Towards remote monitoring and remotely supervised training

Abstract

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 schematic drawing of the main components and the information exchange pathways are shown in the figure below. RMT systems are in general quite complex, requiring dependable end-to-end systems integrating ambulant sensing of relevant biosignals and context information, an M-Health platform for a secure data transport and storage and a backend system with appropriate decisions support with respect to both technical and clinical aspects. Another key element is the feedback of the information (dotted lines), which is essential for the subject and the care providers to learn from the data and to make the appropriate decisions. Feedback Sensing Care & CoachingDuring the past years considerable knowledge and experience is being gained with the research and development of such smart systems. In parallel, experience is gained with respect to the implementation of RMT systems in a clinical environment and how to assess its potential benefits. Examples concern: Activity monitoring in low back pain: the daily activity patterns of patients with chronic low back pain have been assessed, indicating a similar amount of total daily activity compared to healthy subjects but with a different distribution over the day. The results clearly show in general a higher activity level in the morning and lower activity levels in the afternoon and evening. This provides a starting point for treatment: restore the balance in acivity pattern by providing adequate personalised feedback Monitoring of spasticity: continuous monitoring of muscle activity patterns by means of surface EMG measurement, in subjects with a spinal cord lesion provides insight in the magnitude and distribution of spasticity over the day. It gives direct objective and quantitative information during which activities and during which part of the day spasticity is most hindering the activities of daily living and as such it provides valuable information to optimise the drug delivery to decrease spasticity. Myofeed...

The between-day and inter-rater reliability of a novel wireless system to analyse lumbar spine posture

“…Similarly, whether the provision of postural feedback via the BodyGuard TM improves outcomes in NSCLBP requires investigation. The potential to provide patients with feedback regarding the control of their movement patterns may motivate patients (Horton and Abbott 2008), improve exercise performance (Magnusson et al 2008), reduce the link between pain and movement (Zusman 2008) and might decrease the enormous rehabilitation costs associated with NSCLBP (Hermens and Vollenbroek-Hutton 2008).…”

“…Spinal posture analysis is now possible using accelerometers (Bazzarelli et al 2001, Nevins et al 2002, Wong and Wong 2008, gyroscopes (Lee et al 2003), strain gauges and/or optical sensors (Donatell et al 2005, Dean andDean 2006) and even sensing fabrics (de Rossi et al 2003, Walsh et al 2006. Recent reviews have highlighted that, despite the potential of such devices, there is a lack of empirical data supporting their use (Wong et al 2007, Hermens andVollenbroek-Hutton 2008). Unfortunately, some of the devices are relatively large and invasive, such that they cannot be concealed easily (Donatell et al 2005, Magnusson et al 2008 or only used under supervision (Magnusson et al 2008).…”

Deploying a Telerehabilitation Service Innovation: An Early Stage Business Model Engineering Approach

“…The case consists of a so called myofeedback teletreatment system aimed at patients with 1) chronic neck shoulder pain and 2) whiplashesdirectly in the R&D deployment phase of the service innovation project. Earlier medical trials already proved the medical effectiveness of the specific treatment [9]. The myofeedback teletreatment system monitors muscle relaxation (myo stands for muscle) during daily activities via sensors and actuators implemented in a wearable garment which is connected to a PDA.…”

Remote care nearby

“…As a result there have been many initiatives related to ICT and care. As we have previously pointed out, 11 these can be divided into two main categories:…”