The imagine cup gave us this challenge. “ Where technology helps solve the world ’ s toughest problems. ” For us, one of these problems is pediatric asthma. This is for three reasons. The cost is enormous. The US alone spends 19.7 billion dollars every year on preventable ER visits and lost productivity. This recurring cost CAN be lower if we do a better job managing asthma. (Nithin, do you have some comparative figures to show the gravity of this cost?) We ’ re also talking about THE most common chronic illness in children across the world. Anywhere froim 8-12% of children have asthma. It ’ s worse in minorities and urban areas, not to mention a serious issue in places like India and China where air quality has become a serious concern. Lastly, asthma attacks are traumatic for the children who experience them. Imagine losing the ability to breath, usually when you ’ re doing something fun or active? Such incidents can make children feel like they don ’ t have control over their own health, and that ’ s something that can stick with you for a long time.
So let ’ s talk about the current standard of treatment. Children are supposed to test their daily lung function using either a peak flow meter or a spirometer. These devices record critical lung volume information that can tell doctors how well your lungs are functioning. This information is supposed to be written down in an asthma log and presented to your doctor every time you go to their office. The holy grail for doctors is getting high quality lung function data from their patients daily. With it they are able to see changes in lung function and even anticipate asthma attacks before they occur. This allows doctors to prevent serious asthma attacks from occuring. As Dr. Cliff Dacso likes to say, “ Our goal is to turn a 2 AM emergency into a 10 AM urgency. ” If we can do that, we ’ ll limit the cost and burden of asthma to families and healthcare providers alike. There ’ s just one problem with all of this
Kids don ’ t like it! What we ’ ve done is given kids another homework assignment. Studies have shown that these regimens are easily forgettable. The information is heard once in the doctors office after which both parents and children struggle to remember much of it. Not to mention lugging around a spirometer on top of their other asthma hardware (e.g. inhaler, spacer, etc.) is often a hassle. Writing out this information in an asthma log is tedious. As kids forget to do it they have more incentive to falsify the information. The maneuver itself requires maximal effort from children. If done improperly, the information is worthless. So if kids aren ’ t motivated to do it properly, then we can ’ t get good data. All of this has led to two decades of adherence rates under 50%. We ’ re talking about THE MOST COMMON CHRONIC ILLNESS in children! This is unacceptable, we have to do better! So now we ’ re going to show you our approach…
Our approach is all about PLAY: promoting lung assesment in youth. We do this in three ways: We make it more convenient for children do their assements. Kids will forget a million and one things, but they ’ ll never forget their phones. By incorpating assesments as part of something they already use and carry, we increase the likelihood of children sticking with regimens. We make doing lung function assesments into a fun experience. Kids play games that use a spirometer as a unique input device, such as breathing fire when you ’ re a dragon. This is a 180 from the current chore like system that kids are used to. Lastly, we make the whole system more valuable. We get higher quality diagnositc information (spirometer vs. peak flow) to doctors and can better guarantee the quality of the assesment (in-game quality check algorithms). Thus doctors are better able to care for the individual child as well as accumulate data for general research about asthma and other lung diseases.
We ’ ve used the Windows Phone 7, coding in XNA and married it to a spirometer. The problem with current spirometers is that they are either expensive and only found in the doctor ’ s office or cheap and portable, but proprietary. Our spirometer was created at Rice University by the MobileWARP group and is inexpensive, portable, and open-source meaning that we can merge with mobile phones. It is the FIRST AND ONLY spirometer that brings together these three critical factors, making it a unique and exciting technological venture. NOTES FROM SID Currently, spirometry equipment is limited to a few companies that develop proprietary hardware and software. The clinical hardware is lab based and operated by technicians. There are just a few portable spirometers, most of them targeted towards determining peak ﬂow, just one value rather than the whole maneuver. The few spirometers that do capture the whole maneuver donʼt make the data available in real-time or to any arbitrary device. The data can only be extracted by their proprietary software. We have developed new spirometry hardware that is speciﬁcally targeted at mobile devices. Mobile devices have enough computer power to handle the raw spirometry data as well as the attention of patients to use the data in novel ways. The hardware is bluetooth-based and completely developed in-house at the Center for Multimedia Communication. The main processor is a Texas Instruments MSP430. The hardware was designed by Sid Gupta, ﬁrmware by Patrick Breen and Nonso Anyigbo, Android frameworks by Peter Chang
We ’ ve created a 2D side scrolling RPG that uses this spirometer as a unique input device. Children complete spirometry maneuvers while playing as Azmo the Dragon to defeat castles. These readings are recorded over time and can be sent to physicians and parents.
Our game is based off the fundamentals of CAR. Calibrate Bathe dragon egg in fire by breathing into spirometer Done in doctor ’ s office to ensure validity Serves as baseline for future comparison Requires maximal effort Assess Fight inhabitants, destroy buildings – 2D side scroller Defeat final castle using fire controlled by spirometer Compare assessment to calibration, generate score Review View history of spirometer scores for decline Earn achievments for consistently doing maneuvers Understand changes in lung function over time This is the point where we transition to Chase/Eric for the demo. I will see if I can find a link to our presentation.
Demo finishes…. So you just saw the main goal of our game. Having children complete spirometry maneuvers daily. What ’ s important here is that we go beyond games that aim to improve awareness about issues. We aim to have a critical clinical impact that will improve the function of this healthcare system. We ’ ve also turned the current asthma care paradigm on its head. Rather than having kids see self management as a chore, we ’ ve made it into a fun and dynamic system that rewards children for playing a more active role in their health. These strategies have been proven from other games… Improvement in clinical efficacy from ReMission (Better word than addiction) to a scheduled regiment from Global Timer Mechanic in Farmville
We want to expand the game mechanics to include… Geolocation that changes in game play depending on level of asthma triggers in surrounding location. Take GPS location, map to National Weather Association pollen counts and O-zone levels, change in game play. Unique way to get kids thinking about the effect of asthma triggers. Include social network aspect to bring children with asthma together. Maybe even having them expand the game and create levels for each other to play. We want to create a prototype where the spriometer is actually shaped as a case around a smartphone making it truly mobile. Our next step is to apply for grant funding and complete a clinical study that shows the efficacy of Azmo, both to physicians and children. We believe our product is a step in the direction of technology helping solve the world ’ s toughest problems. Thank you.
Using mobile technology to change the world for kids with asthma Team Dragon Pierre Elias Nithin Rajan The Abramson Center for the Future of Health