Towards remote monitoring and remotely supervised training

The growing number of elderly and people with chronic disorders in our western society puts such pressure on our healthcare system that innovative approaches are demanded to make our health care more effective and more efficient. One way of innovation of healthcare can be obtained by introducing new services which enable less pressure on the intramural health care and support a more independent living and self efficacy of patients. Two of such services are Remote monitoring and remotely supervised training (RMT). Remote monitoring enables freedom to the patient with the assurance that assistance is possible whenever required. Remotely supervised treatment enables efficient and effective user-centred training anywhere and anytime with an intensity not feasible in an intramural setting. It is our vision that remote monitoring and remotely supervised treatment applications will become very important for patients (safety, more in control, convenience), health care insurances (efficiency, cost reduction) and healthcare service providers (more effective, innovative)

A serious game for COPD patients to perform physiotherapeutic exercises

The goal of this research was 1) to investigate the usability of the Orange Submarine game, and 2) to explore the changes in saturation and pulse rate in COPD patients while playing the game. The game was positively received by the patients and could provide a new fun way for performing exercises, either at home or as part of the regular treatment

Motor unit properties of biceps brachii in chronic stroke patients assessed with high-density surface EMG

The aim of this study was to investigate motor unit (MU) characteristics of the biceps brachii in post-stroke patients, using high-density surface electromyography (sEMG). Eighteen chronic hemiparetic stroke patients took part. The Fugl-Meyer score for the upper extremity was assessed. Subjects performed an isometric step contraction consisting of force levels from 5 to 50% MVC while sEMG of the biceps brachii was recorded with a two dimensional 16-channel electrode array. This was repeated for both sides. Motor unit action potentials (MUAPs) were extracted from the EMG signals, and their root-mean-square value (RMSMUAP, reflecting MU size) and mean frequency of the power spectrum (FMEANMUAP, reflecting recruitment threshold) were calculated. \ud FMEANMUAP was smaller on the affected than on the unaffected side, indicating an increased contribution of low-threshold motor units, possibly related to degeneration of high-threshold motor units. The ratio of RMSMUAP on the affected side divided by that on the unaffected side correlated significantly with the Fugl-Meyer score. This ratio may reflect the extent to which reinnervation has occurred on the affected side. \u

Early impact analysis of remote vital sign monitoring after esophagectomy: a multi-method study design

Background: Esophagectomy is associated with serious postoperative complications in 20-40% of the patients. Early recognition and treatment of these complications is critical to prevent secondary damage. To support medical professionals in the timely detection of clinical deterioration in patients admitted to the ward, it is of interest to use wireless sensor technologies allowing unobtrusive continuous vital sign tracking. However, it is yet unclear under which circumstances and to what extent telemonitoring provides beneficial effects in this patient population. Methods: We designed a multi-methods and multicenter study to evaluate the expected effects of continuous vital sign monitoring in the postoperative ward trajectory of patients undergoing esophagectomy. Semi-structured interviews with nurses and surgeons are conducted to elicit the probability of earlier detection and treatment of postoperative complications and the effects on related clinical outcome measures (mortality, ICU readmissions, and hospital stay length). To support valid estimations, interviews include scenario’s incorporating the characteristics and outcomes from center-specific patient population. Decision tree analysis is performed to assess the relation between clinical outcome for current situation and the conceived situation with continuous ward monitoring. Findings: We expect that the proposed study will provide insight in the clinical effects of continuous remote vital sign monitoring in the postoperative ward in patients undergoing esophagectomy. Discussion: Decision tree analysis combined with expert elicitation enables assessment of the afferent (i.e. monitoring) and efferent (i.e. response chain) arm of telemonitoring, and facilitates impact analysis in an early stage. The results of this study can be used to optimize the strategy of vital sign monitoring in wards, and to target situations where improvement in patient outcome and safety is expected

Effect of augmented feedback on motor function of the affected upper extremity in rehabilitation patients: a systematic review of randomized controlled trials

Objective: Assessment of the available evidence regarding the effect of augmented feedback on motor function of the upper extremity in rehabilitation patients.Methods: A systematic literature search was performed to identify randomized controlled trials that evaluated the effect of augmented feedback on motor function. Two reviewers systematically assessed the methodological quality of the trials. The reported effects were examined to evaluate the effect of therapeutic interventions using augmented feedback and to identify a possible relationship with patient characteristics, type of intervention, or methodological quality.Results: Twenty-six randomized controlled trials were included, 9 of which reported a positive effect on arm function tests. Follow-up measurements were performed in 8 trials, 1 of which reported a positive effect. Different therapeutic interventions using augmented feedback, i.e. electromyographic biofeedback, kinetic feedback, kinematic feedback, or knowledge of results, show no difference in effectiveness.Conclusion: No firm evidence was found of effectiveness regarding the use of augmented feedback to improve motor function of the upper extremity in rehabilitation patients. Future studies should focus more on the content, form and timing of augmented feedback concerning the therapeutic intervention. It should be emphasized that motor learning effects can only be determined by re-examining the population after a follow-up period. \u

Exploring Patterns of Activities of Daily Living in the Home Environment

Background: Senior citizens tend to live longer and longer independently. Judging whether a senior person is still capable of living on his own is often based on the occurrence of incidents, with all consequences thereof. In the specific case of early dementia, the symptoms are not immediately apparent and the occurrence and severity of incidents progress gradually over time. In this case, the children or grandchildren are burdened by the question whether or not the elderly adult can still live safely and independently in his or her own home. This decision is only based on input obtained through incidental visits. We believe that the capability of independent living can only be objectively judged, by a health professional, if long term objective information on the elderly person's daily activities of living (ADL) is available

A model-based approach to stabilizing crutch supported paraplegic standing by artifical hip joint stiffness

The prerequisites for stable crutch supported standing were analyzed in this paper. For this purpose, a biomechanical model of crutch supported paraplegic stance was developed assuming the patient was standing with extended knees. When using crutches during stance, the crutches will put a position constraint on the shoulder, thus reducing the number of degrees of freedom. Additional hip-joint stiffness was applied to stabilize the hip joint and, therefore, to stabilize stance. The required hip-joint stiffness for changing crutch placement and hip-joint offset angle was studied under static and dynamic conditions. Modeling results indicate that, by using additional hip-joint stiffness, stable crutch supported paraplegic standing can be achieved, both under static as well as dynamic situations. The static equilibrium postures and the stability under perturbations were calculated to be dependent on crutch placement and stiffness applied. However, postures in which the hip joint was in extension (C postures) appeared to the most stable postures. Applying at least 60 N /spl middot/ m/rad hip-joint stiffness gave stable equilibrium postures in all cases. Choosing appropriate hip-joint offset angles, the static equilibrium postures changed to more erect postures, without causing instability or excessive arm forces to occur

Guideline-based decision support for the mobile patient incorporating data streams from a body sensor network

We present a mobile decision support system (mDSS) which helps patients adhere to best clinical practice by providing pervasive and evidence-based health guidance via their smartphones. Similar to some existing clinical DSSs, the mDSS is designed to execute clinical guidelines, but it operates on streaming data from, e.g., body sensor networks instead of persistent data from clinical databases. Therefore, we adapt the typical guideline-based architecture by basing the mDSS design on existing data stream management systems (DSMSs); during operation, the mDSS instantiates from the guideline knowledge a network of concurrent streaming processes, avoiding the resource implications of traditional database approaches for processing patient data which may arrive at high frequencies via multiple channels. However, unlike typical DSMSs, we distinguish four types of streaming processes to reflect the full disease management process: Monitoring, Analysis, Decision and Effectuation. A prototype of the mDSS has been developed and demonstrated on an Android smartphone

A Feasibility Study in Measuring Soft Tissue Artifacts on the Upper Leg Using Inertial and Magnetic Sensors

Soft-tissue artifacts cause inaccurate estimates of body segment orientations. The inertial sensor (or optical marker) is orientating (or displacing) with respect to the bone it has to measure, due to muscle and skin movement [1]. In this pilot study 11 inertial and magnetic sensors (MTw, Xsens Technologies) were placed on the rectus femoris, vastus medialis and vastus lateralis (upper leg). One sensor was positioned on the tendon plate behind the quadriceps (iliotibial tract, as used in Xsens MVN [1]) and used as reference sensor. Walking, active and passive knee extensions and muscle contractions without flexion/extension were recorded using one subject. The orientation of each sensor with respect to the reference sensor was calculated. During walking, relative orientations of up to 28.6º were measured (22.4±3.6º). During muscle contractions without flexion/extension the largest relative orientations were measured on the rectus femoris (up to 11.1º) [2]. This pilot showed that the ambulatory measurement of deformation of the upper leg is feasible; however, improving the measurement technology is required. We therefore have designed a new inertial and magnetic sensor system containing smaller sensors, based on the design of an instrumented glove for the assessment of hand kinematics [3]. This new sensor system will then be used to investigate soft-tissue artifacts more accurately; in particular we will focus on in-use estimation and elimination of these artifacts