Gamifying wearables for serious medical applications like back health. A wearable with sensors and an app can provide real-time feedback on exercises to treat non-specific lower back pain through a serious game approach. This empowers patients to do self-guided therapy and links to medical professionals. In contrast to general fitness trackers, it focuses on the therapy goal through customized movements, compensation detection, and performance metrics to improve care between therapy sessions.

1. Gamifying wearables for
serious medical
applications: A case
study on back health
Dr. Robert MacKenzie
https://ch.linkedin.com/in/robertneilmackenzie
Royal Society of Medicine: Telemedicine & eHealth
HOW CAN WEARABLES IMPROVE HEALTH AND CARE?

2. The Lokomat
Hocoma - Leader in Robot-Assisted Functional Movement Therapy
Cochrane Review 2013 - Mehrholz, J., Elsner, B., Werner, C., Kugler, J., Pohl, M. (2013). «Electromechanical-assisted training for walking after
stroke.» Cochrane Database Syst Rev 7: CD006185.

3. • Wear a band, watch, belt, clip etc.
• Sensors collect a set of parameters (i.e. data)
• Algorithms (app) provide analysis and
recommendations on how to improve your well being
• Regular folks empower themselves
with appropriate sensors & data
• Increase (awareness of) physical activity
• Improve fitness (“health”)
• Benchmark performance in the context of a larger group
• Leveraged social network support (i.e. accountability)
• High-tech nagging to urge you to do the right thing
• Many become immune to product use and benefit
Telemedicine and eHealth require better
results with new wearable paradigms!

4. !
Solutions looking for problems
Where is the direct causality between problems
(i.e. pathologies) and solutions (i.e. treatments)
for wearables in medical health?
https://rockhealth.com/reports/the-future-of-biosensing-wearables/

5. • Benchmark performance in the context of a larger group
• Leveraged social network support (i.e. accountability) and link to
targeted intervention, control and medical support
• Learn new behaviour(s) for self-guided prevention and treatment
• Enable early diagnosis, treatment and study enablement with
meaningful, contextual data, instead of “just” big data
• Wear a band, watch, belt clip etc.
• Sensors collect a set of parameters (i.e. data)
• Algorithms (app) provide feedback for medically
meaningful, timely (e.g. real-time) learning experience
• Regular folks empower themselves
with specific sensor & app solution
• Increase (awareness of) physical activity
and quantifiable state of health
• Improve health and treat pathology
• Data owned by user for targeting sharing with
medical professionals
Alternative Paradigm
Purpose-driven, evidence-based wearables
focused on self-treatment, experience &
learning with specific links to medical system
How?
Serious Medical Gamification!

7. • Blunt, Richard (2009) Does Game-Based Learning Work? Results from Three Recent Studies
• Van Eck, Richard (2006) Digital Game-Based Learning, EduCause Vol 41. No 2.
• Kapp, Karl (2012) The Gamification of Learning: What Research Says About Simulations and Serious Games
Serious Games
- designed for a primary purpose (i.e. learning) other than pure entertainment

8. How can wearables be trusted for use outside of the medical system?

9. Consumer Wearables
Usable and purchasable by anyone
Consumer Medical Wearables
Purchasable and usable by anyone
Clinical Medical Wearables
Medical expert use or prescription
ECG Signal Continuous Glucose
Motion, Heart Rate
Blood Pressure Continuous Glucose+Posture
ECG & Respiration
Functional Back Therapy
Functional Back Assessment
Fitness Activity
MedicalRegulation
Emerging wearable category for telemedicine & eHealth
… …

10. • 80-90% of lower back pain is
musculoskeletal related
• Classified as non-specific back pain,
because no direct caused can be
diagnosed
• Most people resort to some form of
self-therapy (e.g. yoga, medication,
ignoring the problem)
How do wearables and back pain fit together?

11. Institute for Health Metrics and Evaluation

12. What Is the Optimal Therapy for Back Pain?
Multimodular
Approach
Psychotherapy &
Stress Reduction
Exercise Therapy
Medication &
Surgery
Other (e.g.
Massages, TCM,
Hot/Cold,
Supports,
Magnetic Pulse)
• Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J, 15, Airaksinen, Brox, Cedraschi,
Hildebrandt, Klaber-Moffett, Kovacs, Mannion, Reis, Staal, Ursin, Zanoli, et al., 2006
• High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults, Bigos SJ, Holland J,
Holland C, Webster JS, Battie M, Malmgren JA., 2009 http://www.ncbi.nlm.nih.gov/pubmed/19185272

13. Conventional Back Therapy (e.g. Between Sessions)
Common Patient Problems
• No access to a therapist!
• Interest, time, money, available
appointments, etc.
• Motivation to exercise?
• Movements are boring
• Guidance, real-time feedback &
(expert) source of information?
• What should I do?
• How much should I do it?
• Am I doing it right? Wrong?
• Quantifying performance & my
specific activity?
• To whom accountable?

14. 100
%
Simple Back Therapy Timeline
Therapy
Continues
Therapy Session Therapy SessionBetween Sessions
30
%
Patient “movement”
Pharmacy
Therapist
Chiropractor
Doctor
Prevention
Self-Therapy
No Action
Patient
1) Has low back pain
2) Seeks advice diagnosis and
treatment INSIDE medical system
3) performs self-therapy OUTSIDE of
and with a weak link to the medical
system
70
%

15. 100
%
Alternative Back Therapy Timeline
Therapy Session Therapy Session
Therapy
Continues
Wearable Therapy
Patient
1) Has low back pain
2) Seeks advice diagnosis and
treatment INSIDE medical system
3) Certain population performs self-
therapy OUTSIDE of and with a
weak link to the medical system
4) Consumer medical wearables to
empower self-therapy & link to
medical system
30
%
Empower
Self-Therapy
Pharmacy
Therapist
Chiropractor
Doctor
New patient interaction
Prevention
Self-Therapy
No Action
70
%

16. How
How can a consumer medical wearable help treat chronic low back pain?

17. Functional Movement Therapy
+ Technology
= Redevelopment of Core &
Deep Muscles
= Restoration of Motion to
Vertebral Joints
= Motivation, Learning &
Real-Time Feedback
Exercise
Therapy
Gamification &
Mobile Technology

18. Gamification
Wearable
• 2 Sensors
Medical
• CE, FDA Class 1
Consumer
• End User
• Patient
Mobile
Problem
Non-specific low back pain
Solution
Exercise Therapy +

19. Reinventing the Back Exercising Experience
• Focus on the therapy goal, not just fitness
• Movement Awareness
• Mobilization
• Stabilization
• Stretching
• Balancing
• 17+ movements from classic therapy
• 45+ therapeutic exercises developed with
therapists & movement experts

20. Compensation Feedback
• Mild – Red colour
• Medium – Smoke,
enlarged Movement Tutor,
pre-warning of severity
• Severe – Complete
“Severe Action” window
and game pause to study
ideal movement from the
Movement Tutor
Serious Game Elements
• Continuous correction
small, fine movements
• Back movement mirroring
• Movement guidance
• Movement awareness
• Performance (score,
movement indices)
• Augmented Performance Feedback demonstration of Valedo: www.valedotherapy.com

21. Understandable quantitative & qualitative performance information

22. Trusted consumer medical wearables changes patient-doctor/therapist interaction

23. Users own their data and controls it’s integration

24. Wearable paradigm shift from monitoring & data to
real-time feedback, experiential learning & self-therapy

25. Thank you!
Questions?
?
?
?
?
?
?
?
?
?