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WO2016049688A1 - Systèmes et procédés pour surveiller la performance de marche d'un utilisateur - Google Patents

Systèmes et procédés pour surveiller la performance de marche d'un utilisateur Download PDF

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Publication number
WO2016049688A1
WO2016049688A1 PCT/AU2015/050569 AU2015050569W WO2016049688A1 WO 2016049688 A1 WO2016049688 A1 WO 2016049688A1 AU 2015050569 W AU2015050569 W AU 2015050569W WO 2016049688 A1 WO2016049688 A1 WO 2016049688A1
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WO
WIPO (PCT)
Prior art keywords
user
training
response
server
stimulus
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/AU2015/050569
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English (en)
Inventor
Kim DELBAERE
Stephen Lord
Stuart Smith
Thomas Davies
Daniel Schoene
Jamie LENNOX
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Prince of Wales Medical Research Institute Ltd POWMRI
Original Assignee
Prince of Wales Medical Research Institute Ltd POWMRI
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from AU2014903948A external-priority patent/AU2014903948A0/en
Application filed by Prince of Wales Medical Research Institute Ltd POWMRI filed Critical Prince of Wales Medical Research Institute Ltd POWMRI
Publication of WO2016049688A1 publication Critical patent/WO2016049688A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient; User input means
    • A61B5/742—Details of notification to user or communication with user or patient; User input means using visual displays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb
    • A61B5/1104—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb induced by stimuli or drugs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb
    • A61B5/1116—Determining posture transitions
    • A61B5/1117—Fall detection
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/16—Devices for psychotechnics; Testing reaction times ; Devices for evaluating the psychological state
    • A61B5/162—Testing reaction times
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7275—Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/06—Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
    • G06Q10/063—Operations research, analysis or management
    • G06Q10/0639—Performance analysis of employees; Performance analysis of enterprise or organisation operations
    • G06Q10/06398—Performance of employee with respect to a job function
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q50/00—Information and communication technology [ICT] specially adapted for implementation of business processes of specific business sectors, e.g. utilities or tourism
    • G06Q50/10—Services
    • G06Q50/22—Social work or social welfare, e.g. community support activities or counselling services
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/30—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment

Definitions

  • the present invention relates to systems and methods to monitor the step performance of a user.
  • Embodiments of the invention have been particularly developed to provide an adaptive training routine to the user to reduce the risk of falls and improve balance and cognitive functioning in independently living older people. While some embodiments will be described herein with particular reference to that application, it will be appreciated that the invention is not limited to such a field of use, and is applicable in broader contexts.
  • Exercise can prevent falls in older people, but for optimal gain, exercise needs to challenge balance to a high extent. Compliance with many exercise programs is poor, for reasons including motivation, access and cost. There is a need for low-cost balance training programs that are enjoyable and feasible for older adults.
  • Neuroscience Research Australia have developed an interactive step training system that provides an effective method for training stepping ability and improving balance in older people (see Smith, S. T. et al., "A novel Dance Dance Revolution (DDR) system for in-home training of stepping ability: basic parameters of system use by older adults", Br J Sports Med. 201 1 April 45(5):441 -5).
  • the system is based on the "Dance Dance Revolution” video game and utilises a mat with sensors for receiving user step inputs in response to visual indicia displayed on a screen.
  • the system allows step training to be safely undertaken at home to improve key physical and cognitive parameters of fall risk in older people.
  • Early controlled studies with this technology see Schoene D et al.
  • a system to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls including a processor configured to:
  • step training routine to control a visual stimulus on an associated display device, the stimulus including a prompt for a user to make a predefined step action at a predefined time;
  • a user step response signal from one or more sensors of an input interface, the response signal being indicative of the timing and/or direction of the user's step action in response to the stimulus;
  • a remote server which is in turn configured to:
  • the characterisation includes comparing the user response based on one or more predefined benchmarks. In another embodiment the characterisation includes the determination of an average response time for the user step action. In a further embodiment the characterisation includes the determination of a step error in the user's step action.
  • the step error includes a step time error. In another embodiment the step error includes a step direction error.
  • the selective adaptation of the training routine includes a modification to the difficulty of a current training application.
  • the selective adaptation of the training routine includes making additional applications available to the user.
  • the selective adaptation of the training routine is based on the number or frequency of use of the system by the user.
  • the server provides feedback to the user indicative of the step performance over a predetermined time period.
  • the feedback is preferably provided visually on the display.
  • the server is accessible by healthcare professionals to view user response data and the step performance of the user.
  • one or more healthcare professionals are able to provide input to the server through a remote computer to provide some degree of control over the selective adaptation of the training routine.
  • the server based on the received user response data, provides recommendations to the one or more healthcare professionals for selective adaptation of the user's training routine.
  • the one or more healthcare professionals are able to specify, through the server, performance thresholds from which the user's step performance is characterised.
  • the server determines a fall risk level for the user.
  • a method to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls including:
  • a training routine to control a visual stimulus on an associated display device, the stimulus including a prompt for a user to make a predefined step action at a predefined time;
  • a user step response signal from one or more sensors of an input interface, the response signal being indicative of the timing and/or direction of the user's step action in response to the stimulus; and receiving, at a server located remotely from the processor, user response data derived from the user response signal;
  • a computer system configured to perform a method according to the second aspect.
  • a non-transitive carrier medium carrying computer executable code that, when executed on a processor, causes the processor to perform a method according to the second aspect.
  • a system to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls including:
  • a display device configured to display a visual stimulus including a prompt for a user to make a predefined step action at a predefined time
  • a processor for executing a training routine to control the visual stimulus
  • an input interface configured to receive a user step response signal from one or more sensors, the response signal being indicative of the timing and/or direction of the user's step action in response to the stimulus;
  • a server located remotely from the processor and configured to:
  • Figure 1 is a functional block diagram of a system to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls;
  • Figure 2 is system-level overview of the system of Figure 1 ;
  • Figure 3 is a schematic illustration of the system of Figure 1 in use
  • Figure 4 is a screenshot of an exemplary menu displayed on a television
  • Figure 5 is a plan view of a sensor pad used in the system of Figure 1 ;
  • Figure 6 illustrates an exemplary menu structure
  • Figure 7 is a schematic illustration of the system of Figure 1 ;
  • Figure 8 is a process flow diagram of a method to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls
  • FIG. 1 there is illustrated a system 1 to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls.
  • system 1 is targeted towards the elderly, it will be appreciated that will be applicable to other users such as users undergoing rehabilitation (from an injury, vascular event, etc), users with chronic conditions such as Parkinson's disease or Multiple Sclerosis, and athletes wishing to improve balance, cognitive functioning or reaction times.
  • System 1 includes a processor in the form of a personal computer 3 configured to execute a training routine to control a visual stimulus on an associated display device such as a television 5.
  • the stimulus includes at least one and preferably a series of prompts for a user to make a predefined step action.
  • Computer 3 is also configured to receive a user response signal 7 from one or more sensors of an input interface in the form of a wireless step sensor pad 9, which is placed on the floor.
  • Sensor pad 9 is connected wirelessly to computer 3 through a known wireless transmission protocol such as BluetoothTM or Wi-FiTM.
  • the response signal is indicative of the timing and/or direction of the user's step action in response to the stimulus.
  • System 1 also includes a remote server 1 1 in communication with computer 3 through a network such as the internet 13.
  • Computer 3 and server 1 1 communicate via Ethernet or a USB GSM modem.
  • Server 1 1 receives user response data 12 derived from user response signal 7, characterises, from the user response data 12, a step performance of the user's step action in response to the stimulus and selectively adapts the training routine provided to the user based on the characterisation.
  • One or more healthcare professionals are able to provide input to server 1 1 (either directly or indirectly via the internet) from a remote computer 15 to provide some degree of control over the selective adaptation of the training routine.
  • Healthcare professionals include doctors, nurses, carers, health professionals and other people associated with the assistance and rehabilitation of the user.
  • server 1 1 communicates with computer 15 to provide recommendations to the healthcare professionals for selective adaptation of the user's training routine.
  • Healthcare professionals accessing computer 15 are able to specify, through server 1 1 , performance thresholds from which the user's step performance is characterised.
  • server 1 1 or computer 3 can automatically adapt the user's training routine by applying inbuilt protocols and rules to the received user response data 12.
  • the display device is illustrated as a television, in other embodiments, the display device is one or more of a computer monitor, image projector, or a tablet or Smartphone screen.
  • the sensor pad 9 is not wireless but is connected to computer 3 through an electrical cable such as an Ethernet cable, firewire cable, optical fibre, USB cable, coaxial cable, component cable or HDMI cable.
  • personal computer 3 has the form of a desktop computer, laptop computer, tablet, Smartphone, PDA or video game console.
  • computer Y has the form of a desktop computer, laptop computer, tablet, Smartphone or PDA.
  • server 1 1 includes a processor 17 coupled to a memory module 19 and a communications interface 21 , such as an Internet connection, modem, Ethernet port, wireless network card, serial port, or the like.
  • a communications interface 21 such as an Internet connection, modem, Ethernet port, wireless network card, serial port, or the like.
  • distributed resources are used.
  • server 1 1 includes a plurality of distributed servers having respective storage, processing and communications resources.
  • Memory module 19 includes software instruction 22, which are executable on processor 17.
  • Server 1 1 is coupled to a database 23.
  • the database leverages memory module 19.
  • server 1 1 is accessed by users and healthcare professionals via a web interface 25, which may include one or more websites.
  • the computer devices used by users and healthcare professionals to access server 1 1 are collectively referred to as client terminals 27. These include both personal computer 3 and remote computer 15.
  • client terminals 27 These include both personal computer 3 and remote computer 15.
  • the term "website" should be read broadly to cover substantially any source of information accessible over the Internet or another communications network (such as WAN, LAN or WLAN) via a browser application running on a client terminal.
  • a website is a source of information made available by a server and accessible over the Internet by a web-browser application running on a client terminal. The web-browser application downloads code, such as HTML code, from the server.
  • This code is executable through the web-browser on the client terminal for providing a graphical and often interactive representation of the website on the client terminal.
  • a user of the client terminal is able to navigate between and throughout various web pages provided by the website, and access various functionalities that are provided.
  • the interface presented to users may be different to the interface presented to healthcare professionals.
  • client terminals 27 maintain software instructions for a computer program product that essentially provides access to a portal via which system 1 is accessed (for instance via an iPhone app or the like).
  • each terminal 27 includes a processor 29 coupled to a memory module 31 and a communications interface 33, such as an internet connection, modem, Ethernet port, serial port, or the like.
  • Memory module 31 includes software instructions 35, which are executable on processor 29. These software instructions allow terminals 27 to execute a software application, such as a proprietary application or web browser application and thereby render on-screen a user interface and allow communication with server 1 1 .
  • This user interface allows for the creation, viewing and administration of profiles, access to the internal communications interface, and various other functionalities.
  • the front-end of system 1 includes those elements accessed directly by the user. These include personal computer 3, television 5 and sensor pad 7, as illustrated in Figure 3.
  • the user lays out the sensor pad 9 on a flat surface such as a floor facing television 5.
  • Sensor pad 9 is connected wirelessly or otherwise to computer 3, which is located nearby.
  • Computer 3 is connected to television 5.
  • the training routines are accessed through a software application executed on computer 3.
  • the application displays a menu on a screen of television 5 with various selectable options.
  • An exemplary menu 37 is illustrated in Figure 4.
  • the menu includes a clock 39 in the lower right corner and a menu list 41 including three buttons in the lower left corner: 'HOME'; 'HELP'; and 'BACK'.
  • buttons are presented in a program listing 43 in the centre of the screen: 'Video tutorials', 'StepMania' and 'Stepper'. These three buttons represent executable programs available to the user and 'StepMania' and 'Stepper' represent interactive games in which the user can participate. As will be described below, additional programs can be added to the program listing based on the user's profile and the user's adherence, progress and performance in a prescribed step training regime as described in detail below.
  • Pad 9 includes ten sensors, each having corresponding indicia.
  • Two centrally disposed home sensors 45 and 47 include foot symbols and represent the standing location of a user's two feet from which steps are to be made.
  • Home sensors 45, 47 are positioned to correspond to a typical user standing with their feet hip width apart.
  • Six directional sensors are disposed around the home sensors for sensing step motion in various directions.
  • Two forward sensors 49, 51 are positioned a reasonable step length in front of each home sensor.
  • two backward sensors 53, 55 are positioned a reasonable step length behind each home sensor.
  • a left sensor 57 and a right sensor 59 are positioned a reasonable step to the left of the left home sensor.
  • two action sensors 'A' and 'B' are disposed at two upper corners of pad 9 adjacent the forward sensors. Action sensors A and B are provided for making selections of menu options and providing some additional functionality in some training routines.
  • a highlighted box 61 appears around the currently selected menu item ('StepMania' in the illustrated case) at any one time.
  • the highlighted box is moved by the user stepping on appropriate directional sensors. For example, to move from the program listing to a menu item, the user steps on a backward directional arrow sensor on the sensor mat. The user can move the highlighted box back to the program listing by stepping on a forward arrow sensor on the sensor mat.
  • the user steps on an action sensor.
  • sensor pad 9 includes sensors under the home foot positions to allow for the detection of step reaction times and total movement times.
  • the home sensors 45, 47 can also be used to determine when the user is in position and ready for the next stimulus.
  • the sensors are also positioned further apart than other known pads. This allows for adults to comfortably stand on the home sensors without activating other sensors at the same time. Additionally longer steps are needed to activate the arrow shaped sensors, which are more indicative of real world stepping.
  • the software application launched on computer 3 includes three functional sections; mission control, shell and games/tests. These sections communicate with each other and are controlled by instructions from server 1 1 .
  • Mission control functions to control the programs available to the user and is the underlying local data manager of the system.
  • Mission control communicates to the shell; a structure detailing what is to be shown by the program listing (including games and other functions).
  • mission control will log the event and fork a new process. The forked process will be at a safe permission level to run the requested program with pre specified configuration options.
  • Mission control communicates with server 1 1 and data security such as asymmetric key cryptography is used for authentication and encryption.
  • Mission control periodically accesses server 1 1 to asynchronously update its current status and transfer recent user response data.
  • Server 1 1 specifies which users are present on computer 3 (in the case that more than one user accesses the system through computer 3), which programs should be accessible on computer 3 and the structure in which the programs should be displayed.
  • Mission control maintains a local relational database containing the current and all previous configurations of computer 3, along with a local log of all data generated by the programs.
  • data is uploaded to server 1 1 , it is marked as updated in the database and archived. A copy is kept on the device in case of remote server failure.
  • the shell represents the main user interface for the system. When displayed on television 5, shell is represented as a menu (e.g. menu 37 of Figure 4). In menu 37, the shell consists of menu list 41 and program listing 43. In other embodiments, the shell includes other layouts and other combinations of buttons. [0046]
  • the program listing displays current available programs that can be accessed on the system. The programs are displayed as a large easily recognizable icon with a name underneath. An exemplary menu structure is shown in Figure 6. When computer 3 is first activated, a root node 63 is activated by default. All possible configurations contain a root node. Root nodes may, for example, represent different user profiles for different users of computer 3.
  • root node 63 When root node 63 is activated, the user is able to browse the direct children of the activated node as the current program listing displayed.
  • a node that has no children is known as a leaf node and corresponds to an action.
  • the shell communicates to mission control that that the action corresponding to the node is to be launched.
  • the HOME button brings the program listing back to root node 63.
  • the BACK button brings the program listing up one level in the tree hierarchy.
  • the HELP button brings up a screen explaining what actions the pressing of the sensors on the sensor mat achieve.
  • Games and tests are executable programs available to the user which involve user interaction and are the primary means for obtaining user step data and performance measures.
  • An example of a game is StepMania, which is an open-source version of the popular arcade and console games Dance Dance Revolution. The open source nature of StepMania allows tailored games to be generated for specific applications such as step training.
  • StepMania players are scored by how well they time their dance steps to displayed stimuli.
  • This game requires multi-directional and variable-speed stepping, challenging balance, coordination, reaction time and attention.
  • the game requires users to step as accurately as possible, both in terms of direction and timing, while synchronizing their stepping with instructions presented on the screen. Arrows drift from the bottom to the top of the screen and over a target arrow.
  • step training games will be introduced by an in-built coaching software (described below) at certain time intervals during the step training routine.
  • a message is displayed on television 5 or added to a notification system/program to alert users to the new step training game being "unlocked". Users are encouraged to try the new game and continue to enjoy the old stepping exercises as they like. Instructions on how to play each game are provided with on-screen text, video demonstrations and a call-in service to healthcare professionals offered for clarification if required.
  • Additional step training games that have or are currently being developed include step training modified versions of existing videogames traditionally played with the hands while seated. These include but are not limited to; Tetris, Pac-man, Word Scramble, Jigsaw Puzzle, Bejewelled, Pong and Space Invaders. In some embodiments, these step training games have no ceiling effect regarding training intensity.
  • tests are made available to users and the users are encouraged to participate in the tests at their convenience.
  • the tests provide for estimating a user's fall risk and help to determine positive or negative effects that the step training has provided. Exemplary tests are described below in the section entitled 'Assessment of fall risk'.
  • Programs that run on the system are adapted to be controllable exclusively by sensor pad 9. They do not require the use of a keyboard or mouse.
  • an option is presented to allow the user to select their own user profile from a list of all users provided by mission control.
  • user step data is uploaded to mission control.
  • the programs launched by the shell do not need to be created specifically for the system. Provided the control structure is simple enough a key remap utility can be run in conjunction with the program to map the correct steps on the sensor mat to actions in the program. A wrapper program that handles all communication with mission control can be provided to select the user and handle uploading of the results to mission control. This allows programs running on the system to be completely unaware of the underlying structure of the system.
  • a back-end of system 1 includes the elements not accessed directly by the user. These include server 1 1 and one or more remote computers 15, which are accessed by healthcare professionals.
  • server 1 1 is hosted by an online health service such as DigiHealth, which is backed by a relational database.
  • server 1 1 is accessible to the various client terminals through three interfaces: XML-RPC 65; HTTPS website 67; and a console 69. All three interfaces act on the same database but do so with different methods, protocols and permissions.
  • the XML-RPC interface 65 is used by authorised computers of the various users such as personal computer 3, which communicates with server 1 1 .
  • Server 1 1 is securely accessible by computer 3 through security measures such as public-key cryptography (each device has a unique key, this is explained in the next section).
  • the users of computer 3 are able to query other users of server 1 1 , structure and programs that are configured for the device and upload data that has been generated on the device. Uploaded data is divided based on the particular program from which it was created. Each program that generates user data has a corresponding data handler on server 1 1 .
  • Each handler parses uploaded data into a database and makes available views on the uploaded data that provides analysed interpretation of what has been uploaded.
  • the HTTPS website 67 is used by healthcare professionals to access server 1 1 . It provides a simple graphical interface to the configuration and monitoring of studies using the system. A health professional can edit the user profiles, programs and configurations on devices as well as edit the standard configurations for studies to which they have access. Healthcare professionals can also add and remove users through website 67 and are able to monitor which users are online and connected to the server via a 'Ping' view. The healthcare professionals can also view all the data uploaded to the server by the various user computers. Through this access to user data, the healthcare professionals can make informed decisions about adherence and compliance to the study.
  • the console 69 is for use by administrators of the system, it is accessible via SSH.
  • the scriptable interface allows for mass downloading, editing and updating of data across entire studies.
  • a boot USB or disk is connected to an internet-enabled user computer and the computer is activated.
  • the boot USB/disk contains a boot loader that begins a net install of the software.
  • the boot loader points to a kick-start file that is a PHP script residing remotely on a build server.
  • the PHP script queries the key and configuration server that returns the current study configuration settings for a new user along with a fresh canonical name (CNAME) for the new user computer.
  • the PHP script then processes all the information together to return complete installation instructions for the new device.
  • the new device installs the packages specified by the kick-start file from the repository hosted on the build server.
  • the new device After installing the packages the new device is instructed to create a private cryptographic key and a key signing request.
  • the key signing request (KSR) is sent to the configuration server which signs the KSR and stores the resulting certificate if and only if the configuration server is expecting a KSR from that IP with that CNAME in that time window.
  • the configuration server After successfully signing the KSR, the configuration server creates a new device record on server 1 1 containing CNAME, certificate details and current study details. The user computer's private key and certificate will be used for authenticating and encrypting communication between the device and server 1 1 .
  • server 1 1 After a new user computer has finished the installation process, it will be visible on server 1 1 .
  • a healthcare professional then logs into server 1 1 (either via the console 69 or HTTPS website 67) and adds the user, programs and a structure to a user profile visible on the user computer.
  • server 1 1 either via the console 69 or HTTPS website 67
  • a generic program and structure can be attached to a study and by assigning the device to the study (this can be done by the configuration server or manually) it will inherit the structure.
  • the user computer is now ready for use in system 1 . The first time the user computer it is started after installation, it will receive its structure, programs and users from server 1 1 .
  • the intensity and type of the step training exercises can be adjusted as user performance improves to ensure that the intervention remains challenging. Similarly, if the user's performance decreases, appropriate changes can be made to reduce the training difficulty.
  • Progression of training intensity is guided by inbuilt "coaching" software implemented on server 1 1 .
  • the coaching software characterises the step performance of the user, makes recommendations on the next level of training and, in some embodiments, automatically implements these recommendations.
  • Adaptation of the training routine includes increasing/decreasing the difficulty of a game, making additional games available and offering one or more tests.
  • the coaching software Through the coaching software, health professionals are able to selectively adapt or tailor the difficulty of the games on the system remotely from their computers via server 1 1 . Another adaptation of the training routine includes making additional games available to the user. On server 1 1 , the health professional is able to specify progression thresholds for each game and for the game launcher that the progressions correspond to.
  • Exemplary characterisations of the user performance include the determination of an average response time for the user step action and the determination of a step error in the user's step action.
  • the step error may include one or both of a step time error and a step direction error.
  • the specifics of the thresholds are handled by the server plug-in for each game.
  • the threshold settings are bundled with program listing messages sent to the device.
  • a game is selected by a user, the user profile is identified and a current progression status is determined using the previous results and threshold values provided by mission control.
  • the game queries the correct configuration for the user's progression from mission control, applies the configuration and begins the game. Saved along with the results from the game are the progression level and configuration settings that it was run with. In some embodiments, there is no ceiling effect regarding training intensity. In other embodiments, training intensity is capped.
  • Training adherence and performance can be monitored remotely following daily or other periodic data transfer to a server, and then accessed by healthcare professionals from remote computers.
  • Computer 3 in the user's home queries server 1 1 on a regular or irregular basis (an exemplary default query setting is 12 hour intervals) to receive its current state and upload all data that has been generated since the last data sync.
  • Server 1 1 saves the uploaded data in a structured fashion in its Relational Database Management System (RDBMS), which includes associated database 23.
  • RDBMS Relational Database Management System
  • Healthcare professionals are able to login to server 1 1 and view the data generated from the user. For example,
  • data uploaded from computer 3 to server 1 1 is in the form of a data message containing a number of data segments.
  • Each segment contains:
  • a program ID that identifies the program that generated the data to be stored.
  • server 1 1 receives an upload message each data segment is processed individually. Firstly the integrity of the data is checked then a data element is created in the database containing the computer the upload came from, the user who generated the data, the time it was received in mission control on the computer and the time it was received at server 1 1 . Then a lookup is done on the program ID contained in the segment and the data payload along with the data element that was just created is passed to a plug-in of the responsible program. The plug-in will then parse the payload into the database and link the parsed data to the previously created data element. Then when a health professional wishes to view the uploaded data they select the root data element and the plug-in provides a view to display the uploaded data in a suitable format for tracking adherence and progression.
  • computer 3 In addition to uploading the results from games and tests, computer 3 also uploads log events of the levels 'WARN' or 'ERROR'. These uploaded logs can be used to help remotely diagnose the cause for issues the user may be encountering.
  • the shell includes an application allowing users to issue a request for contact, feedback or help from a healthcare professional.
  • the request is sent to a healthcare professional by one or more of email or SMS. Feedback to Participants
  • step performance In-game user feedback regarding step performance over a predetermined time period. For example, the background of the television screen visually flashing red or another colour when an error is made or displaying "perfect", "good” or “miss” in the middle of the screen after a step action.
  • Post-game feedback is provided at a number of levels. A user can see the result of their most recent game immediately after completion. For example, a number denoting this score and displaying "New High Score! if they have bested their previous efforts. A user can see their previous scores displayed in a graph over time. This illustrates their progress (positive or negative) and provides incentive to keep playing and keep improving.
  • the shell includes a 'Notification' or 'Feedback' application which allows users to access information and feedback provided by healthcare professionals. Healthcare professionals are also able to call, SMS, email or visit the user to give encouragement, advice or enquire why their performance has changed over time.
  • System 1 is a valid and reliable tool for assessing a user's stepping ability, monitoring the step performance of the user over time and providing an adaptive training routine to the user to reduce the risk of falls.
  • Three exemplary proven stepping tests to determine a person's fall risk and to determine training effects are described below:
  • the Choice Stepping Reaction Time Test is a composite assessment of balance and reaction time. Participants step as quickly as they can in different step directions indicated by arrows, which change in colour on the television screen.
  • the Inhibitory Stepping Test is a measure that combines stepping with selective attention and response inhibition. Participants step as quickly as they can in different step directions indicated by green arrows on the screen. Participants have to inhibit taking a step if the step direction is indicated by a red arrow on the screen.
  • the Stroop Stepping Test is a measure of combined stepping and executive functioning. In the centre of a display screen an arrow appears pointing in one of four directions (front, right, back, left). Inside this arrow is a written word indicating a different direction. Participants are required to step by the word and ignore the orientation of the arrow.
  • An outcome of the tests is a determination of a fall risk level for the user. Based on test results, a user can be characterised qualitatively into different groups including a generic 'fallers' and 'non-fallers' group or more specific fall risk categories such as 'high fall risk', 'moderate fall risk' and 'low fall risk'. In some embodiments, users may be characterised quantitatively into different fall risk groups.
  • system 1 provides for facilitating a method 100 to monitor the step performance of a user and to provide an adaptive training routine to the user to reduce the risk of falls.
  • Method 100 includes, at step 101 , executing, on computer 3, a training routine to control a visual stimulus on television 5.
  • the stimulus includes a prompt for a user to make a predefined step action.
  • a user response signal is received from one or more sensors of sensor pad 9.
  • the response signal is indicative of the timing and/or direction of the user's step action in response to the stimulus.
  • user response data is received at server 1 1 that is derived from the user response signal.
  • server 1 1 1 characterises a step performance of the user's step action in response to the stimulus.
  • feedback to computer 3 is provided by server 1 1 to selectively adapt the training routine provided to the user based on the characterisation.
  • the present invention is a novel, interactive step training system using sensor mat technology that provides an effective method for training stepping ability and improving balance and cognitive functioning in independent living older people.
  • the system is easily installed into people's homes and provides an unsupervised home-based exercise program for older adults delivered through the television.
  • the system described herein uses low-cost video game technology, including a stepping mat (also known as the sensor pad, see Figure 3).
  • the system allows users to perform home-based step training games for the purpose of physical and cognitive exercise in their own homes. Games and tests are provided to a user to train and assess their stepping ability. Additional games, tests and applications can be added to the program listing based on the user's profile and the user's adherence, progress and performance in a prescribed step training regime.
  • the interactivity and entertainment aspects of the technology are anticipated to prompt higher adherence of users to the training routines provided.
  • step training and video games makes it possible to increase complexity and engagement by adding challenging cognitive tasks.
  • These cognitive-motor games target specific executive functions including: working memory, visuo-spatial skills, dual-tasking, inhibition and attention.
  • Games that have currently been developed include modified versions of popular videogames such as Dance Dance Revolution and Tetris.
  • Neuroplasticity i.e. changes in brain structure, function, neurometabolites.
  • any one of the terms comprising, comprised of or which comprises is an open term that means including at least the elements/features that follow, but not excluding others.
  • the term comprising, when used in the claims should not be interpreted as being limitative to the means or elements or steps listed thereafter.
  • the scope of the expression "a device comprising A and B" should not be limited to devices consisting only of elements A and B.
  • Any one of the terms including or which includes or that includes as used herein is also an open term that also means including at least the elements/features that follow the term, but not excluding others. Thus, including is synonymous with and means comprising.
  • exemplary is used in the sense of providing examples, as opposed to indicating quality. That is, an "exemplary embodiment” is an embodiment provided as an example, as opposed to necessarily being an embodiment of exemplary quality.
  • processor may refer to any device or portion of a device that processes electronic data, e.g., from registers and/or memory to transform that electronic data into other electronic data that, e.g., may be stored in registers and/or memory.
  • a "computer” or a “computing machine” or a “computing platform” may include one or more processors.
  • Methodologies described herein are, in one embodiment, performable by one or more processors that accept computer-readable (also called machine-readable) code containing a set of instructions that when executed by one or more of the processors carry out at least one of the methods described herein.
  • Any processor capable of executing a set of instructions (sequential or otherwise) that specify actions to be taken are included.
  • a typical processing system that includes one or more processors.
  • Each processor may include one or more of a CPU, a graphics processing unit, and a programmable DSP unit.
  • the processing system further may include a memory subsystem including main RAM and/or a static RAM, and/or ROM.
  • a bus subsystem may be included for communicating between the components.
  • the processing system further may be a distributed processing system with processors coupled by a network. If the processing system requires a display, such a display may be included, e.g., a liquid crystal display (LCD) or a cathode ray tube (CRT) display. If manual data entry is required, the processing system also includes an input device such as one or more of an alphanumeric input unit such as a keyboard, a pointing control device such as a mouse, and so forth.
  • the processing system in some configurations may include a sound output device, and a network interface device.
  • the memory subsystem thus includes a computer-readable carrier medium that carries computer-readable code (e.g., software) including a set of instructions to cause performing, when executed by one or more processors, one of more of the methods described herein.
  • computer-readable code e.g., software
  • the software may reside in the hard disk, or may also reside, completely or at least partially, within the RAM and/or within the processor during execution thereof by the computer system.
  • the memory and the processor also constitute computer-readable carrier medium carrying computer-readable code.
  • a computer-readable carrier medium may form, or be included in a computer program product.
  • the one or more processors operate as a standalone device or may be connected, e.g., networked to other processor(s), in a networked deployment, the one or more processors may operate in the capacity of a server or a user machine in server-user network environment, or as a peer machine in a peer-to-peer or distributed network environment.
  • the one or more processors may form a personal computer (PC), a tablet PC, a set-top box (STB), a Personal Digital Assistant (PDA), a cellular telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing a set of instructions (sequential or otherwise) that specify actions to be taken by that machine.
  • PC personal computer
  • PDA Personal Digital Assistant
  • one embodiment of the methods described herein is in the form of a computer-readable carrier medium carrying a set of instructions, e.g., a computer program that is for execution on one or more processors, e.g., one or more processors that are part of web server arrangement.
  • a computer-readable carrier medium carrying computer readable code including a set of instructions that when executed on one or more processors cause the processor or processors to implement a method.
  • aspects of the present invention may take the form of a method, an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects.
  • the present invention may take the form of carrier medium (e.g., a computer program product on a computer-readable storage medium) carrying computer-readable program code embodied in the medium.
  • the software may further be transmitted or received over a network via a network interface device.
  • the carrier medium is shown in an exemplary embodiment to be a single medium, the term “carrier medium” should be taken to include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) that store the one or more sets of instructions.
  • the term “carrier medium” shall also be taken to include any medium that is capable of storing, encoding or carrying a set of instructions for execution by one or more of the processors and that cause the one or more processors to perform any one or more of the methodologies of the present invention.
  • a carrier medium may take many forms, including but not limited to, non-volatile media, volatile media, and transmission media.
  • Non-volatile media includes, for example, optical, magnetic disks, and magneto-optical disks.
  • Volatile media includes dynamic memory, such as main memory.
  • Transmission media includes coaxial cables, copper wire and fiber optics, including the wires that comprise a bus subsystem. Transmission media also may also take the form of acoustic or light waves, such as those generated during radio wave and infrared data communications.
  • carrier medium shall accordingly be taken to included, but not be limited to, solid-state memories, a computer product embodied in optical and magnetic media; a medium bearing a propagated signal detectable by at least one processor of one or more processors and representing a set of instructions that, when executed, implement a method; and a transmission medium in a network bearing a propagated signal detectable by at least one processor of the one or more processors and representing the set of instructions.
  • some of the embodiments are described herein as a method or combination of elements of a method that can be implemented by a processor of a computer system or by other means of carrying out the function.
  • a processor with the necessary instructions for carrying out such a method or element of a method forms a means for carrying out the method or element of a method.
  • an element described herein of an apparatus embodiment is an example of a means for carrying out the function performed by the element for the purpose of carrying out the invention.
  • Coupled when used in the claims, should not be interpreted as being limited to direct connections only.
  • the terms “coupled” and “connected,” along with their derivatives, may be used. It should be understood that these terms are not intended as synonyms for each other.
  • the scope of the expression a device A coupled to a device B should not be limited to devices or systems wherein an output of device A is directly connected to an input of device B. It means that there exists a path between an output of A and an input of B which may be a path including other devices or means.
  • Coupled may mean that two or more elements are either in direct physical or electrical contact, or that two or more elements are not in direct contact with each other but yet still co-operate or interact with each other.

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Abstract

La présente invention concerne des systèmes et des procédés pour surveiller la performance de marche d'un utilisateur et pour fournir un programme d'entraînement adaptatif à l'utilisateur afin de réduire le risque de chutes. Un mode de réalisation concerne un système (1) comprenant un ordinateur (3) configuré pour exécuter un programme d'entraînement de marche pour contrôler un stimulus visuel sur un dispositif d'affichage associé (5). Le stimulus comprend au moins une invite pour un utilisateur pour effectuer une action de marche prédéfinie à un temps prédéfini. L'ordinateur (3) est en outre configuré pour recevoir un signal de réponse de marche d'utilisateur (7) depuis un ou plusieurs capteurs d'un bloc de capteur de marche (9). Le signal de réponse (7) est indicatif de la temporisation et/ou la direction de l'action de marche de l'utilisateur en réponse au stimulus. L'ordinateur (3) est également configuré pour communiquer avec un serveur distant (11), qui est lui-même configuré pour recevoir des données de réponse d'utilisateur dérivées du signal de réponse d'utilisateur (7), caractériser une performance de marche de l'action de marche de l'utilisateur en réponse au stimulus et adapter sélectivement le programme d'entraînement fourni à l'utilisateur sur la base de la caractérisation.
PCT/AU2015/050569 2014-10-03 2015-09-23 Systèmes et procédés pour surveiller la performance de marche d'un utilisateur Ceased WO2016049688A1 (fr)

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EP3238620A3 (fr) * 2016-04-25 2018-02-28 dividAT GmbH Plaque de détection de mouvement
WO2018161896A1 (fr) * 2017-03-06 2018-09-13 上海市第六人民医院 Système de rééducation à distance
CN114569955A (zh) * 2022-01-19 2022-06-03 同济大学 一种多目标迈步训练装置
JP7550827B2 (ja) 2022-10-07 2024-09-13 株式会社アシックス 評価装置、登山能力評価システム、および評価方法

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Publication number Priority date Publication date Assignee Title
EP3238620A3 (fr) * 2016-04-25 2018-02-28 dividAT GmbH Plaque de détection de mouvement
WO2018161896A1 (fr) * 2017-03-06 2018-09-13 上海市第六人民医院 Système de rééducation à distance
CN108523841A (zh) * 2017-03-06 2018-09-14 顾以群 一种远程康复系统
CN114569955A (zh) * 2022-01-19 2022-06-03 同济大学 一种多目标迈步训练装置
CN114569955B (zh) * 2022-01-19 2023-03-14 同济大学 一种多目标迈步训练装置
JP7550827B2 (ja) 2022-10-07 2024-09-13 株式会社アシックス 評価装置、登山能力評価システム、および評価方法

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