CURA          2011www.design-engineering.ee
Janno Nõu - product designer, Estonia    Alan Guillemot - Engineer, exchange student, France    Larissa Frosch - product m...
ContentsIntroduction 4Subject research 4Innovation context 10Global solution 11MonitoringDevicesPre-conceptsUsability 14Br...
Introduction   This report is a conclusion of our teamwork on concep-                   tual design studies.              ...
It has been stated in many papers that bone fractureamong older people is a serious concern as it will lead toa decrease i...
While population is                                                               getting healthier, the                  ...
The circle that describes falling is linked with anotherone that describes social isolation. People who are recov-ering fr...
only simple meals and is missing being able to bake for                                               her friends. Jean ca...
aches sometimes at night. She has become anxious and           is easily upset.           We decided to concentrate on the...
Innovation     Context                                    Hospital                                 Home                   ...
Monitoring Our solution is to imitate some aspectsof the therapist to give patient reassurance that he is        Globalbei...
Legend:      Good      Bad      Neutral      Possible solution    Concept 1: Plasters Concept 2: Strap/pants              ...
Possibility to       Can´t change               difficult if it is undercorrect the position immediately                dr...
Usability   Patches Patient is wearing patches all the time, these                 are applied and changed during medical ...
Characteristics of tablet:•	 has two working positions: standing and lying for   various using patterns•	 doesn’t have a b...
16
17
18
19
Storyboard                  The clock is ringing Ants opens his eyes, he puts one leg                  over the bedside to...
It is time for everyday workout. Well, it isn’t so much anexercise as it is just bending practice, he thinks. At thelast m...
Everyday life     bracelet’s interface          Situations         Vibration alarm          Sound alarm           Visual a...
Working-out                                                                bracelet’s and tablet’s interface              ...
Technical               The figure below describes the interactions between the                             patches, brace...
Motion sensor To measure movements, several kind                                  Patchesof electronic components can be u...
Autonomy calculation Because the patches will be                 changed every 3-4 weeks only, they should have this      ...
The main advantages are:•	 Electronic paper uses natural light. So it is visible   even in difficult condition (except dar...
Vibration alarm The same kind of vibration motor                                     as used in cellphones is suitable. Th...
SERVICE FLOW MAP                  PATIENT                                                                    DEVICE (KIT) ...
Service blueprint                                 Device                     Medical                Patient               ...
The project has a lot to be developed, for instance weleft aside the doctor’s side of the information flow.               ...
Home-Based Multicomponent Rehabilitation Program for Older. Persons After Hip Fracture: A     Randomized Trial (Arch Phys ...
AppendixesAppendix I: Findings among older peopleOpinion of 3.elderly person ( women ) in 65, 76 and 90 years about equipm...
Appendix II              Bracelets interface test results:                what is important for user                      ...
Appendix IV  Tablet interface test results           question                           solutionHow can I start the exerci...
Appendix VI                                                                                                               ...
Cura
Cura
Cura
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Cura

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This is a study project of the Design & Engineering programme, the joint International programme of Tallinn University of Technology and Estonian Academy of Arts.

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Cura

  1. 1. CURA 2011www.design-engineering.ee
  2. 2. Janno Nõu - product designer, Estonia Alan Guillemot - Engineer, exchange student, France Larissa Frosch - product manager, Estonia Madheswaran Chidambaram - structural engineer, India2
  3. 3. ContentsIntroduction 4Subject research 4Innovation context 10Global solution 11MonitoringDevicesPre-conceptsUsability 14BraceletTabletStoryboardEveryday lifeWorking-outTechnical working 24Patches 25Motion sensorWireless connectionAutonomy calculationBracelet 26Wireless connectionMicrocontrollerMemoryVibration alarmVisual alarmSound alarmActivity displayTablet 28Wireless connectionMemoryMicrocontrollerLCD displaySpeakerService 29Further developments 31Conclusion 31References 31Appendixes 33 3
  4. 4. Introduction This report is a conclusion of our teamwork on concep- tual design studies. The aim of this assignment is to develop a concept for personal training device. All though we started the de- sign process with the classical gym equipment we real- ised only after several backfirings that our project had a different angle for the theme. It took an independent workshop that was comfortably joined with the project to really get a firm foundation to get going. Subject We started the project with a superficial overall re- search which lasted one day and after what we nar- Research rowed our project scope down. We chose the theme of motivation which had to be narrowed down further as it was still way too wide. We introduced three sub-themes: seniors, equilibrium and interaction which were narrow enough to get usable results out of the research. Output of the research was a giga-scale map (more than 300 en- tities) that brought out the problem and illustrated the overall situation quite well (the map itself can be seen here: dl.dropbox.com/u/20271965/Map.pdf ). We discovered that quite many problems among older people are accident related. Accidents are the only domain in health care that will increase as population is getting healthier and with aging population accident related injuries and results are demanding more and more money. The population percentage that is over 65 will skyrocket in the beginning of the 2nd decade of 21st century be- cause of the post WW2 baby boom. In 2030, the propor- tion of those over 65 will be 33% in Australia, or 50% in Germany. A really important factor is also the amount of healthy years to live for people 65 years old which shows that poorer countries who don’t have enough money to spend on personal healthcare have problems with many ill people who haven’t received full deten- tion, this in turn will demand even more money. After retiring your physical activity decreases, increasing the chance of accident with serious consequenses.4
  5. 5. It has been stated in many papers that bone fractureamong older people is a serious concern as it will lead toa decrease in life quality in about half of the cases. Twothirds from among the people who will even recoverwon’t get back the same movement level as they hadbefore the accident. The hip fracture is usually statedto be one of the most serious that will lead to immobil-ity, decrease in life quality, fear and quite often to nextfracture or another illness. Amazingly there hasnt beenany serious research to find out how many deaths thatare caused by other factors can be traced back to hipfracture. Swedish health care report thinks it to be up tothree times as much as there are deaths caused directlyby hip fracture.Accident and bone fracture that will decrease yourmoving capacity can be described as a self feeding circle.Quite often people who have had bone fracture in theolder age and even completely healthy people who arein the older age will develop fear of falling. This in turnwill lead to moving less that will decrease the equilib-rium and muscle fitness and this increases the likelihoodof falling and fracturing a bone. Once fallen the fear offall will increase and the circle starts again.BREAKDOWN FOR MENLife expectancy/healthyyears after age 50UK: 79.5/19.7Sweden: 80.3/20.2France: 79.6/18.0Spain: 79.5/19.2Austria: 79.1/14.5Germany: 79.0/13.6Finland: 78.5/12.9Denmark: 78.3/23.6Estonia: 72.4/9.0Latvia: 71.3/11.0 Population is ageing,BREAKDOWN FOR WOMEN that means there areLife expectancy/healthy years more and more peopleafter age 50 who won’t work.UK: 82.7/20.8France: 85.4/19.7Spain: 85.0/18.6Finland: 84.1/13.9Sweden: 84.0/20.3 After retiring your Old-Age Dependency Ratio 2020 forecast %Austria: 83.7/15.7 physical activity 30–50 10–19.9Germany: 83.0/13.5 decreases. 20–29.9 0–9.9Denmark: 81.9/24.1 Not IllustratedEstonia: 80.5/10.4Latvia: 79.3/12.7 WESTERN EUROPE IN DETAILIn 2030, theproportion of thoseover 65 will be 33% Populationin Australia, or 50%in Germany.Population percentage whois over 65 will skyrocket in ndthe beginning of the 2 stdecade of 21 centurybecause of the post WW2baby boom. 5
  6. 6. While population is getting healthier, the amount of accident injuries is increasing Accident injuries Opthalmic – Eye problem is very common in old people. Osteoporosis Hearing – loss of hearing and hard- hearing are the major hearing problems of old age. Cardiovascular – hypertension, heart about half of the attack, rupture of blood population over vessels etc. are common 65 disorders in old age. Sight impairments Major health Diabeties problems among seniors Musculoskeletal – osteoporosis, spasm, drooping shoulder are invariably found in aged people. Avoid falling down • Regular physical activity Musculoskeletal pain • Equilibrium exercises (weight shift, knee flexion, toe raise, etc.) Endocrinological – • Good shoes diabetes is major disease. • Grab bars / handrails • Avoid domicile dangers (carpets tacked down, stable chairs, etc.) Psychological Problems and • Tai Chi Emotional problems Cancer – the danger of cancer is multiplied with Reduce the fall effect the advancement of age. • Healthy diet (stronger bones) • Hip protector Rehabilitation • Immobilisation (Cast, lay in bed, etc) • Surgery • Training (continued after reha- bilitation) *Physiotherapist *Rehabilitation centre *In-home assisted care • Healthy diet6
  7. 7. The circle that describes falling is linked with anotherone that describes social isolation. People who are recov-ering from fracture are in bigger risk to be left in socialisolation. Right now there are two solutions for peoplerecovering to help them get back their confidence andmobility. One of them includes staying at rehabilita-tion center where professionals have the know-how andequipment to help, but staying outside home will de-crease motivation and about half of the people wont goback home. Second of them lets people to stay at homeand is a device (protective padding) that you wear onyour hip, it doesn’t do much more than give you reassur-ance that when you fall then there is bigger possibilitythat you won’t fracture anything. This will obviouslywork only when you wear it. Rehabilitation while livingat home will give older people much more motivationas they can see the possibility of getting along by them-selves. It has been noted that people staying at homehave still problems with motivation - for some reasonthey won’t do enough exercises. They have the goalin sight but they don’t exercise enough, when they dothough they have better results than people who stay ata rehabilitation centre. When people fail to recover theyface really serious consequences. A staggering eightyper cent of women who have survived a hip fracturewould rather be dead than experience the loss of inde-pendence and quality of life that results from a bad hipfracture and subsequent admission to a nursing home.Here are four cases that describe the situation of hipfracture:Full health—Anne She lives in her own home andcares for herself. Anne is active in her local commu-nity and is out and about with friends quite a bit. Sheswims regularly and enjoys visiting her children eachweekend. Anne walks without any aids and can manageher 12 steps at home without any problems. She enjoysshopping and cooking for herself. Anne does not needany help with the housework and derives pleasure andrelaxation from gardening.Fear of falling—Mary She lives alone in her own homeand cares for herself. Mary is involved in communityfundraising and enjoys playing bridge. Mary recentlyhad a fall. She did not break any bones but was badlycut and bruised. She is scared of falling. Mary continuesto walk without aids. She still looks after herself anddoes her own housework. Mary has been a bit depressedsince her fall. She has returned to her bridge group butis anxious when she is outside the home because she isscared of falling again.Good hip fracture—Jean She lives in her own homeand cares for herself. Before her fall Jean was out andabout quite a bit with her church group. She swam ona regular basis and occasionally looked after her grand-children. Jean broke her hip when she fell. She is findingit difficult to do everything at home now that she walkswith a stick. She needs help in shopping as she no longerdrives or feels confident to shop alone. She can prepare 7
  8. 8. only simple meals and is missing being able to bake for her friends. Jean can no longer manage the housework by herself. She misses her church activities but finds it too painful and tiring to be out for long periods. Jean experiences feelings of frustration and anger. Jean gets tearful thinking about all the things she can’t do. Bad hip fracture—Elizabeth Until her recent fall, she lived in her own home and managed to care for herself. She was active in her local community. Elizabeth broke her hip when she fell. She is now unable to live alone as she requires a great deal of help to do most things. Elizabeth now lives in a nursing home near to her family but away from her friends. She is limited in where she can walk because of the frame and is un- able to walk for long distances. She is unable to shower or dress without help from the nurse. She is unable to pursue her gardening or community work. Her leg impact (FoF) bad experience equilibrium is controlled by deep muscles immobility Back problems no sucsess + group activities are possible lack of training stay at home Lack of8
  9. 9. aches sometimes at night. She has become anxious and is easily upset. We decided to concentrate on the circle that will de- velop after the fall and put our efforts towards easing the problem and helping along with rehabilitation after hip fracture. We went to Viimsi hospital to speak with physiotherapists working there. When mapping the situation in real life, we learned that the problem is not in the hospital but at home. Rehabilitation hospitals are quite well equipped. The equipment is simple, elegant, professional and easy to use but with the help of a thera- pist. Furthermore, it turns out that most of the older people, at least in Estonia, don’t have enough money to buy necessary equipment for themselves, which means going to therapy regularly. But most people will start going to therapy far too late. - poor respect - poor respect + no more relationship with the partner + emotional support - don’t meet people - + practical support - contact with store keepers + emotional support, Hobbies, solidarity - di culties to meet people + afraid to go out - no more buisness asociates - less involved in the societypossible + less money - di cult to go to activity places - decrease the walk and drive avility 9
  10. 10. Innovation Context Hospital Home external passive Everyday fixation or active training life training Internal with (low-stress Active training fixation physiotherapist workouts) alone (surgery) simplified scenario of recovery after a serious joint fracture In case of a serious joint fracture, the recovery period is divided in 4 parts. For instance after a hip fracture surgery with prosthe- sis in Estonia: • The patient will stay maximum 14 days in the hospi- tal. • A medical visit is planned 2,5 month after surgery. If the joint can move at 90 degrees, the operation is considered as a success. • If after 6 month, the joint is still not recovered, the patient will go to therapy. This system has many problems: • Some people don’t exercise at home (lack of motiva- tion, lack of confidence, don’t remember the exer- cises, don’t think about it, etc.) • Some people work out too much and risk to hurt themselves (over-motivation, body limits unaware- ness, etc.) • If a movement is done in a wrong way or with too much amplitude, the joint can dislocate or break again. • If physiotherapy is done too late after the surgery, its efficiency is very low. Globally, the existing system minimizes the direct costs (equipment, medical visits and physiotherapy). How- ever, because it’s efficiency is quite low, it has many additional costs like additional physiotherapy sessions, personal assistance for non-self-contained people, etc.10
  11. 11. Monitoring Our solution is to imitate some aspectsof the therapist to give patient reassurance that he is Globalbeing looked after, knowledge what to do when he isexercising, motivation to do the exercises thoroughly Solutionand all of that in home environment. We achieve it withsensors that are placed on the body.Devices Sensors can’t do anything reasonable bythemselves - they need some interpretation. So oursolution consists of three different parts. Firstly, asmentioned there are sensors, secondly there is a devicethat is with you all the time (even when you are sleep-ing) to monitor your physical activity and warn youwhen needed. Thirdly there is a device that will assistyou when you are working out - it has more specificcapabilities to help you along the way.Pre-Concepts Nb: “Doctor” can designate a physi-otherapist or a nurseConcept 1: Plasters and frequent visitsSensors are placed on the body with a kind of plaster,this is done by a doctor to ensure the right placement.The doctor will set up the devices and teach patient touse them. Plasters are thereafter changed every 1 to 2weeks during visits to the doctor. Sensors and braceletare replaced with new ones that have charged battery.Data stored in the bracelet is transferred over blue-tooth to the doctor’s computer where it is analysed bya computer program which is in turn overviewed bythe doctor. Doctor receives information about patients’activity between the visits, wrong movements made bypatients and joints’ movement amplitude and can givesuggestions and new workouts directly face to face.Concept 2: Strap/pants and distance monitoringSensors are placed on the body with several straps orpants-like things, by the patient him/herself. Deviceis removed every night and re-applied every morning.Sensors are big enough to be feeled and put in a goodposition (more space for electronics). Data is sent auto-matically to the doctor via phone system. Doctor analy-ses the data from his/her office, then can call or meetthe patient if needed. Doctor can be alarmed in case ofemergency (fall etc). Device is set up first time by thedoctor and thereafter by the patient him/herself. Feed-back about current situation is received over phone orin case of a very serious problem the patient is called tothe hospital for an emergency visit. 11
  12. 12. Legend: Good Bad Neutral Possible solution Concept 1: Plasters Concept 2: Strap/pants and frequent visits and distance monitoring Wash the device Don’t need to be Washable waterproof washed and temperature resistant Not usable during washing sensors must be removable from straps Possible to not wash it often? Take a shower/bath Possible Has to be removed Need to be waterproof which is expensive if bathing should be included Go to toilets No changes Straps: no changes Pants: Need to be removed Comfort Sweat Straps: need to be tight Need to be flexible Pants: ok Painful when removed can be removed with solvaint Battery all components must be Seems ok, especially with really power efficient pants (1 battery and 1 transmitter) Extra power to send energy Accuracy Good because applyed Straps: Difficult to put by the doctor/nurse accurately Can move if skin is Can move afterwards flabby Pants: ok for the position placed in non flabby Good stability places Aesthetics ok more visible Price and time for Medium Depends of the needs doctors Can be combined with Doctor needs to file a distance monitoring if report even if monitoring no battery problem from distance Efficiency Long time before Doctor receives the data feedback of doctor quickly Can be combined with Don’t see the patient distance monitoring if directly no battery problem Direct contact with doctor immediate feedback Communication Good and predictable Few direct meetings less confidence Amount of work and None Every morning and12 difficulty for patient evening
  13. 13. Possibility to Can´t change difficult if it is undercorrect the position immediately dressingwhen it is disturbed Painful to take offPhysical conditions good, because I can’t Pants: difficult to put on,of patient: memory, feel it all the time/ to correct them( balancevision, balance, possible to forget that and possibility to turn themovements you have it on body, stomach aloud not); fingers will not move well; forget to put on Straps: difficult to feet down the leg ( balance, fingers will not move well, stomach aloud not), difficult to worship; forget to put on, cant see the connection markingHow it feet with Very well- possible to Pants: impossible todressing put on as pants , so as compose with other tights (women) dressing(type, colour, boots- stout body) Straps: difficult to put on with tights; connections remain in the fabricsHow it fit with the Doesn’t disturb body Pants: uncomfortable -body movements; can’t change the pants if its too warm. It is needed to put on and off mornings and evenings- I don’t want to do it again , because it is painful and difficult; should be right size; it supports body- helps to move Straps: scale of sizes; if it is not well placed it can slip down or move to the wrong position; disturbing to lie down or took of for resting time- squeezes and disturbs because of the thickness of the fabric);Conclusion We decided to go with the plaster concept, mainly so becauseof the benefits when wearing it and the fact that it’s less demanding for thepatient. The plaster concept got even stronger when feedback from our fam-ily doctor came back saying that even when they monitor from the distancethey still must file the report, so there is no time benefit for doctors withdistance monitoring, if anything then the time will be increased because ofthe denser monitoring cycle. 13
  14. 14. Usability Patches Patient is wearing patches all the time, these are applied and changed during medical visit that hap- pens roughly once every month. The patches are invis- ible under clothes, they withstand showering but bath- ing and swimming is not allowed during recovery period (this will exclude water therapy). Patches are made from fabric that lets skin breathe but makes the patch more durable. When a patch has been applied on skin for a month it could be stuck quite toughly so solvent can be applied to remove it. Bracelet & Tablet Usability qualities of the bracelet (device that is always with you and is meant to monitor your overall activity) and tablet (specialized for exer- cising) are made to meet the possible physical changes of aging. Typically these are diminished vision, vary- ing degrees of hearing loss, hand eye coordination and psychosomatic impairments including difficulty with small motor coordination. Important factor to follow is the emotional and physical stage after surgery or injury rehabilitation in hospital. Emotional qualities of bracelets and tablets usability: safety motivation assurance independence self-confidence Usability milestones of bracelet: • uniformly understandable display data • easily manipulative grasp of the bracelet, so it is easy to put it on and take it off (see image on the facing page) • antibacterial material • good contrast of display colors • visual, sound and vibration alarms provide efficiency in the different physical conditions of the elderly users • is applicable with one hand Benefits of bracelet: • black-white and two warning colors • uses 3 different possibilities of alarm: visual, sound and vibration - they all work simultaneously and complement each other to give clear understanding of the situation • it has also low battery indicator (emergency only, normally battery is replaced in hospital) • easy to put on and take off because of material of the strap and system of the clasp what is broaded on the end so that it is impossible to pull it out of the buckle14
  15. 15. Characteristics of tablet:• has two working positions: standing and lying for various using patterns• doesn’t have a battery and only needs to be plugged in to operate• display orientation will change according to the posi- tion of the device• two buttons to use: on/off and pause/play• exercises are displayed as video, these are the same videos that are already in use at the rehabilitation centres• speaker and warning signs let the person know about too fast and wrong movements, also voice command is played when proceeding to the next exerciseThe bracelet uses Velcro to open and close easily. The end of the strap is bigger than the buckleso the bracelet never completely opens, and is therefore easy to slip on the wrist. 15
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  20. 20. Storyboard The clock is ringing Ants opens his eyes, he puts one leg over the bedside to stand up. Something on his night- stand goes BEEP-BEEP-BEEEP... he hears it almost every morning, it is an alarm saying he bends his leg to a dangerous position. As the sound isn’t violent he knows that he is in the safe zone and that this is just a reminder. He raises to sitting position, picks up the bracelet that doctor gave him after his hip surgery and fastens it on his hand. Over last couple of weeks Ants has developed a habit of going to the market place with his wife. Doctor suggest- ed him to walk daily and going to marketplace is a nice and pleasing outcome of trying to fulfill that command. As the weather is nice and their house isn’t far they de- cide to walk back. In front of the house Ants is looking at the bracelet that doctor gave him and he smiles. The watch shows that he has already done half of the daily physical activity required.20
  21. 21. It is time for everyday workout. Well, it isn’t so much anexercise as it is just bending practice, he thinks. At thelast meeting the doctor showed him some exercises thatwould be best performed next to table. As always heturns on the device that shows him exercises the doctordescribed. The display on the device starts to glow andplays a video clip of the exercise. Ants is already famil-iar with the exercises so he isn’t looking at the screen somuch because he knows the movements and the devicetells him with nice voice when he is doing somethingwrong. After some repetitions device says: “That’senough it will do. Lets move on to the next exercise”and the video showing next exercise starts. Right thentelephone rings! Without hesitation he pushes one ofthe two buttons on device, which pauses and answersthe phone, it was his daughter checking his progress onrecovery. After call ends he walks back to the table andturns on the device, screen starts to glow and it starts toplay the same video it was prior to shutting off.In the evening Ants decides to take a shower. As heundresses he puts the bracelet on top of the washingmachine. As in their apartment shower and bathtub isjoined, getting under shower is hard work for someonewho is recovering from hip surgery. The bracelet seemsto agree as it starts vibrating and beeping vigourosly afew times during his “mountain climbing”. This mightbe the most extreme point of the day regarding to hisrecovering limb. Ants thinks that he might avoid show-ering altogether when there weren’t this little helper. 21
  22. 22. Everyday life bracelet’s interface Situations Vibration alarm Sound alarm Visual alarm Screen morning, wake up, beginning of the day wrong movement, too large amplitude of movement or too fast starts with low starts with low interval impulse, alarm light alarm light interval impulse, grows more vigorous outside the screen. outside the screen as the limit gets grows more closer. vigorous as the limit gets closer. amount of activity is too close to the limit Limit is achieved 2x beep 2x vibration impulse Amount of activity is to less 2x beep 2x vibration impulse Baracelet is not on the hand steady alarm light steady signal steady alarm light outside the screen outside the screen Stay a long in wrong position or fall down stop after a while stop after a while stop after a while stop after a while22
  23. 23. Working-out bracelet’s and tablet’s interface bracelet’s interface tablet’s interface situations Sound alarm vibration Visual screen Voice on Screen alarm tablet startexercising wrongmovement, too largeamplitude alarm light of starts with starts with alarm lightmovement low interval low interval outside the outside the screen impulse, screen. grows more impulse, vigorous as grows more the limit gets vigorous as closer the limit gets closer too fastmovementthe end of exercises depends on how much is donetoo much is done off off 2x beep 2x vibration impulse too little is done off off 2x beep 2x vibration impulse stay longin a wrongposition or stop after a stop after a stop after a fall down while while while stop after a while 23
  24. 24. Technical The figure below describes the interactions between the patches, bracelet and tablet electronic components. working The patches capture the body movements with the mo- tion sensors (1) and send it to the bracelet via bluetooth (2). The collected data are then processed by the bracelet microcontroller (3), to calculate the joint angles. These angles are saved in the bracelet memory (4). The brace- let display changes according to the quantity of move- ment registered (5). If a problem is detected by the microcontroller, the alarms will work (6). When the user is working out, the LCD screen displays a video of the exercise, which is stored in the tablet memory (7-8). The exercise is chosen according to the settings of the bracelet (4-3-7-9). The data processed by the bracelet are used by the tablet microcontroller to command the speaker (3-7-9-10). Patches Bracelet Interface Vibration alarm 4 6 1 Visual 6 alarm 6 3 Sound alarm 2 5 7 Tablet 9 8 Movement 7 Wired 10 Wireless24
  25. 25. Motion sensor To measure movements, several kind Patchesof electronic components can be used:• Accelerometer and gyroscopeThey measure respectively the linear and rotational ac-celeration.To measure a position, it should be calibrated (refer-ence position and sensibility). Also, they have a limitedmeasure speed; if this speed is exceeded, the referenceposition has to be set again.• Infrared DEL and cameraThis solution uses special camera to follow the move-ment of infrared DEL (For instance in the NitendoWii™). Because the camera is external and shouldalways point at the DEL, it’s not suitable for our appli-cation.• Incremental encoderIt measures the angular position or motion of an axle.Because it measures the position only around an axle,it’s not suitable for complex joints like the hip, which canrotate in every direction.• Electronic compassAn electronic compass uses the magnetic fields to knowits orientation. By calculating the difference betweenthe angular position of the two compass, it’s easy tomeasure an angle.In this way, the reference is always the same for everysensor, so the measures are reliable.These components are cheap (~2€), small (~15mm3) andconsume little energy (~100µA in normal mode, 1µA insleeping mode).An electronic compass in each patch will be used tomeasure the joints’ angles.For instance, the STMicroelectronics LSM303DLHCcould be used (see Appendix VI)Wireless connection Because the bracelet is alwaysclose to the patches, and people work-out near the tab-let, the distance range is approximately 5m (plus secu-rity margin).The amount of data is very low (few kbit/s).The Bluetooth v4.0 with low energy technology suitsvery well. Bluetooth low energy chipBluetooth v4.0 low energy characteristics: Distance range 10 to 60m Bit rate ~200 kbit/s Current consumption 15.8 mA (0.001mA in sleeping mode) Size 6mm x 6mm x 0.85mm Price ~2€ 25
  26. 26. Autonomy calculation Because the patches will be changed every 3-4 weeks only, they should have this autonomy at least. The patches are worn all the time, so their electronic part (including the battery) should be as small and lightweight as possible. For this reason, it is important to optimize the energy consumption. • Bluetooth consumption: Single connection event of BLE: 2.3 ms @10Hz active time: ~2% The average current consumption during a single con- nection event: ~10.655 mA Sleep current: 0.001 mA =>Average consumption: [ (1000 ms – 2.348 ms)*(0.001 mA) + (2.348 ms)*(10.655 mA) ] / (1000 ms) = 0.026 mA (Sleeping mode / Normal mode) • Compass consumption Compass average current consumption: 0.11 mA • Global autonomy Coin cell battery* nominal capacity: 550mAh 550mAh /(0.026mA + 0.11mA)= 4044h 4044h/24h = 168,5 days = 24 weeks => A patch can have a long enough autonomy with a very small and lightweight battery. *A coin cell battery is used for calculations as an ex- ample. The final device could use any kind of battery (disposable or rechargeable). The example battery has following characteristics: 3V, 13mA, 24.5 x 5.0 mm, 6.2g, 0.08 - 0.16 € / Piece. Bracelet Wireless connection See “Technical working/ Patches/Wireless connection” page 25 Microcontroller The bracelet microcontroller is used 44 to: • Calculate the joint angle from the sensors data • Control the bracelet alarms • Control the bracelet display • Store the data in the bracelet memory Because the required speed is very low comparing to existing microcontrollers, the bluetooth embedded mi- 54 crocontroller could maybe be used. Memory The bracelet memory should store: • The bracelet firmware • All movement data between two medical visits • The reference of the exercises gave by the doctor • The limit angle settings In this way, during a medical visit the physiotherapist 14 can download the movement data and set up the system via bluetooth. Activity display The display should be easily readable in all conditions. A liquid crystal display (LCD) is not readable if the light level is too high. Also, the back-light of an LCD screen consumes a lot. For these reasons, an electronic paper (E-ink) will be26 used.
  27. 27. The main advantages are:• Electronic paper uses natural light. So it is visible even in difficult condition (except dark), just like usual paper.• The energy consumption is very low (and null when the display remains the same).• Cheap (a few euros)The E-ink is usually only black and white (color screensexist but are expensive). Because the displayed colorsare constant (orange and red), some color filters will beplaced above the display. It will color the white parts ofthe display, but will remain almost invisible on the blackparts.Visual alarm For the visual alarm, a LED light ismore suitable than the E-ink, because it is more «ag- Bracelet displaygressive». To include the led light in the E-ink display,there are several possibilities:• Because the electronic paper can be translucent, a backlight can be placed behind (the display back- ground would become white for a better visibility).• A light can be placed around the display (the display background would also become white for a better visibility).• A hole can be drilled in the center of the display to insert a light (the E-ink would still work). Filters can give color to electronic paper Visual alarm with backlight Visual alarm with light around the display Visual alarm with light in the center 27 of the display
  28. 28. Vibration alarm The same kind of vibration motor as used in cellphones is suitable. They are cheap, small, lightweight, etc. An example is the “Precision Microdrives 310-103” Sound alarm The alarm should be loud enough to be heard in a noisy environment. A powerful enough speaker would be big, heavy and power consuming. The alarm will then be a simple polyphonic “beep”. In order to not be too loud in more quiet environment, Precision Microdrives 310-103 a small and cheap microphone will be used to measure the environment noise level, and then adjust the alarm level. Wireless connection (Bluetooth low energy) See Tablet “Technical working/Patches/Wireless connection” page 25 Memory The tablet memory will store every exercise demonstration. Each exercise has a reference, so the bracelet can control which exercises will be displayed. It also stores the vocal records used by the speaker. Microcontroller The tablet microcontroller controls the screen and the speaker. It also counts the exercise movements with the measured joint angles. LCD display The tablet will be used indoor, and will be mains-operated (plugged). A color LCD screen will be used to display the exercise demonstration. Indeed, the light and consumption are not problematic in this case. Speaker To give clear information, the tablet will use a recorded voice. Normal speakers used in multimedia equipments are suitable. 270 201 7628
  29. 29. SERVICE FLOW MAP PATIENT DEVICE (KIT) AT HOME PRODUCER/SUPPLIER Admit to hospital HOSPITAL 2.Surgery, Sensor fixing and Rehabilitation training START 3.Patient back to home 4.Patient Visits every 3-4 weeks 5.Check the sensor and battery, change plasters LEGEND LOCAL SERVICE 6. Technical service and COMPANY Support material information financial labour flows flows flows performances Service29
  30. 30. Service blueprint Device Medical Patient producer staff Bone fracture Device Surgery Surgery production Beginning of Intensive care Device supply rehabilitation Normal logistics Put the sensors on Get the sensors Teach how to use Learn how to use the device the device Technical support Working- Everyday Time out life • Remove sensors • Download and Medical visit analyse data • Gives feedback • Put new plaster • Learn new • Physical check • Change watch exercises and practise battery • Set-up (Angle limits, exercises and speed) • Teach new exercises Working- Everyday out life Send discharged sensors • Receive sensors • Remove sensors • Test battery Final medical • Download and • Recharge visit analyse data battery • Physical check • Pack sensors in Give back the • Recovery new plasters watch and external validation • Ship back device • Advices sensors30
  31. 31. The project has a lot to be developed, for instance weleft aside the doctor’s side of the information flow. FurtherWe included some information but the area is lack-ing deeper research and development. Similarly we developmentsdidn’t go into further details with the electronicspartly because our team lacks the competence andpartly because the project will be taken further byPeeter Lump - a master student from the depart-ment of mechatronics who will prototype the neces-sary components as his master thesis. Also rehabili-tation nurses in Viimsi hospital offered their helpwith finding patients for testing if the project reachesprototype stadium.Further development should also take place ongraphical interface part - there are already manychanges that could improve the performance on theinterface level that didn’t fit to the report.It seems that the project timing was very good, as afew key components that were crucial for project’s Conclusionsuccess were released after the start of this project.For that reason high activity can be expected in thatpart of the field this year. We believe that in a fewyears personal monitoring will become highly acces-sible. It is possible today and will be more effectivetomorrow. Technical development is definitely head-ing that way.Technical ReferencesBluetooth low energy (05/12/2011)http://www.bluetooth.com/Pages/Low-Energy.aspxElectronic Paper Displays (27/12/2011)http://www.eink.com/Vibration Motors - Precision Microdrives (24/11/2011)https://catalog.precisionmicrodrives.com/order-parts/product/310-103-10mm-vibration-motor-2-7mm-typeExistingMovea - Joint Assessment (18/11/2011)http://www.movea.com/applications/e-health-and-wellness/joint-assessmentMotion trackers and motion capture systems for biomechanics research - Xsens (18/11/2011)http://www.xsens.com/en/movement-science/mtwUp by Jawbone | Band + App Inspires Healthy Living (09/12/2011)http://jawbone.com/up/productMedicalQuality of life related to fear of falling and hip fracture in older women: a time trade off study ; GSalkeld, I D Cameron, R G Cumming, S Easter, J Seymour, S E Kurrle, S Quine (BMJ VOLUME320 5 FEBRUARY 2000) “Forget-me-not: Long-term Post-operative Care in Hip Fracture Patient” presentation by: Jay Magaziner, PhD, MSHyg 31
  32. 32. Home-Based Multicomponent Rehabilitation Program for Older. Persons After Hip Fracture: A Randomized Trial (Arch Phys Med Rehabil Vol 80, August 1999 ) A SOCIAL PORTRAIT OF OLDER PEOPLE IN IRELAND (Government of Ireland 2007) A healthier elderly population in Sweden! Göran Berleen (ational institute of public health – swe- den 2004) PREVENTION OF HIP FRACTURE IN ELDERLY PEOPLE WITH USE OF A HIP PROTEC- TOR (The New England Journal of Medicine VOLUME 343 NOVEMBER 23, 2000) Randomised factorial trial of falls prevention among older people living in their own home (BMJ 2002)Lesley Day, Brian Fildes, Ian Gordon, Michael Fitzharris, Harold Flamer, Stephen Lord Fear of Falling After Hip Fracture: A Systematic Review of Measurement Instruments, Prevalence, Interventions, and Related Factors (2010, The American Geriatrics Society) Older adults’ perspectives on home exercise after falls rehabilitation: Understanding the impor- tance of promoting healthy, active ageing Helen Hawley (Health Education Journal September 2009 vol. 68) SOCIAL AND HEALTH PROBLEMS OF THE ELDERLY Ljiljana Pesic (Acta Medica Medianae 2007) Joint fracture treatment (04/01/2012) http://bonesfracture.com/joint-fracture-treatment-joint-bone-fracture-surgery-fractured-joint- healing-time-symptoms-and-recovery/ Tools Workshop attended on 26.09.2011 and venue Tallinn University of Technology, room V 215 Title of workshop: System design for sustainability and service http://www.lens.polimi.it/index.php?P=lr_upload_course.php&ID=MLYUUXUFON2009070820 2156&DWNL=Y# Tests and interviews dropbox/ report/ appendixes/tests results dropbox/ report/ appendixes/elders view32
  33. 33. AppendixesAppendix I: Findings among older peopleOpinion of 3.elderly person ( women ) in 65, 76 and 90 years about equipment, comparingplasters and pants, wearing and use : • All worried about how to remember exercises they should to do: what exercises, how much and how often • Liked idea of plasters more, because it is simply to wear, possible to compose with other dresses • Plasters, because it is not needed to put on and take off • 2. of them (90 and 76 ) was worried about how carefully they should wear plasters for not making wet or not to take off accidentally • Liked watch idea very much, because it is like a milestone of remembering, possibility to see how much exercises have been done • But worried about when the watch let them know about wrong movement , how they will get know what position exactly was done with wrong angle or direction • Worried about watch to put on and off because fingers don´t move so good ( 76, 90 ) • About the display of watch to be clear to view and to understand, because they afraid to do something wrong with electronic equipments • Liked alarm and vibration of watch, because it seems better when both signals works at one time But: All of them thought that this is a good idea to be controlled by equipment andPlasters- simple to wear, possible to compose System-how to remember exerciseswith other dressesPlasters- it is not needed to put on and take off how carefully they should wear plastersWatch- like a milestone of remembering, when the watch let them know about wrongpossibility to see how much exercises have movement , how they will get know whatbeen done position exactly was done with wrong angle or directionAlarm and vibration of watch- better when watch to put on and off because fingers don´tboth signals works at one time move so good ( 76, 90 ) System-it is a good to be controlled by watch to be clear to view and to understand,equipment and interaction with a doctor or a because they afraid to do something wrongspecialist with electronic equipments interaction with a doctor or a specialist 33
  34. 34. Appendix II Bracelets interface test results: what is important for user Visual Sound Vibration alarm alarm alarm Limit set by Wrong Wrong doctor movement movement control control Limit set by Wrong Wrong doctor, battery movement movement control, control Over limit Limit set by Over limit Wrong doctor, battery movement control Appendix III Bracelets interface test results question answer Should I wear a bracelet all the Yes, it is the main idea time ? Will it possible to remain me I It is possible, but it will be should do exercises ? complicated to compare all alarms When I should check my results: It is possible to check during the during the day or on the end of the day or in the end day ? What I`ll see on the bracelet Visual alarm as a light outside the screen after I do the wrong screen. It is not needed to push movement? What I should do the any button (not exist), the next, push some button ? signal will stop if the position will change Will I see next day yesterday Start with a new one achievement or start with new?34
  35. 35. Appendix IV Tablet interface test results question solutionHow can I start the exercise Just push the on/off buttonvideo ?How can I stop and Push the pause/play buttoncontinue ?If I do wrong movement will I Yes, a red triangle and a voicesee info on the screen? declaring itWill I see the certain place on No, it will be just video ofthe screen I did wrong exercises, not animation ofmovement? real movementsDoes the video stop after I do Video stops with voice alarmwrong movement that I may and red triangle and continuethen continue? itself after position is changed Appendix V Usability of bracelet and external device Functional qualities “ Soft “ qualitiesSound and vibration alarm Safety: wrong movement controlExercises menu- Independence:`”I may do itintroductory video, reminder by myself without asking “Activity results will be Assurance: results will becollected independently analysed by specialistAlarm when the limit is Encouragement: allowedexceeded limit set by the doctorActivity screen Self-confidence: “ I can move and see results “ 35
  36. 36. Appendix VI LSM303DLHC Ultra compact high performance e-compass 3D accelerometer and 3D magnetometer module Preliminary data Features ■ 3 magnetic field channels and 3 acceleration channels ■ From ±1.3 to ±8.1 gauss magnetic field full- scale ■ ±2g/±4g/±8g/±16g selectable full-scale LGA-14 (3x5x1mm) ■ 16 bit data output ■ I2C serial interface ■ Analog supply voltage 2.16 V to 3.6 V Description ■ Power-down mode/ low-power mode The LSM303DLHC is a system-in-package ■ 2 independent programmable interrupt featuring a 3D digital linear acceleration sensor generators for free-fall and motion detection and a 3D digital magnetic sensor. ■ Embedded temperature sensor LSM303DLHC has linear acceleration full-scales ■ Embedded FIFO of ±2g / ±4g / ±8g / ±16g and a magnetic field full- ■ 6D/4D orientation detection scale of ±1.3 / ±1.9 / ±2.5 / ±4.0 / ±4.7 / ±5.6 / ±8.1 gauss. All full-scales available are fully ■ ECOPACK® RoHS and “Green” compliant selectable by the user. LSM303DLHC includes an I2C serial bus interface Applications that supports standard and fast mode 100 kHz ■ Compensated compass and 400kHz. The system can be configured to generate interrupt signals by inertial wake- ■ Map rotation up/free-fall events as well as by the position of the ■ Position detection device itself. Thresholds and timing of interrupt ■ Motion-activated functions generators are programmable by the end user on the fly. Magnetic and accelerometer parts can be ■ Free-fall detection enabled or put into power-down mode separately. ■ Click/double click recognition The LSM303DLHC is available in a plastic land ■ Pedometer grid array package (LGA) and is guaranteed to ■ Intelligent power-saving for handheld devices operate over an extended temperature range from -40 °C to +85 °C. ■ Display orientation ■ Gaming and virtual reality input devices ■ Impact recognition and logging ■ Vibration monitoring and compensation Table 1. Device summary Part number Temperature range [°C] Package Packing LSM303DLHC -40 to +85 LGA-14 Tray LSM303DLHCTR -40 to +85 LGA-14 Tape and reel April 2011 Doc ID 018771 Rev 1 1/42 This is preliminary information on a new product now in development or undergoing evaluation. Details are subject to www.st.com 4236 change without notice.

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