Optimization Algorithms for Integrating Advanced Facility-Level Healthcare Technologies into Personal Healthcare Devices

Healthcare is one of the most important services to preserve the quality of our daily lives, and it is capable of dealing with issues such as global aging, increase in the healthcare cost, and changes to the medical paradigm, i.e., from the in-facility cure to the prevention and cure outside the facility. Accordingly, there has been growing interest in the smart and personalized healthcare systems to diagnose and care themselves. Such systems are capable of providing facility-level diagnosis services by using smart devices (e.g., smartphones, smart watches, and smart glasses). However, in realizing the smart healthcare systems, it is very difficult, albeit impossible, to directly integrate high-precision healthcare technologies or scientific theories into the smart devices due to the stringent limitations in the computing power and battery lifetime, as well as environmental constraints. In this dissertation, we propose three optimization methods in the field of cell counting systems and gait-aid systems for Parkinson's disease patients that address the problems that arise when integrating a specialized healthcare system used in the facilities into mobile or wearable devices. First, we present an optimized cell counting algorithm based on heuristic optimization, which is a key building block for realizing the mobile point-of-care platforms. Second, we develop a learning-based cell counting algorithm that guarantees high performance and efficiency despite the existence of blurry cells due to out-focus and varying brightness of background caused by the limitation of lenses free in-line holographic apparatus. Finally, we propose smart gait-aid glasses for Parkinson’s disease patients based on mathematical optimization. ⓒ 2017 DGISTopenI. Introduction 1-- 1.1 Global Healthcare Trends 1-- 1.2 Smart Healthcare System 2-- 1.3 Benefits of Smart Healthcare System 3-- 1.4 Challenges of Smart Healthcare. 4-- 1.5 Optimization 6-- 1.6 Aims of the Dissertation 7-- 1.7 Dissertation Organization 8-- II.Optimization of a cell counting algorithm for mobile point-of-care testing platforms 9-- 2.1 Introduction 9-- 2.2 Materials and Methods. 13-- 2.2.1 Experimental Setup. 13-- 2.2.2 Overview of Cell Counting. 16-- 2.2.3 Cell Library Optimization. 18-- 2.2.4 NCC Approximation. 20-- 2.3 Results 21-- 2.3.1 Cell Library Optimization. 21-- 2.3.2 NCC Approximation. 23-- 2.3.3 Measurement Using an Android Device. 28-- 2.4 Summary 32-- III.Human-level Blood Cell Counting System using NCC-Deep learning algorithm on Lens-free Shadow Image. 33-- 3.1 Introduction 33-- 3.2 Cell Counting Architecture 36-- 3.3 Methods 37-- 3.3.1 Candidate Point Selection based on NCC. 37-- 3.3.2 Reliable Cell Counting using CNN. 40-- 3.4 Results 43-- 3.4.1 Subjects . 43-- 3.4.2 Evaluation for the cropped cell image 44-- 3.4.3 Evaluation on the blood sample image 46-- 3.4.4 Elapsed-time evaluation 50-- 3.5 Summary 50-- IV.Smart Gait-Aid Glasses for Parkinson’s Disease Patients 52-- 4.1 Introduction 52-- 4.2 Related Works 54-- 4.2.1 Existing FOG Detection Methods 54-- 4.2.2 Existing Gait-Aid Systems 56-- 4.3 Methods 57-- 4.3.1 Movement Recognition. 59-- 4.3.2 FOG Detection On Glasses. 62-- 4.3.3 Generation of Visual Patterns 66-- 4.4 Experiments . 67-- 4.5 Results 69-- 4.5.1 FOG Detection Performance. 69-- 4.5.2 Gait-Aid Performance. 71-- 4.6 Summary 73-- V. Conclusion 75-- Reference 77-- 요약문 89본 논문은 의료 관련 연구시설 및 병원 그리고 실험실 레벨에서 사용되는 전문적인 헬스케어 시스템을 개인의 일상생활 속에서 사용할 수 있는 스마트 헬스케어 시스템에 적용시키기 위한 최적화 문제에 대해 다룬다. 현대 사회에서 의료비용 증가 세계적인 고령화에 따라 의료 패러다임은 질병이 발생한 뒤 시설 내에서 치료 받는 방식에서 질병이나 건강관리에 관심있는 환자 혹은 일반인이 휴대할 수 있는 개인용 디바이스를 이용하여 의료 서비스에 접근하고, 이를 이용하여 질병을 미리 예방하는 방식으로 바뀌었다. 이에 따라 언제, 어디서나 스마트 디바이스(스마트폰, 스마트워치, 스마트안경 등)를 이용하여 병원 수준의 예방 및 진단을 실현하는 스마트 헬스케어가 주목 받고 있다. 하지만, 스마트 헬스케어 서비스 실현을 위하여 기존의 전문 헬스케어 장치 및 과학적 이론을 스마트 디바이스에 접목하는 데에는 스마트 디바이스의 제한적인 컴퓨팅 파워와 배터리, 그리고 연구소나 실험실에서 발생하지 않았던 환경적인 제약조건으로 인해 적용 할 수 없는 문제가 있다. 따라서 사용 환경에 맞춰 동작 가능하도록 최적화가 필요하다. 본 논문에서는 Cell counting 분야와 파킨슨 환자의 보행 보조 분야에서 전문 헬스케어 시스템을 스마트 헬스케어에 접목시키는데 발생하는 세 가지 문제를 제시하고 문제 해결을 위한 세 가지 최적화 알고리즘(Heuristic optimization, Learning-based optimization, Mathematical optimization) 및 이를 기반으로 하는 시스템을 제안한다.DoctordCollectio

A new approach to study gait impairments in Parkinson’s disease based on mixed reality

Dissertação de mestrado integrado em Engenharia Biomédica (especialização em Eletrónica Médica)Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. PD onset is at 55 years-old on average, and its incidence increases with age. This disease results from dopamine-producing neurons degeneration in the basal ganglia and is characterized by various motor symptoms such as freezing of gait, bradykinesia, hypokinesia, akinesia, and rigidity, which negatively impact patients’ quality of life. To monitor and improve these PD-related gait disabilities, several technology-based methods have emerged in the last decades. However, these solutions still require more customization to patients’ daily living tasks in order to provide more objective, reliable, and long-term data about patients’ motor conditions in home-related contexts. Providing this quantitative data to physicians will ensure more personalized and better treatments. Also, motor rehabilitation sessions fostered by assistance devices require the inclusion of quotidian tasks to train patients for their daily motor challenges. One of the most promising technology-based methods is virtual, augmented, and mixed reality (VR/AR/MR), which immerse patients in virtual environments and provide sensory stimuli (cues) to assist with these disabilities. However, further research is needed to improve and conceptualize efficient and patient-centred VR/AR/MR approaches and increase their clinical evidence. Bearing this in mind, the main goal of this dissertation was to design, develop, test, and validate virtual environments to assess and train PD-related gait impairments using mixed reality smart glasses, integrated with another high-technological motion tracking device. Using specific virtual environments that trigger PD-related gait impairments (turning, doorways, and narrow spaces), it is hypothesized that patients can be assessed and trained in their daily challenges related to walking. Also, this tool integrates on-demand visual cues to provide visual biofeedback and foster motor training. This solution was validated with end-users to test the identified hypothesis. The results showed that, in fact, mixed reality has the potential to recreate real-life environments that often provoke PD-related gait disabilities, by placing virtual objects on top of the real world. On the contrary, biofeedback strategies did not significantly improve the patients’ motor performance. The user experience evaluation showed that participants enjoyed participating in the activity and felt that this tool can help their motor performance.A doença de Parkinson (DP) é a segunda doença neurodegenerativa mais comum depois da doença de Alzheimer. O início da DP ocorre, em média, aos 55 anos de idade, e a sua incidência aumenta com a idade. Esta doença resulta da degeneração dos neurónios produtores de dopamina nos gânglios basais e é caracterizada por vários sintomas motores como o congelamento da marcha, bradicinesia, hipocinesia, acinesia, e rigidez, que afetam negativamente a qualidade de vida dos pacientes. Nas últimas décadas surgiram métodos tecnológicos para monitorizar e treinar estas desabilidades da marcha. No entanto, estas soluções ainda requerem uma maior personalização relativamente às tarefas diárias dos pacientes, a fim de fornecer dados mais objetivos, fiáveis e de longo prazo sobre o seu desempenho motor em contextos do dia-a-dia. Através do fornecimento destes dados quantitativos aos médicos, serão assegurados tratamentos mais personalizados. Além disso, as sessões de reabilitação motora, promovidas por dispositivos de assistência, requerem a inclusão de tarefas quotidianas para treinar os pacientes para os seus desafios diários. Um dos métodos tecnológicos mais promissores é a realidade virtual, aumentada e mista (RV/RA/RM), que imergem os pacientes em ambientes virtuais e fornecem estímulos sensoriais para ajudar nestas desabilidades. Contudo, é necessária mais investigação para melhorar e conceptualizar abordagens RV/RA/RM eficientes e centradas no paciente e ainda aumentar as suas evidências clínicas. Tendo isto em mente, o principal objetivo desta dissertação foi conceber, desenvolver, testar e validar ambientes virtuais para avaliar e treinar as incapacidades de marcha relacionadas com a DP usando óculos inteligentes de realidade mista, integrados com outro dispositivo de rastreio de movimento. Utilizando ambientes virtuais específicos que desencadeiam desabilidades da marcha (rodar, portas e espaços estreitos), é possível testar hipóteses de que os pacientes possam ser avaliados e treinados nos seus desafios diários. Além disso, esta ferramenta integra pistas visuais para fornecer biofeedback visual e fomentar a reabilitação motora. Esta solução foi validada com utilizadores finais de forma a testar as hipóteses identificadas. Os resultados mostraram que, de facto, a realidade mista tem o potencial de recriar ambientes da vida real que muitas vezes provocam deficiências de marcha relacionadas à DP. Pelo contrário, as estratégias de biofeedback não provocaram melhorias significativas no desempenho motor dos pacientes. A avaliação feita pelos pacientes mostrou que estes gostaram de participar nos testes e sentiram que esta ferramenta pode auxiliar no seu desempenho motor

Designing socially acceptable mHealth technologies for Parkinson's disease self-management

Mobile health (mHealth) technologies for Parkinson’s disease management have developed quickly in recent years. Research in this area typically focuses on evaluation of the accuracy and reliability of the technology, often to the exclusion of social factors and patient perspectives. This qualitative systematic review aimed to investigate the barriers to and facilitators of use mHealth technologies for disease self-management from the perspective of People with Parkinson's (PwP). Findings revealed that technological, as well as social, and financial factors are key considerations for mHealth design, to ensure its acceptability, and long-term use by PwP. This study proposes that a co-design approach could contribute to the design and development of mHealth that are socially acceptable to PwP, and enable their successful long-term use in the context of daily life.Mobile health (mHealth) technologies for Parkinson’s disease management have developed quickly in recent years. Research in this area typically focuses on evaluation of the accuracy and reliability of the technology, often to the exclusion of social factors and patient perspectives. This qualitative systematic review aimed to investigate the barriers to and facilitators of use mHealth technologies for disease self-management from the perspective of People with Parkinson's (PwP). Findings revealed that technological, as well as social, and financial factors are key considerations for mHealth design, to ensure its acceptability, and long-term use by PwP. This study proposes that a co-design approach could contribute to the design and development of mHealth that are socially acceptable to PwP, and enable their successful long-term use in the context of daily life

Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis

Background: Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective: This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods: A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta - Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation The Cochrane Collaboration tool was used to evaluate the risk of bias. Results: In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36%) contributed information to the meta-analysis. Overall, 64% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95% CI -0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change -1.211, 95% CI -3.2005 to 0.7768; z=1.194; P=.23). Conclusions: AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed

O uso de tecnologias assistivas para o cuidado às pessoas com doença de Parkinson: uma revisão integrativa

TCC (graduação) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Enfermagem.INTRODUÇÃO: A Doença de Parkinson apesar de ser amplamente conhecida por seus sintomas motores, possui também uma gama de sintomas não motores, que acarretam em dificuldades na realização de suas atividades diárias. As tecnologias assistivas são uma estratégia importante para promover sua funcionalidade. Diante da necessidade de aquisição de conhecimento da enfermagem acerca de novas tecnologias que auxiliem no autocuidado das pessoas com Doença de Parkinson justifica-se esta revisão de literatura. OBJETIVO: Identificar a produção científica acerca das tecnologias assistivas para pessoas com a doença de Parkinson publicadas nos últimos cinco anos. MÉTODO: Trata-se de uma pesquisa exploratória modelada por uma revisão de literatura integrativa. RESULTADOS: Foram encontrados vinte e seis artigos que submetidos a análise temática de conteúdo resultaram em cinco categorias de Tecnologias Assistivas para: o controle e manejo da medicação; tremor na Doença de Parkinson; estimular a marcha durante o congelamento; melhora da marcha; e melhora da sialorréia. CONSIDERAÇÕES FINAIS: Os estudos encontrados sobre tecnologias assistivas disponíveis foram em pequeno número, para o uso das pessoas com doença Parkinson, e ainda a revisão mostrou ferramentas em fase de testes, e outras que não obtiveram êxito ou que não foram avaliadas até então. Levando em consideração que os profissionais de enfermagem estão envolvidos no cuidado, e em contato direto com a população com Parkinson, o conhecimento, acesso, testagem e a utilização destas tecnologias pela enfermagem contribuirá para um cuidado mais individualizado e promotor de autonomia com pessoas com Doença de Parkinson

Assessment and exercise for Freezing of Gait in Parkinson’s Disease

Parkinson's disease (PD) is a neurodegenerative disorder characterized through multiple motor- and non-motor symptoms. Gait disorders and balance deficits are very common in people with PD and often cannot be fully alleviated by standard therapy. The mentioned deficits not only lower the quality of life but also increase the risk for falls. Especially people with PD who experience Freezing of Gait (FOG), an episodic gait disturbance, are at risk and need individualized therapy options. Therefore, exercise and physical therapy have become increasingly important in the rehabilitation of PD. This work aims to investigate the validity and reliability for assessment methods for FOG and check their potential as outcome measures for clinical trials. Furthermore, it explores feasibility and treatment options of the Split-belt treadmill (SBT) as a tool modulate gait asymmetry in people with PD as well as the short-term effects on gait. Study 1 focused on the validity of the German version of the New Freezing of Gait-Questionnaire. It found that the translated version was a valid instrument to assess the severity of FOG in the German-speaking PD population. Study 2 investigated the within-session reliability of the assessment of anticipatory postural adjustment in PD+FOG and found a high variability in the reliability scores, depending on the outcome of interest. Study 3 summarized the current literature on SBT walking in people with PD and showed that people with PD can successfully adapt their gait to the split belts. The final study investigated the short-term effects of one SBT training session and found that SBT with changing conditions was most useful to improve gait adaptation in PD+FOG. This thesis provides some important findings regarding the assessment of FOG and highlights opportunities for suitable outcome measures for clinical studies in this field. Furthermore, it highlights the potential of SBT training for the rehabilitation of PD by showing that it is feasible, safe and above all has positive effects on gait adaptation in people with PD. Those findings give important implications for the selection of outcome measure and the design of training interventions for PD+FOG in future studies

Revisión del estado del arte sobre tendencias tecnológicas para el análisis del comportamiento y actividades humanas

The study of human behavior allows the knowledge about people's behaviors, behavior determined by multiple factors: cultural, social, psychological, genetic, religious, among others, which affect the relationships and interaction with the environment. The infinity of data in our lives and the search for behavioral patterns from that data has been an amazing work whose benefit is focused on the determined patterns and intelligent analysis that lead to new knowledge. A significant amount of resources from pattern recognition in human activities and daily life has had greater dominance in the management of mobility, health and wellness.The current paper presents a review of technologies for human behavior analysis and use as tools for diagnosis, assistance, for interaction in intelligent environments and assisted robotics applications. The main scope is to give an overview of the technological advances in the analysis of human behavior, activities of daily living and mobility, and the benefits obtained.El estudio del comportamiento humano permite el conocimiento sobre las conductas de las personas, conducta determinada por múltiples factores: culturales, sociales, psicológicos, genéticos, religiosos, entre otros; que inciden en las relaciones y la interacción con el entorno. La infinidad de datos en nuestras vidas y la búsqueda de patrones de comportamiento a partir de esos datos ha sido un trabajo asombroso cuyo provecho se centra en los patrones determinados y el análisis inteligente que conducen a nuevos conocimientos. Una cantidad significativa de recursos a partir del reconocimiento de patrones en las actividades humanas y de vida diaria ha tenido mayor dominio en la gestión de la movilidad, la salud y bienestar.El actual documento presenta una revisión de las tecnologías para el análisis del comportamiento humano y del uso como herramientas para el diagnóstico, asistencia, para la interacción en ambientes inteligentes y aplicaciones de robótica asistida. El alcance principal es dar una visión general de los avances tecnológicos en el análisis del comportamiento humano, actividades de la vida diaria y movilidad, y de los beneficios obtenidos