JMIR Rehabilitation and Assistive Technologies

Fuzzy inference based scoliotic low back pain treatment prediction and evolution monitoring system

Background: There is increasing rate of low back pain pathologies among the young adults. These pathologies are the result of the IT oriented lifestyle and long hours of incorrect sitting position in front of a computer screen and lack of physical exercises Objective: Our main objective is to create a system that can suggest a correct treatment: spinal cord surgery or medical recovery exercise for each patient to maximize the treatments effect and minimize the necessary sick leave time. The secondary objective is to create a system that can be installed at low costs in the patient’s home to monitor the evolution of the patients during the recovery treatment. Methods: In the first stage to correctly predict the most efficient treatment procedure for a patient first the patient was investigated using the Zebris device to collect data about the thoracic motion ranges and then the collected data was analyzed by a fuzzy inference system. In the second stage at the patient’s home or at the chiropractor’s office a Microsoft Kinect device was installed which has the role to monitor in real time the patient’s evolution. To have permanently access to the medical data, all of the data is stored on a cloud based database with HL7 compatibility. Results: The testing of the first stage was done on 260 patients: lot 1 with 107 surgery patients and lot 2 with 163 medical recovery patients. Each patient was measured for the thoracic motion ranges once at every 6 month. In total 1300 evaluations have been made. The fuzzy system in 4 cases of 229 suggested a medical recovery over surgery and in 10 cases from 1071 suggested surgery instead of the medical recovery. In the first case the system error is under 2% and in the second case is under 1%. The second stage using the Microsoft Kinect was introduced at the last evaluation session. The measured values were identical to the measures with the zebris devices in the case of the thoracic tracking. Conclusions: Young adults are more willing to follow through a rehabilitation process if they are positively motivated. By using advanced medical devices like the Zebris and the Kinect device an objective picture about the patient’s motion range can be formed. The data obtained from these devices can be used in combination with other data collected from the patients thought questionnaires. The sum of these data provide an objective suggestion about the correct treatment. It is important to have all the data stored in a place where all the medical system can access them. This is done by using the HL7 CDA standard. All of these can provide a correct treatment and a better patient care.

2014-10-27

Open Access and no publication or submission fees!

JMIR Rehabilitation and Assistive Technologies is a new spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2010: 4.7). JMIR Rehab focusses on development and evaluation of rehabilitation and cyborg technologies, i.e. assistive, adaptive, and rehabilitative hi-tech approaches, for example robotic/medical devices, prosthetics, and software for people with chronic or acute conditions and disabilities, as well as for performance enhancement of healthy individuals.

Become a founding author and/or editor in this emerging field and submit your paper to JMIR Rehab and/or apply as section editor (you must have published and reviewed for JMIR to be eligible as editorial board member).

Published by JMIR Publications, publisher of the Journal of Medical Internet Research (JMIR), the leading eHealth/mHealth journal (Impact Factor 2013: 4.4), JMIR Mental Health publishes even faster and has a broader scope with including papers which are more technical or more formative than what would be published in the Journal of Medical Internet Research.  JMIR Rehabilitation journal features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central/PubMed), and an ipad App (in prep.). JMIR Rehab adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics (http://www.jmir.org/issue/current).

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Recent Articles:

  • Position of the inertial sensors on the back of patients.

    Mobile Functional Reach Test in People Who Suffer Stroke: A Pilot Study

    Abstract:

    Background: Postural instability is one of the major complications found in people who survive a stroke. Parameterizing the Functional Reach Test (FRT) could be useful in clinical practice and basic research, as this test is a clinically accepted tool (for its simplicity, reliability, economy, and portability) to measure the semistatic balance of a subject. Objective: The aim of this study is to analyze the reliability in the FRT parameterization using inertial sensor within mobile phones (mobile sensors) for recording kinematic variables in patients who have suffered a stroke. Our hypothesis is that the sensors in mobile phones will be reliable instruments for kinematic study of the FRT. Methods: This is a cross-sectional study of 7 subjects over 65 years of age who suffered a stroke. During the execution of FRT, the subjects carried two mobile phones: one placed in the lumbar region and the other one on the trunk. After analyzing the data obtained in the kinematic registration by the mobile sensors, a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the mobile sensors were distance, maximum angular lumbosacral/thoracic displacement, time for maximum angular lumbosacral/thoracic displacement, time of return to the initial position, and total time. Using these data, we calculated speed and acceleration of each. A descriptive analysis of all kinematic outcomes recorded by the two mobile sensors (trunk and lumbar) was developed and the average range achieved in the FRT. Reliability measures were calculated by analyzing the internal consistency of the measures with 95% confidence interval of each outcome variable. We calculated the reliability of mobile sensors in the measurement of the kinematic variables during the execution of the FRT. Results: The values in the FRT obtained in this study (2.49 cm, SD 13.15) are similar to those found in other studies with this population and with the same age range. Intrasubject reliability values observed in the use of mobile phones are all located above 0.831, ranging from 0.831 (time B_C trunk area) and 0.894 (displacement A_B trunk area). Likewise, the observed intersubject values range from 0.835 (time B_C trunk area) and 0.882 (displacement A_C trunk area). On the other hand, the reliability of the FRT was 0.989 (0.981-0.996) and 0.978 (0.970-0.985), intrasubject and intersubject respectively. Conclusions: We found that mobile sensors in mobile phones could be reliable tools in the parameterization of the Functional Reach Test in people who have had a stroke.

  • Smart insole.

    A Smart Insole to Promote Healthy Aging for Frail Elderly Individuals: Specifications, Design, and Preliminary Results

    Abstract:

    Background: Older individuals frequently experience reversible “frailty syndrome,”, increasing incidence of disability. Although physical exercise interventions may delay functional decline, there are difficulties in implementing them and performing seamless follow-up at home. Very few technological solutions attempt to address this challenge and improve individual participation. Objective: Our objectives are to (1) develop a technological solution designed to support active aging of frail older persons, (2) conduct a first laboratory evaluation of the device, and (3) design a multidimensional clinical trial to validate our solution. Methods: We conducted a first phase of multidisciplinary meetings to identify real end users and health professional’s unmet needs, and to produce specifications for the architecture of the solution. In a second phase, we performed laboratory tests of the first proposed prototype (a smart insole) with 3 healthy volunteers. We then designed an ongoing clinical trial to finalize the multidimensional evaluation and improvement of the solution. Results: To respond to the needs expressed by the stakeholders (frailty monitoring and adherence improvement), we developed a prototype of smart shoe insole to monitor key parameters of frailty during daily life and promote walking. It is a noninvasive wireless insole, which automatically measures gait parameters and transmits information to a remote terminal via a secure Internet connection. To ensure the solution’s autonomy and transparency, we developed an original energy harvesting system, which transforms mechanical energy produced by the user’s walking movement into electrical energy. The first laboratory tests of this technological solution showed good reliability measures and also a good acceptability for the users. We have planned an original iterative medical research protocol to validate our solution in real life. Conclusions: Our smart insole could support preventive strategies against disability in primary care by empowering the older patients without increasing the busy health professional’s workload. Trial Registration: Clinicaltrials.gov NCT02316600; https://clinicaltrials.gov/ct2/results?term=NCT02316600&Search=Search. Accessed: 2015-05-13 . (Archived by WebCite at http://www.webcitation.org/6YUTkObrQ).

  • iPhone 4 on subject.

    Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones

    Abstract:

    Background: In recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration. Objective: The aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space. Methods: This cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated. Results: Descriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860). Conclusions: The use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient.

  • Tablet and mounting platform for in-chair training.

    Rehab on Wheels: A Pilot Study of Tablet-Based Wheelchair Training for Older Adults

    Abstract:

    Background: Alternative and innovative strategies such as mHealth and eLearning are becoming a necessity for delivery of rehabilitation services. For example, older adults who require a wheelchair receive little, if any, training for proficiency with mobility skills. This substantive service gap is due in part to restricted availability of clinicians and challenges for consumers to attend appointments. A research team of occupational therapists and computer scientists engaged clinicians, consumers, and care providers using a participatory action design approach. A tablet-based application, Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels), was developed to enable in-chair home training, online expert trainer monitoring, and trainee-trainer communication via secure voice messaging. Objective: Prior to undertaking a randomized controlled trial (RCT), a pilot study was conducted to determine the acceptability and feasibility of administering an mHealth wheelchair skills training program safely and effectively with two participants of different skill levels. The findings were used to determine whether further enhancements to the program were indicated. Methods: The program included two in-person sessions with an expert trainer and four weeks of independent home training. The EPIC Wheels application included video instruction and demonstration, self-paced training activities, and interactive training games. Participants were provided with a 10-inch Android tablet, mounting apparatus, and mobile Wi-Fi device. Frequency and duration of tablet interactions were monitored and uploaded daily to an online trainer interface. Participants completed a structured evaluation survey and provided feedback post-study. The trainer provided feedback on the training protocol and trainer interface. Results: Both participants perceived the program to be comprehensive, useful, and easily navigated. The trainer indicated usage data was comprehensive and informative for monitoring participant progress and adherence. The application performed equally well with multiple devices. Some initial issues with log-in requests were resolved via tablet-specific settings. Inconsistent Internet connectivity, resulting in delayed data upload and voice messaging, was specific to individual Wi-Fi devices and resolved by standardizing configuration. Based on the pilot results, the software was updated to make content download more robust. Additional features were also incorporated such as check marks for completed content, a more consumer-friendly aesthetic, and achievement awards. The trainer web interface was updated to improve usability and provides both a numerical and visual summary of participant data. Conclusions: The EPIC Wheels pilot study provided useful feedback on the feasibility of a tablet-based home program for wheelchair skills training among older adults, justifying advancement to evaluation in an RCT. The program may be expanded for use with other rehabilitation interventions and populations, particularly for those living in rural or remote locations. Future development will consider integration of built-in tablet sensors to provide performance feedback and enable interactive training activities. Trial Registration: ClinicalTrials.gov NCT01644292; https://clinicaltrials.gov/ct2/show/NCT01644292 (Archived by WebCite at http://www.webcitation.org/6XyvYyTUf).

  • Zephyr BioHarness.

    Measurement and Data Transmission Validity of a Multi-Biosensor System for Real-Time Remote Exercise Monitoring Among Cardiac Patients

    Abstract:

    Background: Remote telemonitoring holds great potential to augment management of patients with coronary heart disease (CHD) and atrial fibrillation (AF) by enabling regular physiological monitoring during physical activity. Remote physiological monitoring may improve home and community exercise-based cardiac rehabilitation (exCR) programs and could improve assessment of the impact and management of pharmacological interventions for heart rate control in individuals with AF. Objective: Our aim was to evaluate the measurement validity and data transmission reliability of a remote telemonitoring system comprising a wireless multi-parameter physiological sensor, custom mobile app, and middleware platform, among individuals in sinus rhythm and AF. Methods: Participants in sinus rhythm and with AF undertook simulated daily activities, low, moderate, and/or high intensity exercise. Remote monitoring system heart rate and respiratory rate were compared to reference measures (12-lead ECG and indirect calorimeter). Wireless data transmission loss was calculated between the sensor, mobile app, and remote Internet server. Results: Median heart rate (-0.30 to 1.10 b∙min-1) and respiratory rate (-1.25 to 0.39 br∙min-1) measurement biases were small, yet statistically significant (all P≤.003) due to the large number of observations. Measurement reliability was generally excellent (rho=.87-.97, all P<.001; intraclass correlation coefficient [ICC]=.94-.98, all P<.001; coefficient of variation [CV]=2.24-7.94%), although respiratory rate measurement reliability was poor among AF participants (rho=.43, P<.001; ICC=.55, P<.001; CV=16.61%). Data loss was minimal (<5%) when all system components were active; however, instability of the network hosting the remote data capture server resulted in data loss at the remote Internet server during some trials. Conclusions: System validity was sufficient for remote monitoring of heart and respiratory rates across a range of exercise intensities. Remote exercise monitoring has potential to augment current exCR and heart rate control management approaches by enabling the provision of individually tailored care to individuals outside traditional clinical environments.

  • (cc) Lam et al. CC-BY-SA-2.0, please cite as (http://rehab.jmir.org/article/viewFile/3484/1/52473).

    Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups

    Abstract:

    Background: Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients’ technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs. Objective: This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use. Methods: We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data. Results: We identified three key themes: (1) clients’ use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups. Conclusions: Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games.

  • Rehabilitation through serious interactive games.

    THERAPIST: Towards an Autonomous Socially Interactive Robot for Motor and Neurorehabilitation Therapies for Children

    Abstract:

    Background: Neurorehabilitation therapies exploiting the use-dependent plasticity of our neuromuscular system are devised to help patients who suffer from injuries or diseases of this system. These therapies take advantage of the fact that the motor activity alters the properties of our neurons and muscles, including the pattern of their connectivity, and thus their functionality. Hence, a sensor-motor treatment where patients makes certain movements will help them (re)learn how to move the affected body parts. But these traditional rehabilitation processes are usually repetitive and lengthy, reducing motivation and adherence to the treatment, and thus limiting the benefits for the patients. Objective: Our goal was to create innovative neurorehabilitation therapies based on THERAPIST, a socially assistive robot. THERAPIST is an autonomous robot that is able to find and execute plans and adapt them to new situations in real-time. The software architecture of THERAPIST monitors and determines the course of action, learns from previous experiences, and interacts with people using verbal and non-verbal channels. THERAPIST can increase the adherence of the patient to the sessions using serious games. Data are recorded and can be used to tailor patient sessions. Methods: We hypothesized that pediatric patients would engage better in a therapeutic non-physical interaction with a robot, facilitating the design of new therapies to improve patient motivation. We propose RoboCog, a novel cognitive architecture. This architecture will enhance the effectiveness and time-of-response of complex multi-degree-of-freedom robots designed to collaborate with humans, combining two core elements: a deep and hybrid representation of the current state, own, and observed; and a set of task-dependent planners, working at different levels of abstraction but connected to this central representation through a common interface. Using RoboCog, THERAPIST engages the human partner in an active interactive process. But RoboCog also endows the robot with abilities for high-level planning, monitoring, and learning. Thus, THERAPIST engages the patient through different games or activities, and adapts the session to each individual. Results: RoboCog successfully integrates a deliberative planner with a set of modules working at situational or sensorimotor levels. This architecture also allows THERAPIST to deliver responses at a human rate. The synchronization of the multiple interaction modalities results from a unique scene representation or model. THERAPIST is now a socially interactive robot that, instead of reproducing the phrases or gestures that the developers decide, maintains a dialogue and autonomously generate gestures or expressions. THERAPIST is able to play simple games with human partners, which requires humans to perform certain movements, and also to capture the human motion, for later analysis by clinic specialists. Conclusions: The initial hypothesis was validated by our experimental studies showing that interaction with the robot results in highly attentive and collaborative attitudes in pediatric patients. We also verified that RoboCog allows the robot to interact with patients at human rates. However, there remain many issues to overcome. The development of novel hands-off rehabilitation therapies will require the intersection of multiple challenging directions of research that we are currently exploring.

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  • Fuzzy inference based scoliotic low back pain treatment prediction and evolution monitoring system

    Date Submitted: Jun 29, 2015

    Open Peer Review Period: Jul 2, 2015 - Aug 27, 2015

    Background: There is increasing rate of low back pain pathologies among the young adults. These pathologies are the result of the IT oriented lifestyle and long hours of incorrect sitting position in...

    Background: There is increasing rate of low back pain pathologies among the young adults. These pathologies are the result of the IT oriented lifestyle and long hours of incorrect sitting position in front of a computer screen and lack of physical exercises Objective: Our main objective is to create a system that can suggest a correct treatment: spinal cord surgery or medical recovery exercise for each patient to maximize the treatments effect and minimize the necessary sick leave time. The secondary objective is to create a system that can be installed at low costs in the patient’s home to monitor the evolution of the patients during the recovery treatment. Methods: In the first stage to correctly predict the most efficient treatment procedure for a patient first the patient was investigated using the Zebris device to collect data about the thoracic motion ranges and then the collected data was analyzed by a fuzzy inference system. In the second stage at the patient’s home or at the chiropractor’s office a Microsoft Kinect device was installed which has the role to monitor in real time the patient’s evolution. To have permanently access to the medical data, all of the data is stored on a cloud based database with HL7 compatibility. Results: The testing of the first stage was done on 260 patients: lot 1 with 107 surgery patients and lot 2 with 163 medical recovery patients. Each patient was measured for the thoracic motion ranges once at every 6 month. In total 1300 evaluations have been made. The fuzzy system in 4 cases of 229 suggested a medical recovery over surgery and in 10 cases from 1071 suggested surgery instead of the medical recovery. In the first case the system error is under 2% and in the second case is under 1%. The second stage using the Microsoft Kinect was introduced at the last evaluation session. The measured values were identical to the measures with the zebris devices in the case of the thoracic tracking. Conclusions: Young adults are more willing to follow through a rehabilitation process if they are positively motivated. By using advanced medical devices like the Zebris and the Kinect device an objective picture about the patient’s motion range can be formed. The data obtained from these devices can be used in combination with other data collected from the patients thought questionnaires. The sum of these data provide an objective suggestion about the correct treatment. It is important to have all the data stored in a place where all the medical system can access them. This is done by using the HL7 CDA standard. All of these can provide a correct treatment and a better patient care.