older adults. Older adults age 65 and above are at higher risk of fall. Predicting fall risk...

Sensing technologies hold enormous potential for early detection of health changes that can dramatically affect the aging experience. In previous work, we developed a health alert system that captures and analyzes in-home sensor data. The purpose of this research was to collect input from older adults and family members on how the health informatio...

Early detection of heart failure in older adults will be a significant issue for the foreseeable future. The current article presents a case study to describe how monitoring ballistocardiogram (BCG) waveforms captured non-invasively using sensors placed under a bed mattress can detect early heart failure changes. Heart and respiratory rates obtaine...

Children, parents, older adults, and caregivers routinely use sensor technology as a source of health information and health monitoring. The purpose of this paper is to describe three exemplars of research that used a human-centered approach to engage participants in the development, design, and usability of interventions that integrate technology...

Inspired by the application of recurrent neural networks (RNNs) to image recognition, in this paper, we propose a heartbeat detection framework based on the Gated Recurrent Unit (GRU) network. In this contribution, the heartbeat detection task from ballistocardiogram (BCG) signals was modeled as a classification problem where the segments of BCG si...

- Background: Current protocol for monitoring high-risk patients in psychiatric hospital calls for a staff member to enter each room every 15 minutes to visually ensure that each patient is still breathing. This protocol has been set up for fast intervention in the case of a patient's self-inflicting harm. However, this procedure is disruptive to t...

In recent years voice-assisted technologies, such as the Amazon Echo Show and Google Home, have been harnessed to help older adults manage their health. However, little is known about the use of such technologies in combination with in-home sensor systems to help older adults age in place. Therefore, this research explored user preferences of older...

The specific aim of this case study was to describe how monitoring ballistocardiogram (BCG) waveforms can detect early heart failure (HF) changes. HF significantly impairs quality of life and is the principal cause for hospital readmissions in older adults. HF prevalence in American adults aged 65 years and older is expected to increase over 70% by...

Chronic illness is the primary reason for hospitalization and rehospitalization in the US today. Nearly 1/3 of older adults have 3 or more chronic illnesses. Chronic illnesses require significant self-management or management by nursing staff. This paper highlights the use of a change model to assist in sustaining nursing interventions in assisted...

The quality of sleep has a significant impact on health and life. This study adopts the structure of hierarchical classification to develop an automatic sleep stage classification system using ballistocardiogram (BCG) signals. A leave-one-subject-out cross validation (LOSO-CS) procedure is used for testing classification performance. Convolutional...

Longitudinal monitoring of sleep related parameters can be used for early detection of diseases and also as an indication to physicians for effective adjustment of medication and dosage treatments for people at risk. The correlation between sleep disorders and health conditions such as Alzheimer's and Parkinson's diseases has already been reported...

Voice-controlled in-home personal assistants have a great potential to assist older adults. This paper explores the aspects of a human-computer interface design, specifically a voice assistant, to help older adults manage their personal health, especially in the case of chronic health conditions. In our previous work, we have built a web interface...

In this study, we develop a health index that quantifies changes in the functional health of older adults. The heuristic model of the health index is based on a set of frequently collected nursing assessment scores in the Electronic Health Record (EHR), such as Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-M...

We propose a nonwearable hydraulic bed sensor system that is placed underneath the mattress to estimate the relative systolic blood pressure of a subject, which only differs from the actual blood pressure by a scaling and an offset factor. Two types of features are proposed to obtain the relative blood pressure, one based on the strength and the ot...

We propose a nonwearable hydraulic bed sensor system that is placed underneath the mattress to estimate the relative systolic blood pressure of a subject, which only differs from the actual blood pressure by a scaling and an offset factor. Two types of features are proposed to obtain the relative blood pressure, one based on the strength and the ot...

Background Anterior cruciate ligament (ACL) injury rates in adolescent female athletes are 3x greater than males, with peak incidence at 16 and 17 years of age for girls and boys, respectively. As increased knee valgus during a jump landing task has been linked to ACL injury risk, portable motion capture devices offer capabilities of widespread scr...

Objective: to develop quantitative methods for the clinical interpretation of the ballistocardiogram (BCG). Methods: a closed-loop mathematical model of the cardiovascular system is proposed to theoretically simulate the mechanisms generating the BCG signal, which is then compared with the signal acquired via accelerometry on a suspended bed. R...

Background and purpose: Multiple sclerosis (MS) is a progressive neurological disorder, characterized by exacerbations and remissions, often resulting in disability affecting multiple neurological functions. The purpose of this article was (1) to describe the frequencies of self-reported symptoms in a natural environment and (2) to determine chara...

Context:: Knee abduction angle (KAA), as measured by three-dimensional marker-based motion capture systems during jump landing tasks, has been correlated with an elevated risk of anterior cruciate ligament (ACL) injury in females. Due to the high cost and inefficiency of KAA measurement with marker-based motion capture, surrogate two-dimensional f...

Objective: to develop quantitative methods for the clinical interpretation of the ballistocardiogram (BCG), a signal generated by the repetitive motion of the human body due to sudden ejection of blood into the great vessels with each heart beat. Methods: a closed-loop mathematical model of the cardiovascular system is proposed to theoretically sim...

A multiple instance dictionary learning approach, Dictionary Learning using Functions of Multiple Instances (DL-FUMI), is used to perform beat-to-beat heart rate estimation and to characterize heartbeat signatures from ballistocardiogram (BCG) signals collected with a hydraulic bed sensor. DL-FUMI estimates a "heartbeat concept" that represents an...

Sensing technologies hold enormous potential for early detection of health changes that can dramatically affect the aging experience. In previous work, we developed a health alert system that captures and analyzes in-home sensor data, and flags possible health changes. Health information generated from this technology is used by an interdisciplinar...

Interactive technologies are beneficial to stroke recovery as rehabilitation interventions; however, they lack evidence for use as assessment tools. Mystic Isle is a multi-planar full-body rehabilitation game developed using the Microsoft Kinect® V2. It aims to help stroke patients improve their motor function and daily activity performance and to...

Pseudocode for preprocessing the joint data from the Kinect and Vicon system. The data was preprocessed by R2017a MATLAB. The Kinect data were transformed, filtered and synchronized. The Vicon data were synchronized and down-sampled. (PDF)

Validation results of extent of reach metrics. (XLSX)

Comparison of measurement validity under difference sample rates. The influence of the sample rates of the Kinect to the accuracy of clinical measurement were investigated. (PDF)

Start and stop points for synchronization. The figure illustrates the starting point and stop point on one subject’s data. (PDF)

Validation results of max and mean speed metrics. (XLSX)

Spatiotemporal accuracy results. (ZIP)

Sleep posture has been shown to be important in monitoring health conditions such as congestive heart failure (CHF), sleep apnea, pressure ulcers, and even blood pressure abnormalities. In this paper, we investigate the use of four hydraulic bed transducers placed underneath the mattress to classify different sleep postures. For classification, we...

Background: Individuals with peripheral neuropathy (PN) frequently experience balance and gait impairments that can lead to poor physical function, falls, and injury. Nurses are aware that patients with cancer experience balance and gait impairments but are unsure of optimal assessment and management strategies. Objectives: This article reviews...

In this paper, we present a novel method to measure the anterior (ANT) reach distance of the modified Star Excursion Balance Test (mSEBT). Using depth images obtained from the Microsoft KinectTM V2 sensor, we compared our results against a "gold standard" marker-based Vicon motion capture system. Seven healthy subjects participated in the study and...

This paper examines the fall signatures observed by the Doppler radar at the different positions and evaluates their consistencies with respect to the fall directions and locations. The complementary characteristics of the fall signatures motivate the integration of the features from multiple radars to improve the fall detection performance. Experi...