DR.BEAT: Initial Functional Testing of a BCG Wearable Prototype for Recording Ballistocardiographic Signals.

DR.BEAT ("Digital Research on Ballistocardiography for Extraterrestrial And Terrestrial use") develops a miniaturized sensor system with signal processing to interpret ballistocardiographic signals and implements an application oriented user interface. Presented is a breadboard prototype's functional tests with regard to data completeness and plausibility. The analysis confirmed a reliability of 99.99995% over the tests and the signals displayed the expected heart-specific characteristics. These results support the ethical justifiability of an initial study.

DR.BEAT: First Insights into a Study to Collect Baseline BCG Data with a Sensor-Based Wearable Prototype in Heart-Healthy Adults.

The DR.BEAT project aims at the further development of a measurement system for recording ballistocardiographic signals into a body-worn sensor system combined with extensive signal processing, data evaluation and visualization. With a first breadboard prototype, an explorative feasibility study for acquiring initial signals of healthy cardiac activity in adults was performed. This paper briefly presents the DR.BEAT project, the breadboard prototype, the study conducted, and initial insights into the study results. The signals obtained in the study exhibit the seismocardiographic characteristics as reported in the literature and form the basis for further development of the hardware as well as the pre-processing and automated analysis algorithms in the DR.BEAT project.Clinical Relevance- The characteristics of ballisto- and seismocardiographic signals allow to infer about the mechanical work of the heart. The development of a body-worn sensor system to record ballisto- and seismocardiographic signals, compact enough for everyday wear, enables the acquisition of heart-specific parameters in terrestrial as well as extraterrestrial application scenarios. Combined with extensive signal analysis and visualization, it holds the potential to monitor heart health in a variety of contexts and support its maintenance and improvement.

Towards a Recommendation for Good Health Data Modeling (GHDM) - Results of Expert Interviews.

Appropriate data models are essential for the systematic collection, aggregation, and integration of health data and for subsequent analysis. However, recommendations for modeling health data are often not publicly available within specific projects. Therefore, the project Zukunftslabor Gesundheit investigates recommendations for modeling. Expert interviews with five experts were conducted and analyzed using qualitative content analysis. Based on the condensed categories "governance", "modeling" and "standards", the project team generated eight hypotheses for recommendations on health data modeling. In addition, relevant framework conditions such as different roles, international cooperation, education/training and political influence were identified. Although emerging from interviewing a small convenience sample of experts, the results help to plan more extensive data collections and to create recommendations for health data modeling.

[Health enabling technologies and intelligent environments in rehabilitation]. / Assistierende Gesundheitstechnologien und intelligente Umgebungen in der Rehabilitation.

BACKGROUND: The increasing digitalization of society is having an impact on medicine. People increasingly use digital devices and services for various purposes (e.g., sports, security, convenience). Ubiquity, a strong degree of connectivity and high context sensitivity are creating intelligent environments that generate data about individuals. Suitable evaluation algorithms can extract information about the personal health status that can be used for diagnostics and treatment. Gamification methods allow patients to be more actively involved in their recovery, which can have a positive effect on adherence. Particularly in the field of rehabilitation medicine, which often affects and interacts with the personal living environment, the use of this information can make a difference. OBJECTIVE: Using specific examples of the application of assistive health technologies and intelligent environments in rehabilitation medicine, the current state of development is presented and the possible future research directions and needs for action in this field are presented in a practical way. MATERIAL AND METHODS: Three exemplary research projects introduce the topic, are embedded in the current state of research and allow a projection into the future against the background of many years of experience. RESULTS: The reported projects show not only the technical feasibility but also individually the medical effectiveness of interventions. CONCLUSION: Finally, an analysis of the barriers that have so far prevented a more intensive use of the technologies and how these might be countered is carried out.

Compiling Criteria for Assessing Essential Aspects of Home Exercise Performance: A Questionnaire-Based Approach.

Health-enabling technologies (HET) have high potential in rehabilitation to support patients performing their home exercises. The modeling of human movements as well as the modelling of quality criteria of an exercise performance remains challenging when implementing HETs. A combination of data-driven approaches and knowledge-based methods may deliver new insights. This requires structured quality assessments of concrete exercise performances from a therapists' point of view. Therefore, a structured, easy to use questionnaire to assess home exercise performances is developed and implemented. The questionnaire consists of eight items in three categories: (1-4) overall assessment of quality and quantity, (5-7) need for correction, and (8) correction hints. The collected data will be the basis for mathematical modeling of home exercise performance assessment as foundation for the development of patient supporting HETs.

Factors for Individualization of Therapeutic Exercises for the Design of Health-Enabling Technologies.

Designing health-enabling technologies (HETs) to support individualized physiotherapeutic exercises requires comprehensive knowledge of bio-psycho-social factors to be considered. Therefore, this review identified factors for individualization of therapeutic exercises in patients with musculoskeletal shoulder disorders in peer-reviewed articles searched in MEDLINE. The final full-text analysis included 16 of 335 search results and extracted nineteen main categories of individualization factors. The most frequently identified main categories include progression of exercises, exercise framework, and assessment. An iterative approach with constant reassessments represents the key principle for the process of individualization. Categories that are difficult to standardize were rarely mentioned, but should also be considered. The identified factors can improve the design-process of HETs by sensitizing developers, enable further formal modelling, and support communication between developers, physiotherapists, and patients.

Image Processing of Conventional Computer Tomography Images for Segmentation of the Human Cochlea.

Against the background of increasing numbers of indications for Cochlea implants (CIs), there is an increasing need for a CI outcome prediction tool to assist the process of deciding on the best possible treatment solution for each individual patient prior to intervention. The hearing outcome depends on several features in cochlear structure, the influence of which is not entirely known as yet. In preparation for surgical planning a preoperative CT scan is recorded. The overall goal is the feature extraction and prediction of the hearing outcome only based on this conventional CT data. Therefore, the aim of our research work for this paper is the preprocessing of the conventional CT data and a following segmentation of the human cochlea. The great challenge is the very small size of the cochlea in combination with a fairly bad resolution. For a better distinction between cochlea and surrounding tissue, the data has to be rotated in a way the typical cochlea shape is observable. Afterwards, a segmentation can be performed which enables a feature detection. We can show the effectiveness of our method compared to results in literature which were based on CT data with a much higher resolution. A further study with a much larger amount of data is planned.

Mobile Health Applications for Rehabilitation of Musculoskeletal Diseases of the Shoulder: A Systematic Analysis.

Rehabilitation of musculoskeletal diseases (MSD) of the shoulder is a multifaceted long-term process, which is often not transparent to affected patients. Mobile health applications (apps) have the potential to support this complex process by improving patients' self-management skills. However, there seems to be a lack of apps providing a holistic approach to motivate and guide patients during the whole rehabilitation process. Therefore, a systematic analysis of apps on Google Play Store was conducted by two independent reviewers. A total of 3227 apps were identified, of which 64 met the eligibility criteria for the qualitative analysis. The majority of analyzed apps were developed generally for patients with MSD of the shoulder, rarely for specific diseases (individual needs of patients). The majority of apps focus on the provision of information, exercise training, and alternative medicine. Apps for diagnostics, inpatient treatment, and self-management, especially for multiple rehabilitation phases, are rare or even not existent. Game design elements are seldom used. If there are any, then simple to implement ones, e.g. messages and progress bars. The (psychological) effects of individual game design elements on patients seem to be neglected, when selecting and implementing game-components.

OnTARi: an ontology for factors influencing therapy adherence to rehabilitation.

BACKGROUND: Adherence and motivation are key factors for successful treatment of patients with chronic diseases, especially in long-term care processes like rehabilitation. However, only a few patients achieve good treatment adherence. The causes are manifold. Adherence-influencing factors vary depending on indications, therapies, and individuals. Positive and negative effects are rarely confirmed or even contradictory. An ontology seems to be convenient to represent existing knowledge in this domain and to make it available for information retrieval. METHODS: First, a manual data extraction of current knowledge in the domain of treatment adherence in rehabilitation was conducted. Data was retrieved from various sources, including basic literature, scientific publications, and health behavior models. Second, all adherence and motivation factors identified were formalized according to the ontology development methodology METHONTOLOGY. This comprises the specification, conceptualization, formalization, and implementation of the ontology "Ontology for factors influencing therapy adherence to rehabilitation" (OnTARi) in Protégé. A taxonomy-oriented evaluation was conducted by two domain experts. RESULTS: OnTARi includes 281 classes implemented in ontology web language, ten object properties, 22 data properties, 1440 logical axioms, 244 individuals, and 1023 annotations. Six higher-level classes are differentiated: (1) Adherence, (2) AdherenceFactors, (3) AdherenceFactorCategory, (4) Rehabilitation, (5) RehabilitationForm, and (6) RehabilitationType. By means of the class AdherenceFactors 227 adherence factors, thereof 49 hard factors, are represented. Each factor involves a proper description, synonyms, possibly existing acronyms, and a German translation. OnTARi illustrates links between adherence factors through 160 influences-relations. Description logic queries implemented in Protégé allow multiple targeted requests, e.g., for the extraction of adherence factors in a specific rehabilitation area. CONCLUSIONS: With OnTARi, a generic reference model was built to represent potential adherence and motivation factors and their interrelations in rehabilitation of patients with chronic diseases. In terms of information retrieval, this formalization can serve as a basis for implementation and adaptation of conventional rehabilitative measures, taking into account (patient-specific) adherence factors. OnTARi also enables the development of medical assistance systems to increase motivation and adherence in rehabilitation processes.

Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review.

BACKGROUND: Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. OBJECTIVE: This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. METHODS: The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. RESULTS: Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient's range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients' evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. CONCLUSIONS: There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects.

AGT-Reha-WK study: protocol for a non-inferiority trial comparing the efficacy and costs of home-based telerehabilitation for shoulder diseases with medical exercise therapy.

INTRODUCTION: Shoulder lesions rank among the top 15 diagnoses accounting for days of incapacity to work. Inpatient or full-day outpatient rehabilitation are some of the standard therapies. For sustainable rehabilitation, continuation of rehabilitation after discharge from a rehabilitation centre is vital. Besides medical exercise therapy (MET), home-based physical exercise programmes are used. To monitor exercise quantity and quality, AGT-Reha, a health-enabling technology for home rehabilitation, has been developed and evaluated in a pilot study for technical feasibility and acceptance. To integrate the digital therapeutic AGT-Reha into regular healthcare processes, an efficacy evaluation is required. METHODS AND ANALYSIS: AGT-Reha-WK is a prospective, monocentric, non-randomised, unblinded non-inferiority trial. Primary objective is to investigate whether AGT-Reha enhanced home-based exercise training is non-inferior to MET as standard aftercare. Secondary objective is to compare the costs of both therapies. Efficacy as medical success (primary outcome) is examined with regard to ability to work, return to work and sustainability of training (secondary outcomes). The outcome measure for non-inferiority is shoulder function (pain and disability) assessed by the standardised Shoulder Pain and Disability Index (SPADI). The non-inferiority margin is set to 10 points on SPADI score using a 95% CI. Subjects will be recruited at the Rehabilitation Center Bad Pyrmont, Germany. The total number of subjects should be 84 (42 per group). Treatment takes 6 months per patient. Subjects will be assessed at four time points: pre-baseline (admission to rehabilitation centre), baseline (discharge from rehabilitation centre), post-therapy and follow-up (3 months post-therapy). ETHICS AND DISSEMINATION: Ethics approval was granted by the Ethics Committee of Hannover Medical School (ethics approval no: 7313). Results of the trial are planned to be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: German Clinical Trials Register DRKS00011596. Registered 2 June 2017. Recruitment started on 3 March 2017, and it is expected to continue until December 2020. PROTOCOL VERSION: V2.0, 23 May 2018, Amendment 01: improved risk analysis, clarification of exclusion criteria to increase reproducibility, additional documentation with OpenClinica; these changes have no effect on structural equality.

Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review.

BACKGROUND: Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. OBJECTIVE: This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. METHODS: We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. RESULTS: A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. CONCLUSIONS: There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics.

Health-Enabling Technologies for Telerehabilitation of the Shoulder: A Feasibility and User Acceptance Study.

BACKGROUND: After discharge from a rehabilitation center the continuation of therapy is necessary to secure already achieved healing progress and sustain (re-)integration into working life. To this end, home-based exercise programs are frequently prescribed. However, many patients do not perform their exercises as frequently as prescribed or even with incorrect movements. The telerehabilitation system AGT-Reha was developed to support patients with shoulder diseases during their home-based aftercare rehabilitation. OBJECTIVES: The presented pilot study AGT-Reha-P2 evaluates the technical feasibility and user acceptance of the home-based telerehabilitation system AGT-Reha. METHODS: A nonblinded, nonrandomized exploratory feasibility study was conducted over a 2-year period in patients' homes. Twelve patients completed a 3-month telerehabilitation exercise program with AGT-Reha. Primary outcome measures are the satisfying technical functionality and user acceptance assessed by technical parameters, structured interviews, and a four-dimensional questionnaire. Secondary endpoints are the medical rehabilitation success measured by the active range of motion and the shoulder function (pain and disability) assessed by employing the Neutral-0 Method and the standardized questionnaire "Shoulder Pain and Disability Index" (SPADI), respectively. To prepare an efficacy trial, various standardized questionnaires were included in the study to measure ability to work, capacity to work, and subjective prognosis of work capacity. The participants have been assessed at three measurement points: prebaseline (admission to rehabilitation center), baseline (discharge from rehabilitation center), and posttherapy. RESULTS: Six participants used the first version of AGT-Reha, while six other patients used an improved version. Despite minor technical problems, all participants successfully trained on their own with AGT-Reha at home. On average, participants trained at least once per day during their training period. Five of the 12 participants showed clinically relevant improvements of shoulder function (improved SPADI score > 11). The work-related parameters suggested a positive impact. All participants would recommend the system, ten participants would likely reuse it, and seven participants would have wanted to continue their use after 3 months. CONCLUSION: The findings show that home-based training with AGT-Reha is feasible and well accepted. Outcomes of SPADI indicate the effectiveness of aftercare with AGT-Reha. A controlled clinical trial to test this hypothesis will be conducted with a larger number of participants.

Transfer Physical Therapists Knowledge: A Pre-Test to Minimize the Complexity of Physical Therapists' Quality Assessment of Shoulder Exercise Performance.

Exercise therapy aims to restore normal musculoskeletal function or to reduce pain in patients with musculoskeletal shoulder disorders. Especially during long-term treatments, patients perform unsupervised exercises at home. Harmful movement deviations should be identified and avoided. Assistive technologies based on physical therapists' knowledge can support patients. In this paper, we present our approach to minimize the complexity of a physical therapists' quality assessment of a shoulder exercise performance. Four experienced physical therapists assessed the quality of 13 exercise performances shown as video recordings with a visual analogue scale and explained their ratings as free text. In some cases, the resulting assessments differed widely depending on the respective therapeutic goals. The therapists had difficulties to reduce the performances quality to a single value. Despite the existing consensus on exercises' descriptions, a more than one-dimensional scale is needed to evaluate exercises. Therefore, rating categories have to be identified for more detailed assessments.

Wireless Sensor Network for Fall Prevention on Geriatric Wards: A Report.

With regard to the growing number of older adults, it needs smart solutions for fall prevention. Especially at geriatric institutions, the risk of falling is very high and frequently leads to injuries, resulting in serious consequences. We present the Inexpensive Node for Bed Exit Detection (INBED), a comprehensive signaling system for fall prevention. The INBED system is based on a wireless sensor network infrastructure via IEEE802.15.4 and highly-specialized open hardware in-house developed wearable. The device, which will be attached to the patients, can detect several types of movement. Occurring events are forwarded to the nursing staff immediately by using the self-organizing and scalable network including wide area network integration. The system can help to relieve the staff while the personal freedom of movement and privacy of patients is increased. With this development, the energy-efficient, simple and intuitive mechanisms of proximity communication can be combined with broadband benefits.

First Feasibility Analysis of Ballistocardiography on a Passenger Flight.

The project SCARAB2 (Scalable, Robust and Adaptive on Board Ballistocardiography) aims to use Ballistocardiography (BCG) to monitor flight passengers. In order to show that recorded BCG data from flights give evaluable information even in the noisy environment of an airplane, we monitored a heart-healthy passenger using BCG. Furthermore, we show that there can be a conclusion to heart activities from the recorded ballistocardiogram by comparing the data to a concurrently recorded electrocardiogram (ECG).

A Vision Utilizing Gamification to Enhance Patients' with Chronic Shoulder Diseases Adherence to Rehabilitation.

Although adherence is a key factor for successful treatment of chronic diseases, only about 50% of patients achieve good adherence. However, health enabling technologies and gamification offer new possibilities to enhance patient's motivation. In physical rehabilitation, various applications exist. As these often stress a specific part of the rehabilitation process, we introduce a six-step new holistic approach to apply game design elements in the entire rehabilitation process, while focusing on patients with musculoskeletal diseases of the shoulder.

INBED: A Highly Specialized System for Bed-Exit-Detection and Fall Prevention on a Geriatric Ward.

OBJECTIVE: In geriatric institutions, the risk of falling of patients is very high and frequently leads to fractures of the femoral neck, which can result in serious consequences and medical costs. With regard to the current numbers of elderly people, the need for smart solutions for the prevention of falls in clinical environments as well as in everyday life has been evolving. METHODS: Hence, in this paper, we present the Inexpensive Node for bed-exit Detection (INBED), a comprehensive, favourable signaling system for bed-exit detection and fall prevention, to support the clinical efforts in terms of fall reduction. The tough requirements for such a system in clinical environments were gathered in close cooperation with geriatricians. RESULTS: The conceptional efforts led to a multi-component system with a core wearable device, attached to the patients, to detect several types of movements such as rising, restlessness and-in the worst case-falling. Occurring events are forwarded to the nursing staff immediately by using a modular, self-organizing and dependable wireless infrastructure. Both, the hardware and software of the entire INBED system as well as the particular design process are discussed in detail. Moreover, a trail test of the system is presented. CONCLUSIONS: The INBED system can help to relieve the nursing staff significantly while the personal freedom of movement and the privacy of patients is increased compared to similar systems.

Automatic Detection of Depression by Using a Neural Network.

Depression is the most common psychiatric disorder worldwide, which affects more than 300 million people. We aimed to detect depressed patients and healthy people automatically. We work on the PHQ-9 questionnaires and reduced it to a PHQ-5 questionnaires with a new cut-off value of 8 to detect depressed patients. We trained a Neural Network with 70% of our dataset. Then, the proposed classifier was tested with two datasets. The first one consists of 30% of PHQ-5 datasets, which could achieve 85.69%, 99.11% and 90.56% for accuracy, sensitivity and specificity respectively. The second test dataset consists of physical patient's parameters which recorded during a study in the Hanover Medical School. This classifier has shown good results in the detection of depression based on these two datasets.

Advantages of Modular Hybrid Network Communication on Clinical Wards.

The ever-increasing flood of information, especially in the medical-clinical field, inter alia due to the increase of data-intensive mobile/wearable devices, is one of the biggest challenges of medical informatics. In this work different possibilities of the integration of wearable devices on the example of the development of a fall prevention system are presented and classified. We started with a commercial off-the-shelf one-on-one system (Shimmer/Arduino) using a Bluetooth connection, integrated via nurse call system as Human-Machine-Interface. During the evaluation of the system we mentioned several new requirements and optimization possibilities. Thus, we adjusted the hardware-software-system; the near-field communication was realized by IEEE802.15.4, we replaced commercial off-the-shelf devices with highly-specialized open hardware in-house developments and we transferred the nurse call integration by setting up our own network and integrating this into an existing (wireless) local area network. With this development, the energy-efficient, simple and intuitive mechanisms of proximity communication via IEEE802.15.4 can be combined with the benefits broadband functionalities, e.g. of Wi-Fi, with both worlds benefits and the compensation of some disadvantages.