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  Home Care: A Telematic Rehabilitation Exerciser Kai-Uwe Hinderer, Heinz Nixdorf-Lehrstuhl f ¨ur Medizinische Elektronik, Technische Universit¨at M¨unchen Munich, Germany, kai.hinderer@mytum.deProf. Dr.-Ing. Petra Friedrich, Kempten University of Applied SciencesKempten, Germany, petra.friedrich@fh-kempten.deUniv. Prof. Dr. rer. nat. Bernhard Wolf, Heinz Nixdorf-Lehrstuhl f ¨ur Medizinische Elektronik,Technische Universit¨at M¨unchen Munich, Germany, wolf@tum.de  Abstract —This paper deals with the development of a systemestablished on a telematic rehabilitation exerciser, a plug-PC anda real-time web-animation. An easy to use device, which allows atelematically controlled training at home is target of this project.It is thereby based on the diagnosis and therapy platformCOMES R  of the  Heinz Nixdorf-Lehrstuhl f¨ ur Medizinische Elek- tronik of the Technische Universit¨  at M ¨ unchen . In COMES R  mobilemeasured vital parameters are intelligently evaluated by anexpert system before they are provided to the user along withmedical information and trends.A Java application allows the real-time data, which is sent by atelematic exerciser and received over the Bluetooth interface of the plug-PC to be filtered and transmitted over a SQL-connectionon, to a database. These data is retrieved by the animation andevaluated in form of a game. To visualize this web-animation,the screen of a potential terminal device is splitted in two andtaking only a small horizontal part, this animation is shown onthe screen. The other part could be filled by a TV-programm,Video or Skype window depending on the abilities of the terminaldevice which could be any device with an internet browser (e.g.a Smart TV).  Index Terms —Personalized Medicine, Telemedical Assistance-System, Telemedical exerciser, Bluetooth, Animation. I. I NTRODUCTION A Society in demographic change, spending night afternight in front of the TV, provides the inspiration forthis project, which is aimed at inspiring and winning older,physically limited people to get active by using a telemedicalrehabilitation exerciser. Prevention through movement as wellas a controlled and supervised rehabilitation therapy at homeare also aims, which this project pursues.Telemedicine in general, tries to support patients in theirhome environment and in this case tries to preserve or torestore their mobility, muscles and general physical fitness.Older people in particular have big problems to motivatethemselves to exercise. Stiff joints, obesity and the permanentfear of falling contributes to the fact, that afternoons are ratherspent watching television than going for a walk. Additionallythere are surgeries and health-related mobility restrictionsfrom cardiovascular diseases, rheumatism or arthritis, whichmake it considerably more difficult to reach a daily quota of exercise. However physical activity is essential.Researchers from Taiwan for example proved in a eight yearlong study 1 , that people who excercise for 15 minutes daily,compared to people without significant physical activity,have a reduced risk of death by 14 percent and an extendedlife expectancy by three years [3]. This evidentially appliesnot only for active movement, but can also be achievedwith passive movement by for example exercising with the Thera-vital 2 [4].II. I DEA AND  C ONCEPT The Heinz Nixdorf-Lehrstuhl f¨ur Medizinische Elektronik of the Technische Universit¨at M¨unchen developed the idea of extending the existing telemedical assistant system COMES R  3 by a rehabilitation exerciser.  Excursus COMES  R  COMES R  is a mobile diagnostic and therapy platformwhich intends to help elderly people to live a longer, healthierand independent life. Therefore the  Heinz Nixdorf-Lehrstuhl fr Medizinische Elektronik der TU M ¨ unchen  developed asystem of various sensors, which offer the possibility tocollect and intelligently evaluate vital parameters. Hence, thissystem represents the foundation of the feedback and expertsystem for telemedical treatment.The base of the system consists of data, that is measuredby the user independently and locally unbound with thehelp of a radiocapable measuring instrument. These data istransferred wirelessly and automatically to a mobile phone 4 ,which directly transmits it securely via the SOA-Protocol 5 tothe COMES R  - database. COMES R  provides a wide range of possible wireless measuring devices, as listed below: 1 A population of 416 000 people was monitored and observed by thetaiwanese researchers for about eight years [3]. 2 The Thera-vital exerciser of the  medica Medizintechnik GmbH   is aaccredited medical device after EU definition. Both active and motor supportedpassive training is possible with this device. 3 COMES  R  : Cognitive Medizinische Systeme is a developement of theHeinz Nixdorf-Lehrstuhl f¨ur Medizinische Elektronik of the Technische Uni-versit¨at M¨unchen and is a registered trademark. (http://www.comes-care.net/) 4 A BlackBerry  R  or Android OS based mobile phone is provided for theautomatic transmission of the measured data 5 Via the Simple Object Access Protocol a highly secure, XML-basedinformation transfer is allowed. 2012 IEEE Second International Conference on Consumer Electronics - Berlin (ICCE-Berlin)978-1-4673-1547-0/12/$31.00 ©2012 IEEE  2 Fig. 1. Sensor and feedback system of COMES  R  . ã  Blood pressure monitor ã  Scales ã  Glucose monitor ã  Pedometer ã  Spirometer ã  Splint ã  Snore sensorThe written data on the COMES R  - database is linked toan expert software as well as to a feedback and interventionmanagement. Depending on the individual indication, user-specified limits can be set, which create a definable callback like notifying the patient or ringing up the doctor [1]. In thecurrent project stage the callback, respectively the feedback,is realized by a traffic light system, which allows a three-stageevaluation of the measured values.In the COMES R  - portal the users (patients, family membersor treating doctors) can access both a statistical listing of the data, graphics and algorithmically calculated trends. Withthese detailled information an accurate profile of the user’scurrent healthstatus can be drawn, if needed.The telematic rehabilitation exerciser should be integratedinto this platform. The focus of the exerciser system however,lies not only in collectin data, but also in generating themotivation to exercise. Out of this reason, the training shouldtake place in front of the television. Recorded data arevisualized in form of an animation on a small part of theTV-screen. The reason of a training in front of the TV set isto use the daily time of watching television for exercising.The market research company  Media Control  estimated thisamount of time in 2011 on roughly three hours a day forpeople over 50, which supports this concept [2].The recorded training data however is not only shownin that animation on the television, but are also availableon a database system, which soon will be affiliated withthe COMES R  database. This database performs great for therunning COMES R  - project due to complex and intelligent Fig. 2. Visualization of the involved processes during a training on theexerciser Thera-vital. algorithms, which calculate analysis and current trends.These results are medically reviewed and evaluated beforethey are delivered to the patient together with a therapeuticrecommendation for further exercises. So motivation is notonly generated by spontaneous ambition caused by theanimation during the training, but moreover by the long-termanalysis over the achievements as well as the well-foundedmedical feedback, creating new goals and assuring a steadytraining.The innovation and added value of this system lies inthe unique connection between rehabilitation training athome, medical monitoring and validation and a real-timeevaluation by the web-animation. This approach togetherwith the COMES R  system provides an innovative and fullycustomizable solution for a professionally monitored andmotivating rehabilitation training at home.There are feedback systems in the fitness sector, such asthe  Smart coaching  system from polar R  , which are greatfor sportsmen, who like to train on base of pulse regulation.However, these kinds of systems are not suitable to obtain thecurrent healthstate of its users, because too few parametersare considered. On the other hand COMES R  in combinationwith the Thera-vital records a wide range of vital and trainingparameters and is therefore a much more appropriate systemto meet the expectations of the telemedicine. The user benefitsfrom this holistically approach in many respects. On theone hand complete flexibility concerning the training timeor fitness level is given. Then again a fully controlled andregulated training is nevertheless possible. Additionally thepysician or therapist benefits from this concept. It allows anunique insight into the training behavior and the fitness levelof the patient, which could otherwise only be obtained in  3 Fig. 3. Links between the Thera-vital and the Plug-PC. rehabilitation centers. This extra on information can in turnbe used to create a better and more individualized training orrehabilitation concept for the user.III. R EALIZATION Technically, this project is realized by using the telematicexerciser Thera-vital, which provides the live data over itsBluetooth interface, as well as by software implementations,that receive and process the data. This is on the one handaccomplished by a Java application, wich runs on a plug-PC from Globalscale Technologies inc. R  which receives thetraining parameters and writes them in a MySQL-database. Onthe other hand a web application reads out this live data andanimates it in form of a bike race.  A. Rehabilitation exerciser  The Heinz Nixdorf-Lehrstuhl f ¨ur Medizinische Elektronik was provided with a prototype of the telematic rehabilitationexerciser  Thera-vital . It is able of transmitting values likeburned calories, the distance traveled, the current speed andmany more parameters wirelessly via bluetooth. Due to thefact, that if a connection is established, data is transmittedcontinuously, regardless of the ability of the receiving partto handle the data volume, this system can be considered apush architecture. The required bluetooth interface is fitted asstandard, though current models provide only the possibilityto connect an accessory bluetooth printer to it.The architecture of the Bluetooth interface is based onthe RFCOMM 6 protocol [5]. This means that a connectionbetween the sending device and the receiver can be established 6 RFCOMM: Radio Frequency Communication Protocol by emulating a serial port. To secure this connection theunique address of the receiver has to be known to theThera-vital. Only if this is ensured, the potential receiver isgranted the permission to establish a connection, over whichthe data is finally transmitted.  B. Software The transmitted data is received by a Java applicationrunning on the plug-PC, which probes the information andwrites the relevant parameters in a MySQL-database in theweb.In this case the current speed as well as the remainingtraining time are read out and animated in the cylce race. Thepossibilities though of imaginable animations are endless. Anyof the recorded parameters in the database could be easily usedby an animation.A web-based programming was preferred, due to the facilita-tion of accessing the animation and furthermore to create anapplication independent of the user’s terminal. The challenge,when using a web-based technology is the demand of theanimation. A fluent process has to be ensured, which readsand animates the data with as little latency as possible. Thisdisqualifies a sequential processing of the tasks, because withthis approach the animation would falter. Therefore multi-threading 7 or something comparable is needed.This kind of behaviour can be achieved in using AJAX-requests 8 , which allow asynchronous data access. In this caseit means that during the animation php-scripts are executed byAJAX-requests to readout the latest database values, so thatthe animation could be updated. Fig. 4. Structure of the web-animation with the player as green cyclist aswell as its two opponents. The animated cyclist as well as its two opponents shouldmotivate the player to train more often. This motivation isgenerated by for example the treating doctor or therapist ingiving the two opposing cyclists fixed velocities. Hereby atraining target is created, which is medically reviewed andtherefore a motivating achievement, when reached.After the ending of the training, the data is statisticallyevaluated an plotted in a graph. In addition to this instantanalysis, all data is specified on the COMES R  platform. 7 Multithreading describes the parallel execution of several tasks (threads)during one process. 8 An AJAX-request describes the asynchronous access and readout of databetween browser and server. That means that partial information of a websitecould be updated withoud reloading the whole page.  IV. O UTLOOK With this project an innovative system was created, whichis perfectly well suited to be integrated into the telemedicalassistance system COMES R  . With the Thera-vital exerciser asfoundation and the existing COMES R  network, a system canbe created which allows the electronical reproduction of a pa-tient’s fitness status. This can be used to give recommendationon training, diet and further medical treatment, what leads toa supported but fully unaffiliated life.  A. Real-time and virtual guided therapy The virtual therapy in real-time is regarded as visionof the telemedicine. Vital parameters are recorded in real-time, in case of striking values or critical healthstatesimmediate intervening is possible. Treatment from distancewith transmission and digitization of all signals and valuesis believed to be the therapy of the future. This could bea sensible solution for high risk patients to allow them arelativly normal life, despite the high health risk.However, a binding medical diagnostic from distance isprohibited in the german legal area. This confines the presenttelemedicine in Germany to the use of telemedical assistancesystems. Yet, even without binding diagnoses a wide rangeof topics can be covered telemedically. Thus for example,the monitoring of high-risk patients, as mentioned above,is a large application area for the telemedicine. Significantfacilitation of the daily routine can be achieved withoutmedical diagnosis.But not only high-risk patients belong to the potential targetgroups of a real-time therapy. The application in rehabilitationhas also great potential and should be an area where theCOMES R  system will be applied.In 2009, an average of 296 people per 100,000 germaninhabitants replaced their hip, so the figures of the OECDreport [6]. In light of these figures the enormous potential of this area is obvious. It could be considered conceivable, thatafter the stay in a clinical rehabilitation center a standardizedform of rehabilitation at home with the help of a systemlike COMES R  could be introduced. The progress would bedocumented in various, automatically generated statistics.The motivation could be held up by detailled feedback fromthe treating physiotherapist or physician. Complications orfor example a wrong intensity of exercises will be instantlyregisterd by the system and consequences like reporting to adoctor or an altered feedback, can be drawn.This approach however does not intend to fully replace thepersonal contact to the doctor or therapist. Moreover it triesto enrich the therapy with information, so that a more intenseand fully individualized rehabilitation is possible.  B. Trends The current trends in telemedicine respective AAL 9 aredivided into robotics, gesture control and the design of senior- 9 A mbient  A ssisted  L iving summarizes all developments to improve thequality of life of elderly people. games. The huge market behind the demographic changeis no secret anymore and develops fast. In particular, therapidly developing technology of wireless communication andnetworking attract big companies, that invest in this market.Most notably technologies like the Microsoft R  Kinect R  or theNintendo R  Wii R  enable a fast entry into gesture control orsenior game-design. This project however does focus on themedical part of the telemedicine. Entertainment plays a minorrole. Thus the main goal of the animation is, besides themotivational part, to use the daily time of TV consumptionin a sensible and reasonable way.A CKNOWLEDGMENT The author would like to thank the  medica Medizintechnik GmbH   for their great support in providing a prototype exer-ciser with Bluetooth R  technology. The author is also grateful tothe  Heinz Nixdorf-Lehrstuhl f ¨ ur Medizinische Elektronik of theTechnische Universit ¨ at M ¨ unchen  including the  Heinz Nixdorf Stiftung  that supported and encouraged this work.R EFERENCES[1] P. Friedrich, T. Spittler, S. T¨ubinger, W. Tiedge und B. Wolf,  Comes  R  -ein Konzept zur personalisierten telemedizinischen Assistenz - oder - auf  Anruf Arzt  , in e-health 2011 Informationstechnologien und Telematik imGesundheitswesen / Frank Duesberg (Hrsg.) Solingen, Medical FutureVerlag, 2010[2] Zeit.de.  Deutsche gucken noch mehr Fernsehen , http://www.zeit.de/ kultur/film/2011-01/fernsehen-sehdauer-internet, 3. Jan. 2011.[3] Chi Pang Wen, Jackson Pui Man Wai, Min Kuang Tsai, Yi Chen Yang,Ting Yuan David Cheng, Meng-Chih Lee, Hui Ting Chan, Chwen KengTsao, Shan Pou Tsai und Xifeng Wu,  Minimum amount of physicalactivity for reduced mortality and extended life expectancy: a prospectivecohort study , The Lancet, Vol. 378, Nr. 9798, Seiten 1244 - 1253, Online,2011.[4] C. Oberboillig und P. Kirschner,  Postoperative kontinuierliche passive Bewegung (CPM) nach Augmentation von vorderen Kreuzbandrupturenmit Polydioxanon-B¨ andern. Fr¨ uhergebnisse einer prospektiven Studie ,European Journal of Trauma, Vol. 15, Nr. 3, Seiten 145-151, Mainz, 1989.[5] Nathan J. Muller,  Bluetooth , MITP-Verlag, Bonn, 2001.[6] OECD,  - Hip and knee replacement  , http://www.oecd-ilibrary.org/sites/health glance-2011-en/04/07/index.html?contentType= /ns/Chapter,/ns/StatisticalPublication&itemId=/content/chapter/ health glance-2011-35-en&containerItemId=/content/serial/ 19991312&accessItemIds=&mimeType=text/html, Health at a Glance2011.
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