The document describes a proposed mobile application called the Emotion ALERT! System that utilizes wearable biometric sensors and physiological data to detect changes in a user's emotions and provide alerts. It is intended to help trauma brain injury survivors who have difficulties controlling emotional outbursts. The system monitors heart rate, respiration, skin temperature and other data to identify emotional arousal. It alerts users and allows them to get assistance, engage in regulation strategies, or contact emergency services if needed. Conversations with TBI survivors found emotional outbursts were challenging and this type of system could help provide more awareness and control.

1. The Emotion ALERT! System
For
IOS and Android

2. Traumatic brain injury (TBI)
 The Centers for disease Control and Prevention have
identified Traumatic brain injury (TBI) as a serious
public health problem in the United States. Each year,
traumatic brain injuries contribute to a substantial
number of deaths and cases of permanent disability.
Recent data shows that, on average, approximately 1.7
million people sustain a traumatic brain injury
annually.1
 References
 1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency
department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and
Prevention, National Center for Injury Prevention and Control; 2010.

3. Costs of TBI
 The Direct medical costs and indirect costs such as lost
productivity of TBI totaled an estimated $76.5 billion
in the United States in 2000.1,2
 References
 1. Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in
the United States. New York (NY): Oxford University Press; 2006.
 2. Coronado, McGuire, Faul, Sugerman, Pearson. The Epidemiology and Prevention of TBI (in press)
2012.

4. Potential Affects of TBI
 A TBI may lead to a wide range of short- or long-term issues affecting:
 Cognitive Function (e.g., attention and memory)
 Motor function (e.g., extremity weakness, impaired coordination and
balance)
 Sensation (e.g., hearing, vision, impaired perception and touch)
 Emotion (e.g., depression, anxiety, aggression, impulse control,
personality changes)
 Approximately 5.3 million Americans are living with a TBI-related
disability and the consequences of TBI can affect all aspects of an
individual’s life.1 This can include relationships with family and
friends, as well as their ability to work or be employed, do household
tasks, drive, and/or participate in other activities of daily living.
 References
 1. Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in
the United States: a public health perspective. J Head Trauma Rehabil
1999;14(6):602-615.

5. Conversations with TBI Survivors
 We attended 3 separate TBI support groups and talked
to 15 survivors and 5 family members who were their
primary care providers. We asked the survivors what
were the largest challenges they faced after the TBI.
Answers included difficulties with attention
and memory, balance, hearing, and vision. The
most prevalent challenges stated were related to
Emotions, including; depression, anxiety, anger,
aggression, impulse control and changes in
personality.

6. Conversations with Family
 Family members of survivors of TBI often point to the
Survivors emotions as being the most challenging.
They referred to the survivor as having a "short fuse,"
"flying off the handle" easily, being irritable or having
a quick temper. Family members mentioned anger or
temper outbursts because they can be quite startling,
and can overshadow other more serious difficulties,
such as physical or cognitive deficits.

7. Handling Emotions after A Traumatic Brain Injury (TBI)
In our conversations with survivors and family, we found
that emotional outbursts were often experienced “out
of nowhere”. The survivor would have an outburst
without realizing that they were even getting angry.
All respondents wished that this situation could be
controlled and stated that they would be happy to pay
for a solution to this problem.
Our Proposal is to utilize existing technology and
research on physiology and emotion to give the
survivor a “heads up "to an impending outburst. This
would allow the survivor to utilize strategies to control
their emotions.

8. The What:
 An application that starts when the user puts on a Zephyr
BioHarness or shirt and is in the Bluetooth proximity of an
Android or IOS device that is compatible. The app receives
real-time sensor data indicating, recording, and analyzing
physiological conditions of the user. The BioHarness
transmits measurements of the users heart rate,
respiration, skin temperature, activity and posture
continuously. A baseline of measurements is established
for the user. When the app identifies a change in heart rate,
respiration, or skin temperature without a corresponding
change in activity or posture, an event is triggered that
notifies the user (and optionally a remote monitor family)
and gives them a set of options (apps) to mediate the
physiological changes, or gets help.

9. The Why:
 Survivors of TBI are often less aware of changes to their emotions and
experiences (such as stress) and are often frustrated and angered by
others that would point out the changes. These factors can lead to
expressions of their emotions in socially unacceptable and sometimes
damaging ways. It is also well documented that long-term stress has
adverse effects on a person’s physical and mental well-being. By
informing the user of physiological changes before the event that is
causing them has gotten out of hand, the user is able to affect the
changes in the environment (earplugs, sunglasses, time out, or relocate
to a less stressful area). The user can also get suggestions from the
associated apps i.e. “Have you taken your meds?”, “would you like to do
a breathing exercise or meditate?”. If the user’s measurements go
uncontrolled and the user does not acknowledge the alerts, an app can
be triggered to contact a family member, care provider, monitoring
station, or emergency service as would be the case with a posture of
prone indicated with other measurements out of range.

10. Zephyr Bioharness connects to IOS / Android Device

11. What:
Posture indication
Green Circle: Within Red Circle: Exceeds
parameters parameters
The user must press the red “ALERT” button to acknowledge
the event within a certain time frame, otherwise Central
Monitoring is notified, or a 911 call is initiated.

12. If the user acknowledges the event within the alloted time
frame, a selection screen is presented.
Emergency: I need help NOW!
I am OK
I want assistance

13. Selecting “Panic” sends SMS messages to
notify emergency contacts. The messages
include the current GPS location. Audio and
video monitoring may also be initiated.
The user must respond to the Yes/No
question, otherwise Central Monitoring will
be notified. If there is no Central
Monitoring, then a 911 call will be initiated.
If the users selects “YES”, a 911 call is
initiated. A medical emergency app is
launched giving responders vital
information such as emergency contacts,
allergies, and medical conditions.

14. Selecting “OK” sends SMS messages to the
emergency contacts, letting them know the
user is alright and providing current vitals,
and asks if the user would like to call
someone.
The alert will temporarily be suspended for
a predefined amount of time. If the alert
occurs again, the same process will be
repeated.
The user can temporarily disable the allert
based on a selectable amount of time. This
would be convinient if the alert is a false
positive based on activities or a
malfunction. An SMS will then be sent to
the emergency contacts letting them know
the user has disabled the alert.

15. Selecting “Advice” prompts the user to
make other selections
Phone or Texting app
Breathing apps, relaxing sound apps,
meditation apps
Medication, anxiety, depression, and
emotional assessment apps