Development and Feasibility of a Smartphone, ECG and GPS Based System for Remotely Monitoring Exercise in Cardiac Rehabilitation

Background Despite its efficacy and cost-effectiveness, exercise-based cardiac rehabilitation is undertaken by less than one-third of clinically eligible cardiac patients in every country for which data is available. Reasons for non-participation include the unavailability of hospital-based rehabilitation programs, or excessive travel time and distance. For this reason, there have been calls for the development of more flexible alternatives. Methodology and Principal Findings We developed a system to enable walking-based cardiac rehabilitation in which the patient's single-lead ECG, heart rate, GPS-based speed and location are transmitted by a programmed smartphone to a secure server for real-time monitoring by a qualified exercise scientist. The feasibility of this approach was evaluated in 134 remotely-monitored exercise assessment and exercise sessions in cardiac patients unable to undertake hospital-based rehabilitation. Completion rates, rates of technical problems, detection of ECG changes, pre- and post-intervention six minute walk test (6 MWT), cardiac depression and Quality of Life (QOL) were key measures. The system was rated as easy and quick to use. It allowed participants to complete six weeks of exercise-based rehabilitation near their homes, worksites, or when travelling. The majority of sessions were completed without any technical problems, although periodic signal loss in areas of poor coverage was an occasional limitation. Several exercise and post-exercise ECG changes were detected. Participants showed improvements comparable to those reported for hospital-based programs, walking significantly further on the post-intervention 6 MWT, 637 m (95% CI: 565–726), than on the pre-test, 524 m (95% CI: 420–655), and reporting significantly reduced levels of cardiac depression and significantly improved physical health-related QOL. Conclusions and Significance The system provided a feasible and very flexible alternative form of supervised cardiac rehabilitation for those unable to access hospital-based programs, with the potential to address a well-recognised deficiency in health care provision in many countries. Future research should assess its longer-term efficacy, cost-effectiveness and safety in larger samples representing the spectrum of cardiac morbidity and severity

Fitness for work in mining: Not a "one size fits all" approach

Health promotion programs can help prevent work-related illness or injury. However, in many industries only a very small number of organizations effectively plan, implement, monitor and review risk management processes, and the emphasis has been on injury management rather than prevention. In coal mining, this is exemplified by the lack of accepted strategies to maintain and enhance the fitness levels of miners. A recent survey of a cross-section of OH&S officers working in Queensland and New South Wales mines, nevertheless, indicated that lack of fitness, stamina and skill rank highest, along with work environment factors, as contributors to injury. There is relatively little evidence on the efficacy and cost effectiveness of existing injury prevention programs. An opportunity exists to develop a more holistic approach to the fitness of miners as a component of the health surveillance program. This begins with the selection of miners following a medical examination supplemented by relevant fitness or work related tests, enabling more targeted strength, aerobic and flexibility programs designed to match the physical demands of mining and maintain or enhance fitness at levels required for injury minimisation. This presentation uses the workplace health literature and surveys of the mining industry to suggest strategies to implement realistic and more holistic fitness interventions for miners in line with continuing health surveillance and preservation of longer term health

Directional stimulus-response compatibility: a test of three alternative principles

The basis of directional stimulus-response compatibility was studied using a task in which 128 participants moved a cursor into targets with a joystick, resembling the operation of certain industrial and construction equipment. Compatible and incompatible versions of three alternative compatibility principles were compared in all combinations. Visual Field (VF) compatibility was present if cursor and controlling limb movement were in the same direction in the visual field, Control Display (CD) compatibility meant that the control motion was in the same direction as, and parallel to, cursor motion, and Muscle Synergy (MS) compatibility was defined as use of the muscle synergy normally associated with the required direction as seen in the visual field. VF-compatible conditions had significantly shorter reaction, movement and homing times, and fewer reversal errors, for males and females, in two testing sites. These advantages were maintained over practice. VF compatibility was confirmed as a robust spatial compatibility principle that is affected by neither the orientation of the operator's limb or head, nor the muscle synergy used in executing the task. It offers not only more rapid performance, but also a markedly reduced rate of potentially dangerous directional errors. The relationship between this finding and theoretical aspects of stimulus-response compatibility is discussed

Variability Effects on the Internal Structure of Rapid Aiming Movements

Two experiments are reported in which the effects of different levels of spatial variability in the initial phase of aiming movements were explored. It was found that longer, faster, and more spatially variable initial submovements were associated with an almost proportional increase in the distance between the average location at which the first submovement ended and the target. the first experiment involved a multisegmental arm motion that required a direction reversal, in which spatial variability could be estimated in all three dimensions. The second was a unidirectional, one-degree-of-freedom wrist supination task. The variability-amplitude relationship for the initial submovement was present in both. It is argued that the variability, or unpredictability, of the initial submovement is a determinant of its average amplitude, such that initial submovements approach the target as closely as is permitted by the level of variability. Such a mechanism allows task constraints such as accuracy requirements and allowable error rates to be met most efficiently, in a manner similar to the recently described optimisation of submovement durations. If this mechanism is a general, ubiquitous phenomenon in rapid aiming, certain features of its internal kinematic structure are predictable. A set of five such predictions is outlined

Predictors of Driving Assessment Outcome in Parkinson’s Disease

Introduction: Clinical decisions about driving can be particularly difficult in Parkinson’s Disease (PD), since patients have a range of fluctuating cognitive, motor, and sensory symptoms that, alone or in combination, potentially impair driving. This study evaluated selected clinical and functional tests as predictors of driving safety outcomes in PD patients. Methods: Twenty five PD patients and 21 age-matched controls, all regular drivers, underwent neurological evaluation and assessment of cognitive, visual and motor function and a standardised, on-road driving assessment. The capacity of the tests to predict pass/fail driving outcomes was determined by selecting a sub-set with the highest predictive value from each domain and then subjecting these to discriminant function analysis. Accuracy, sensitivity, specificity and positive and negative predictive values were determined. Results: Three relatively simple tests from the larger battery predicted pass/fail driving outcomes with relatively high specificity (PD: 64.3%, controls: 93.8%, both combined: 85.2%); and moderate sensitivity (PD: 72.7%, controls: 60.0%, both combined: 63.2%). The tests assessed motor performance (Purdue Pegboard test), contrast sensitivity (Pelli-Robson test) and cognitive function (oral version of Symbol Digit Modalities test). Adding time since diagnosis increased specificity to 71.4 % and sensitivity to 90.9% for the PD group. Conclusion: These simple tests confer more objectivity and predictive power to clinical recommendations for driving; they reflect distinct functions that are necessary for safe driving and may be especially useful when on-road assessments are not available

Preparatory processes in a case of hemi-parkinsonism

Reaction times and movement times were recorded in a subject with parkinsonian symptoms confined largely to the left side of the body. Advance information concerning the movement was varied, being with complete, partial or no preparation. The results suggest that processing of preparation for the movement is not qualitatively different for the more affected side, but is substantially slowed

An indication that non-informative vision eliminates the Kinaesthetic Fusion Effect

This study investigated the Kinaesthetic Fusion Effect (KFE) first described by Craske and Kenny in 1981. The current study did not replicate these findings. Participants did not perceive any reduction in the sagittal separation of a button pressed by the index finger of one arm and a probe touching the other, following repeated exposure to the tactile stimuli present on both unseen arms. This study’s failure to replicate the widely-cited KFE as described by Craske et al. (1984) suggests that it may be contingent on several aspects of visual information, especially the availability of a specific visual reference, the role of instructions regarding gaze direction, and the potential use of a line of sight strategy when referring felt positions to an interposed surface. In addition, a foreshortening effect was found; this may result from a line-of-sight judgment and represent a feature of the reporting method used. The transformed line of sight data were regressed against the participant reported values, resulting in a slope of 1.14 (right arm) and 1.11 (left arm), and r > 0.997 for each. The study also provides additional evidence that mis-perceptions of the mediolateral position of the limbs specifically their separation and consistent with notions of Gestalt grouping, is somewhat labile and can be influenced by active motions causing touch of one limb by the other. Finally, this research will benefit future studies that require participants to report the perceived locations of the unseen limbs

Exercise-based cardiac rehabilitation for the 21st century

Exercise-based cardiac rehabilitation (CR) is efficacious in reducing mortality and hospital admissions; however it remains inaccessible to large proportions of the patient population. Removal of attendance barriers for hospital or centre-based CR has seen the promotion of home-based CR. Delivery of safe and appropriately prescribed exercise in the home was first documented 25 years ago, with the utilisation of fixed land-line telecommunications to monitor ECG. The advent of miniature ECG sensors, in conjunction with smartphones, now enables CR to be delivered with greater flexibility with regard to location, time and format, while retaining the capacity for real-time patient monitoring. A range of new systems allow other signals including speed, location, pulse oximetry, and respiration to be monitored and these may have application in CR. There is compelling evidence that telemonitored-based CR is an effective alternative to traditional CR practice. The long-standing barrier of access to centre-based CR, combined with new delivery platforms, raises the question of when telemonitored-based CR could replace conventional approaches as the standard practice

Control/Response Compatibility, Muscle Synergy and the Virtual Visual Field: What You See Is What You Get

Abstract Three components were hypothesized which could affect operator response in the manual control of a system. These included muscle synergy compatibility (MS), geographic control/display compatibility (CD), and visual-field compatibility (VF). Disruption in one of these was suspected as a contributing factor in documented accident cases. A 2 x 2~2 between-subjects factorial design was used to evaluate all combinations of compatible and incompatible arrangements based upon these variables, using 64 undergraduate students as participants. A static-target acquisition task was used in which subjects manipulated a specially designed joystick to move a cursor to defined target locations. Performance measures included reaction time, movement time, homing time, and frequency and magnitude of directional reversals. Results indicated that visual field (VF) compatibility/incompatibility significantly influenced reaction time, homing time, and reversal frequency and magnitude, while CD and MS manipulations had no significant main effects on performance. Significant gender effects were also found. The results of this study suggest that compatibility of control input and system response is judged primarily by direction of movement in the virtual visual field (self reference). This has implications for the design of systems such as small mobile cranes where the operator may be repositioned relative to a fixed directional control. There are a number of systems employing manual controls in which the operator may assume a variety of orientations relative to the control input device. In some cases the control device is fixed relative to the system it operates while in others the control hardware is more loosely connected, often by flexible cable or radio link. Each of these configurations represents a case where some form of incompatibility between control input and system response may be introduced, either by relocation of the operator relative to the control in the first case or reorientation of the control relative to the system in the second case. The latter case is certainly the most recognized as producing input errors (Loveless, 1962) and has, as such, been a suspected source of serious accidents involving small truck-bed-mounted mobile cranes. These accidents have ranged from swinging loads of wallboard through already constructed walls to contacting power lines with subsequent electrocution of the operator. A series of such accidents occurred in the Midwest in the 1980's and was instrumental in the initiation of subsequent research into possible causal factors. The case of reorientation of the operator, though less visible, also produces some potential disruption of compatibility and was first recognized by Humphries and Shepard (Humphries, 1958). Their work indicated that simple direction-of-motion compatibility did not always produce the best performance. Although mention was subsequently made by others that location and orientation of the operator should be taken into consideration, little attention was given to these factors. More attention, in fact, has been given to orientation of the control relative to the "display" or effector A recent attempt was made by Worringham and Beringer (1 989) to explore the operator orientation question more thoroughly. This study examined the influences of three forms of directional compatibility: Visual-motor (VM) compatibility in which movement on the display corresponds with movement of the control in the operator's virtual visual field when the operator looks at the control rather than the display: control-display (CD) compatibility which was the conventional " g e o g rap h i c " d i re c t i o n -of -mot i o n c o m pat i b i I i t y ; a n d visual-trunk (VT) compatibility in which the control movement was in the same direction relative to the operator's trunk as the movement of the display in the visual field. Although VM compatibility appeared to produce performance superior to that obtained with either CD or VT compatibility, the obtained data did not allow one to distinguish between two alternative explanations for its effectiveness. Was this a case of congruence between display motion in the actual visual field and control motion in the "virtual" visual field (what one sees when looking at the control when it is not in the same direction from the operator as the display), or was this a correspondence between the display motion and the direction of limb motion relative to the most distal stationary limb segment? In other words, did the motor programming associated with the most usual muscle responses required to operate the control in the expected fashion affect the timeliness and success of the response? This factor, termed muscle synergy (MS), was a potential contributor which could not be ruled out as a factor. Thus, a subsequent study was designed to examine the role played by muscle synergy

An indication that non-informative vision eliminates \ud the Kinaesthetic Fusion Effect

This study investigated the Kinaesthetic Fusion Effect (KFE) first described by Craske and Kenny in 1981. The current study did not replicate these findings. Participants did not perceive any reduction in the sagittal separation of a button pressed by the index finger of one arm and a probe touching the other, following repeated exposure to the tactile stimuli present on both unseen arms. This study’s failure to replicate the widely-cited KFE as described by Craske et al. (1984) suggests that it may be contingent on several aspects of visual information, especially the availability of a specific visual reference, the role of instructions regarding gaze direction, and the potential use of a line of sight strategy when referring felt positions to an interposed surface. In addition, a foreshortening effect was found; this may result from a line-of-sight judgment and represent a feature of the reporting method used. The transformed line of sight data were regressed against the participant reported values, resulting in a slope of 1.14 (right arm) and 1.11 (left arm), and r > 0.997 for each. The study also provides additional evidence that mis-perceptions of the mediolateral position of the limbs specifically their separation and consistent with notions of Gestalt grouping, is somewhat labile and can be influenced by active motions causing touch of one limb by the other. Finally, this research will benefit future studies that require participants to report the perceived locations of the unseen limbs. \u