Progress 09/01/18 to 04/30/21
Outputs
Target Audience:Lower Extremity Joint Replacements (LEJRs) are one of the most common inpatient procedures with over a million procedures performed annually in the United States. Roughly twenty percent of these procedures are performed on individuals living in rural communities--often far from rehabilitation clinical services [1]. Due to the rapidly shifting U.S. aging demographic, these numbers are expected to rise exponentially over the coming decades [2, 3]. The Mobility Coach system was developed by CreateAbility to address post-surgical compliance with in-home rehabilitation exercises. The primary aim of the project was to improve rural patient-provider interaction by assessing post-surgical exercise compliance by monitoring physical therapy from a distance. Mobility Coach is now commercialized under the name 'The Flex System'. There are two target audiences for Mobility Coach/Flex: 1. Rural patients (45+) recovering from hip and knee replacements The Benefits to rural LEJR patients: Increased exercise compliance Greater involvement and control in the recovery process Reduced number of trips required to PT clinic Faster reduced dependency on dangerous pain medication 2. Physical therapy providers managing increasing caseloads and staying connected with patients in rural areas The Benefits to Physical therapists with rural LEJR patients: Early awareness of patient non-compliance Productivity: Ability to effectively manage larger case load Improved documentation to speed reimbursement claims The number of hip and knee replacements in the rural population will continue to grow as the baby boomer generation ages, and patients are being discharged to their home earlier at increasing rates. Not only is the elderly population expected to expand during the next two decades, but their life expectancy also continues to lengthen. While several grant funded research projects have demonstrated merit using telemedicine or remote monitoring techniques, previous attempts to address this market have not succeeded because they failed to engage the patient and did not seamlessly integrate the physical therapist or provider infrastructure before the project funding was consumed. CMS is exploring ways to reduce LEJR costs because: 1) LEJRs are the most common inpatient procedure for Medicare beneficiaries; 2) these tend to be high-cost, high-utilization surgeries; and, 3) the large cost variance (ranging from $16,500 to $33,000 per procedure). CMS experimented with a bundled payment system called the Comprehensive Joint Replacement (CJR), where CMS will only pay a fixed amount into a fund which is distributed to the care team in a pre-arranged percentage structure. The entire continuum of care team shares in the risk of not meeting the bundled payment for an LEJR episode, which averages $26,000. A failed LEJR from infections or joint failure can easily triple these costs. While CJR is now only mandatory in 33 of the largest metro areas, it is a demonstration of CMS's intention to reduce reimbursements for high frequency procedures throughout the episode (surgery through post-acute care). Seeing the benefits to increasing the quality of care, other hospital systems have volunteered to participate, and 465 hospitals were participating before the Pandemic. While the rural patient will benefit significantly from the implementation of Mobility Coach/Flex, the initial target customer for commercialization of the technology is physical therapy PT providers that meet the following requirements: - Serve rural populations - Have teamed with orthopedic surgery providers to help hip and knee replacement patients meet recovery milestones under value-based post-acute care requirements. Therefore, the commercialization plan was focused on benefits to the PT providers and approaches to commercialize the technology in that market. Mobility Coach/Flex helps physical therapists that work with rural patients to remotely manage their rural patients, make informed decisions, quickly identify potential problems, and make necessary real-time adjustments to the rehab plan. Exercise compliance and pain medication management is essential to this recovery but is currently hampered by the rural patient's low proximity to physical therapy, confusion on what exercises to do and how to do them, and proper use of pain medications, exacerbating the rural opioid crisis. Mobility Coach/Flex connects the PT provider and the rural patient to increase positive outcomes during recovery and rehabilitation from orthopedic surgeries. References 1. Granger, C. V., Markello, S. J., Graham, J. E., Deutsch, A., Reistetter, T. A., & Ottenbacher, K. J. (2010). The Uniform Data System for Medical Rehabilitation report of patients with lower extremity joint replacement discharged from rehabilitation programs in 2000-2007. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists, 89(10), 781. 2. Navathe, A. S., Emanuel, E. J., Venkataramani, A. S., Huang, Q., Gupta, A., Dinh, C. T., ... & Liao, J. M. (2020). Spending And Quality After Three Years Of Medicare's Voluntary Bundled Payment For Joint Replacement Surgery: The spending and quality effects of Medicare's Bundled Payments for Care Improvement initiative among patients undergoing lower extremity joint-replacement. Health Affairs, 39(1), 58-66. 3. Buhagiar, M. A., Naylor, J. M., Harris, I. A., Xuan, W., Adie, S., & Lewin, A. (2019). Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty: a systematic review and meta-analysis. JAMA network open, 2(4), e192810-e192810. Changes/Problems:No changes were made to the plan. The team did however experience and overcame two problems: 1. In the middle of our extended evaluations of the emerging prototype, the COVID-19 pandemic put a halt on all non-essential surgeries, which includedLEJR. Thankfully the team had sufficient feedback from our initial testing to complete the development, and accommodate the changes and enhancements requested by the initial set of patients and their physical therapist. This resulted in a much stronger prototype when the surgeries were allowed again, and testing resumed. 2.Changes were needed to the user interface a.Our initial exercise avatar was not engaging enough. Changes were made to increase the gammification aspects. b.Our original sensor was too large and too heavy. This resulted in a complete redesign to accommodate a smaller and lighter weight battery, as well as several wearable mounting options: double sided peel-and-stick tape, and a rubber wristwatch style band for use near the knee and around the ankle. What opportunities for training and professional development has the project provided?Physical Therapists and Orthopedic Surgeons were able to obtain surveilance and exercise data on their patients at much greater detail and frequency than is typically possible. This may lead to advancements in teaching and training. How have the results been disseminated to communities of interest?CreateAbility has responded to requests for papers, and hopes to present at the American Congress for Rehabilitation Medicine in the fall of 2021. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Previous reports detailed the objectives 1,2 and 4, so this section will only detail Objectives 3 and 5. Objective 3: Extended Evaluation. Faculty and staff of the Center for Inclusive Design and Engineering (CIDE), with Physical Therapists from OTPlus, conducted an extensive usability test of the Flex System with 30 individuals who had experienced hip and/or knee surgery and 30 physical therapists charged with caring for these individuals. 30 licensed physical therapists who routinely manage individuals after total joint arthroplasty were recruited for this study. All therapists specialize in the management of orthopedic patient populations, had a minimum of five years of clinical experience and had experience with telerehabilitation technologies. All 30 PTs thought that the Flex System would help them remotely prescribe and monitor their patient's exercises, particularly for patients who live at a distance from traditional rehabilitation resources. Recovery time was reduced an average of 32% compared to their other rural LEJR patients that did not have the motivation and accountability of the Mobility Coach/Flex system. 25 of the 30 recent and rural LEJR patients expressed their appreciation for how the Flex System improved their confidence that they were performing the exercises correctly, as well as increasing their motivation, and accountability to complete their exercises at home. The ability to share data with their clinician and surgeon was appreciated by all parties as well and is a commendable feature of the product. During the initial pandemic lockdown, 10 LEJR, and 10 of their associated physical therapists study participants took part in a study on the utility and efficacy of the Flex system. This study took place in a full, functional apartment the Bioscience III building located on the Anschutz Medical Campus, Denver, Colorado with appropriate Covid restrictions in place. 10 subjects volunteered to test the Flex System with the study taking less than two hours to complete for each subject. The therapists who volunteered to participate in the user study met with Dr. Bade in the Physical Therapy Department at the University of Colorado Hospital. For the in-home extended evaluations phase, 20 LEJR subjects, with 20 of their physical therapists (again due to pandemic restrictions), the intended home installations and setups were modified by first using in-clinic training sessions (with safety restrictions) where the LEJR patient familiarized themselves with the system, and demonstrated competency before being sent home with a full Flex system, comprised of a wearable sensor, tablet, and Flex App. All participants completed the System Usability Scale (SUS) and the Feasibility of Intervention Measure (FIM). They were also asked to respond to a list of open-ended questions regarding their experience using the Flex System. Beyond recovery time, the potential impact of the Flex System on relevant clinical outcomes was assessed utilizing a 5-item Likert scale questionnaire regarding the following domains: exercise compliance, speed of functional recovery, ultimate level of functional recovery, and patient satisfaction. Items were scored as 1 = "strongly disagree" to 5 = "strongly agree". Evaluation Tasks for LEJR Study Participants The task scenarios were developed by the research team following introduction and training for the Flex System by the project PD (Sutter) at CreateAbility. For PTs, the median score on the SUS questionnaire was 92.5 (range 77.5-95) indicating excellent usability. Key themes identified during the semi-structured interview regarding usability were as follows: Sensor Setup: Several therapists commented on the need for more thorough instructions for sensor setup initially with the option to skip these in the future. Verbal and written instructions were requested. There was also concern regarding if you set up the sensor correctly prior to initiation as you get no feedback during setup if you have done this correctly or incorrectly. Sensor Feedback: The accuracy of the sensor was cited as a concern during the performance of exercises as repetitions would sometimes be missed or counted at too high of frequency. A two-sensor system might allow for less switching between exercises, which can be challenging for older adults, improve accuracy and allow for additional outcomes to be collected. A reliance on visual feedback only was cited as an additional limitation. The median score on the FIM was 5/5 (range 4-5) indicating that the Flex System has the potential for clinical implementation on a wider scale. "I believe use of the Flex System would lead to_" ...increased exercise compliance in patients after joint replacement, Median=4, range 4-5 ...a higher level of functional improvement in patients after joint replacement, Median=4, range 3-4 ...improved patient satisfaction in patients after joint replacement, Median=4, range 4-5 Median scores for all questions were 4/5 indicating the potential for the Flex System to impact these clinical outcomes. Key themes identified during the semi-structured interview regarding clinical outcomes were as follows: Exercise compliance: Feedback and tracking were highlighted as elements that would likely increase exercise compliance in many individuals. Some patients are already very exercise compliance and therefore utilization of the sensor would likely not increase compliance. Therapists agreed that increased exercise compliance would then facilitate a faster recovery in many of their patients. If exercise compliance increased and was sustained over time that this would in turn lead to higher levels of functional recovery in the long-term. For sustainability it was suggested that additional exercises should be programmed to work with the sensor to allow for adequate progression of exercise over time. The 30 PT participants averaged total SUS score of 88.47% equating to an excellent rating. Ratings ranged from a low of 52.5 to a high of 100. 25 subjects rated the Flex System 77.5 or higher. LEJR participants also completed the FIM, a 4-item instrument to assess perceived intervention feasibility, using a 5-point Likert scale (Completely Disagree-Completely Agree). Question "The Flex System seems"...; /x = Mean; % = Percent rating 4 or 5 Q 1. ...implementable; /x=4.6; %=100%. Q 2. ... possible; /x=4.7; %=100%. Q 3. ... doable; /x=4.75; %=100%. Q 4. ... easy to use; /x=4.4; %=90%. LEJR subjects rated the following statements Question "I believe use of the Flex System"...; /x = Mean; % = Percent rating 4 or 5 Q 1. would lead to increased exercise compliance in physical therapy after joint replacement; /x=4.5;%=100%. Q 2. ... would lead to faster recovery after joint replacement;/x=4.6; %=100%. Q 3. ... would lead to a higher level of functional improvement after joint replacement; /x=4.75;% = 90%. Q 4. ... would lead to improved satisfaction after joint replacement;/x=4.2; %=80%. Liked most: "I think this would really motivate me to do my exercises." "I like the size of the sensor and the fact that I can see my progress." Dislikes "I do not like the peel-and-stick method of attaching the sensor to my leg." "The sensor is not consistent sometimes in counting reps." "Don't like having to change the position of the sensor." Objective 5: (socio-economic impact of Flex): Faster return to health and function Builds on the unique strengths of the rural community by being able to return to work, being productive in tourism, agriculture, aquaculture, etc. The ability to stay at home means that there is reduced out of pocket expenses for rural older adults outside the rural community, such as: reduced gas purchase, hotel, restaurants. As the popularity of this approach continues, a new industry may be created in picking up, refurbishing Flex systems, training, and other local support.
Publications
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Progress 09/01/19 to 08/31/20
Outputs
Target Audience:There are two primary target audiences that each want the same thing: prescribe exercises to older rural patients to perform in their home, and verify that they were performed correctly. This requires three components: an avatar to visually instruct the patient on the proper exercises, a sensor to record the patient's movements, and a web-based repository of all data for monitoring and reporting. The two primary target audiences are: 1. Orthopedic Surgeons who perform hip and knee replacements. These Ortho Docs they may perform the surgery in a traditional hospital, but the emerging model is ortho pods, where the entire surgery is performed as an outpatient basis. 2. Physical Therapists charged with assuring that older rural adult patients maintain their exercises post hip or knee replacement. The PTs role is the same, no matter where the surgery was performed. As we are executing the commercialization plan, a third target audience emerged. There are a variety of exercise applications available that are in need of a sensor to verify the user's movement as they follow the exercise instructions. They lack the skills to interface to sensor technology, and could benefit from our application programming interface (API), that simplifies integration. Changes/Problems:Challenge 1: Again, we had serios problems drawing funds. This problem has now been resolved, but this resulted in only being able to draw $70,000.00, far less than our development and testing effort of 3.5 FTEs Challenge 2: Depending on the security settings at varioius organizations, our current deployment sometimes is interrupted by anti virus software. We are working on a solution to this problem and expect to have a solution within a month. Challenge 3: Conferences are primarily the primary way to engage with Orthopedic Surgeon groups, and Physical Therapy groups. Virtual conferences have not matured to be a suitable substitute, necessitating the purchasing of mailing lists, digital marketing campaigns, and cold calling. These are slower, but effective. Challenge 4: Due to COVID-19, Hospitals have cancelled all elective procedures, including Hip and Knee replacement surgeries to free up beds. This necessitated the request for a no cost extension. What opportunities for training and professional development has the project provided?Our marketing manager has developed a digital marketing plan that tracks individuals and organizations that match key profiles, and then respectfully engages with them in a customer journey. Our software developers have matured in the exploration of new tools and techniques, and our support team has matured as they invoked new learning management systems to help customers independently and quickly search for and find the support information they need. Externally, Mobility Coach has provided a fun and innovative approach that engages with older rural adults, and helps them feel more comfortable with technology. When fully delployed, the Mobility Coach approach will also increase job opportunities for training, support, and as-needed assistance in rural communities. How have the results been disseminated to communities of interest?We have responded to request for paper calls from several rehabilitation virtual conferences, including: The American Congress of Rehabilitation Medicine, and the Rehabilitation Engineering Society of North America. What do you plan to do during the next reporting period to accomplish the goals?During our no-cost extension we will be focused on testing the emerging prototype with actual older rural adults who have recently had a hip or knee replacement. We will also be evaluating the prototype with their physical therapist and orthopedic surgeon. Goal 5: Performing a Socio-Economic Impact Assessment Related to commercialization efforts: Associations identified as potential strategic partners that can be tapped for speaking opportunities, advertising, sponsorships, content-sharing, and podcast interviews are as follows: NARA: The National Association of Rehab Providers and Agencies APTA: American Physical Therapy Association (+ 12 state level APTAs) McKenzie Institute AAHKS: American Association of Hip and Knee Surgeons AAOS: American Academy of Orthopedic Surgeons AAOE: American Association of Orthopedic Executives ABS: American Back Society AOA: American Orthopedic Association AOFAS: American Orthopedic Foot and Ankle Society ASOP: American Society of Orthopedic Professionals AAPM&R: The American Academy of Physical Medicine and Rehabilitation
Impacts
What was accomplished under these goals?
Goal 3: Perform Extended Field Evaluation (in parallel with the final software development) Emerging Prototype Evaluation A feasibility study of the Mobility Coach system has started in the lab among 11 rural patients (67 to 91 years old) and their PT. The study measured these patient's ability to independently follow and perform exercises prescribed by the PT, know when to take their pain medications, and answer health, safety, fall risk and pain-related questions. This study compared the Mobility Coach system with their current methods such as using printed/written lists. The basic hypothesis was that rural patients would be able to perform these exercises and pain medication adherence with less assistance and with fewer errors when using the Mobility Coach system prototype as compared to their current method. Selection criteria was developed by OT Plus: > 60 minutes to nearest PT clinic, 60+ years old, and are within 45 days post-surgery for their LEJR. All participants had lived in rural setting for most of their lives. Population: 11 (7 women, 4 men). Subjects were each paid a $50 stipend for participation in the study. Before the experimental session started, each patient completed a survey using a 5-point Likert scale covering key areas identified in focus group (Objective 1). Participants were provided with training that included hands-on instruction and practice before the measurement of the activity began. The order of presentation of the two methods (existing compared to Mobility Coach) was randomized to control for ordering or learning effects. Thus far, the prototype evaluation has taken place over a 12-week period. There were two dependent measures: 1) accuracy as measured by the number of errors made during the experimental session; and 2) independence as measured by the number of prompts required to complete the session. The prescribed exercises and the medication trays were the same. Each participant followed the instruction, took (pretend) medications (swallowing not required), and answered survey questions. Data collection forms were used to record errors and prompts during each experimental session. The performance of each subject was closely monitored, with verbal prompts from the instructor and assistance provided when requested or as soon as mistakes were made. In this way, individuals always achieved success at the task, even if they needed assistance to achieve it. In addition to the quantitative data collected, there was room provided on the data collection forms to record additional observations as well as statements made by subjects during the test sessions. These observations identified areas for more rigorous assessment during the next testing phases in this Phase II project. Results so far by Dependent Measure and by Experimental Condition Average Errors Low score; high score; Average Mobility Coach 0 3 1.63 Typical Method 0 14 5.12 Average Prompts Mobility Coach 0 4 1.82 Typical Method 1 16 7.13 The first dependent measure collected was accuracy, as measured by recording Average Errors which was a measure of subjects' ability to correctly complete the task using both methods (their preferred sensor method using Mobility Coach, and their typical method. When all of the study participant data has been collected (in 2021 and presented in the final report), the team will perform post-hoc tests to specifically investigate the source for the significance. So far, when using Mobility Coach subjects made significantly fewer errors when compared to their normal method. The second dependent variable, independence, as measured by Average Prompts provided to subjects while performing each of the exercises during the experimental sessions. Subjects required significantly fewer prompts when using their preferred Mobility Coach sensor method to complete the tasks as compared to when using their typical method. After the testing was completed, each participant was again asked to rate their experience with Mobility Coach using the same statements and 5-point Likert scale that they had used before the testing began. These answers, plus capturing their qualitative responses helped CCI understand the quantitative data collected. So far, the Mobility Coach system has also been tested with the PTs of the patients in the study. PT population: 19 (13 women, 6 men). These 19 PTs first completed a survey focused on key areas identified in the focus groups. This exercise was repeated after having used Mobility Coach's web-based Dashboard. PTs performed the following tasks: viewed the dashboard and navigated the HIPPA-compliant screens, verified the patient's exercise compliance, played the patient movement data, reviewed med usage, reviewed their fall risk assessment, prescribed new exercises, and posed new questions to the patient. Using a Five Point Likert Scale: 1 = strongly disagree, 3 = Neutral, 5 = strongly agree Percent of Rural Older Adult Patients rating the Mobility Coach method 4 or 5 Rural patients Low score; high score; Percent rating 4 or 5 Increased exercise compliance 3 5 73% Faster recovery 3 5 55% functional improvement 3 5 64% Satisfaction with the approach 4 5 100% None rated their typical approach as 4 or 5 Percent of Physical Therapists rating the Mobility Coach method 4 or 5 Physical Therapists Low score; high score; Percent rating 4 or 5 Immediate awareness of a problem 4 5 100% Intuitive Dashboard 4 5 100% Asynchronous review of patient data 4 5 100% Easily adjust / prescribe new exercises 3 5 58% Monitor pain medication usage 4 5 100% Improves care coordination and reporting 3 5 53% None rated their typical approach as 4 or 5 The initial results from the evaluations with actual customers has confirmed that rural patients and their PT preferred Mobility Coach over their current approach. Goal 4: Develop the Final Software Mobility Coach measures a user's motion for exercise and therapy by combining technology from custom-built mobile and server applications, and one or more motion sensors. The exercise routine is presented to the user on a tablet-based mobile application and the user performs the exercise routine with the sensor attached. The sensor communicates via Bluetooth to the sensor server, which returns real-time motion data back to the mobile application. After each exercise, the user's progress is stored in the application and the server. Serendipitously, the approach we used to simplify the integration of our sensor with our own avatar-led exercise instruction, has positioned us well to offer this capability to the Exercise companies mentioned above. Specifically, this consists of creating a product that resides on Windows 10-based tablets, laptops and PCs that handles all the communication with the sensor and provides a clean application programming interface (API) that the gaming professionals can interact. This module is called the Motion Hub. MOTION HUB Mobility Coach utilizes the Motion Hub sensor server and database. This server application is developed with Python and utilizes Python Flask to send and receive messages from the Mobility Coach application. The server also interfaces with Bluetooth to communicate with the Bluetooth Low Energy motion sensors in use by the user. Also employed by the server are various data stores that contain exercise routine information, such as exercise details, number of reps, and number of sets. A relational database is also used to store exercise history for each user. MOBILE APPLICATION AND DATA FLOW The Mobility Coach mobile application is developed with the Solar2D cross-platform engine. The target platform is an Android tablet device that is easily readable and accessible when performing exercises. The application also utilizes high-speed visual tools to illustrate real-time feedback between the motion sensor and the application's user interface.
Publications
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Progress 09/01/18 to 08/31/19
Outputs
Target Audience:There are two primary target audiences that each want the same thing: prescribe exercises to older rural patients to perform in their home, and verify that they were performed correctly. This requires three components: an avatar to visually instruct the patient on the proper exercises, a sensor to record the patient's movements, and a web-based repository of all data for monitoring and reporting. The two primary target audiences are: 1. Orthopedic Surgeons who perform hip and knee replacements. These Ortho Docs they may perform the surgery in a traditional hospital, but the emerging model is ortho pods, where the entire surgery is performed as an outpatient basis. 2. Physical Therapists charged with assuring that older rural adult patients maintain their exercises post hip or knee replacement. The PTs role is the same, nomatter where the surgery was performed. Changes/Problems:Challenge 1: We had serious problems drawing funds. While we accomplished the tasks from the propsal on schedule, and on budget, we were only able to draw $20,529.00. This has since been resolved. Challenge 2: Some older rural adults struggle with setting up the tripod-based 3D imaging system to watch them perform their exercises. This reduces the quality and accuracy of the movement detection. To address this, a training video will be produced in the next reporting period. Challenge 3: Our selection of components and battery for the wireless wearable sensor 6 axis movement detection system increased the size and weight beyond what we had hoped. To address this, the team will investigate newer, smaller comonents in the next reporting period. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?Goal 3: Perform Extended Field Evaluation (in parallel with the final software development) The team will coordinate with three Physical Therapy firms to select patients that mnatch the inclusion criteria. At at least three intervals, the team will upgrade the evolving prototype software, hardware and web-based components. This will enable the team to receive immediate fedback on each mini release. Goal 4: Develop the Final Software. The team of Sutter(PD) and Daiuto will focus on the development of the sensor, while Larry King focuses on the application and the development of an API to enable our sensor to be integrated into the products other distribution partners. Goal 5: Perform Socio-Economic Impact Assessment
Impacts
What was accomplished under these goals?
Goal 1: Develop Final Requirements for Mobility Coach. Results from focus groups and interviews with stakeholders led to the final set of features and functions. After completing the field interviews, the team refined the "User Stories" and Needs of both the rural older adult patient, and their PT. User stories were used because they are an effective technique for describing the usage and needs of the system. Primary requirements that were analyzed were the amount of information the system must supply to help both the PT and the rural patient: a) become oriented to the system; b) navigate the user interface; and, c) use the system. Specifically, would patients remember to take pain meds, follow rehab exercises and respond to the PT's questions? Would PTs be able to prescribe exercises, pose questions and monitor the patent's progress? Evaluation of the proper prompting strategy and implementation was also investigated and completed during this time via zoom video conferencing led by the PD (Sutter). The system design requirements determined the selection of the appropriate hardware and software mechanisms to present information to users. The resulting benefits are summarized below: Physical Therapists Want: Save time and money through faster patient recovery and reduce the risk of expensive interventions (if things were not caught quickly enough). High level dashboard showing all patients Easily match the sensor method to the patient (Kinect or wearable) Fast Identification of problem - Visual and text alerts Predictive analytics Quickly zoom in to get Details Rehab stage Asynchronous review of exercise data Pain medication usage Push new exercise protocol to patient Confirm battery status / correct setup Initiate/answer video visit session Rural Older Adult Hip or Knee Replacement Patients Want: Accelerated recovery through exercise compliance Reduces trips to therapy and risk of painful interventions Increased clarity on what to do and when (Reminders, Guided instruction, Immediate feedback on progress) Assurance they set it up correctly Pain medication reminders and dispensers Reduced Fall risk Automatic updates of new exercises No hassle equipment returns Request and initiate a video visit session from app Goal 2: Enhanced the Mobility Coach Design and Prototype based on Phase I feedback and focus groups and interviews. The Phase II design is focused on 1) making the approach fun and engaging for the patient; and, 2) adding additional features and functions and ruggedizing the design so that it can function in a wide range of scenarios in the homes of rural patients, and in the offices of physical therapists. All of the software that CCI is developing for the Mobility Coach system is designed operate on all iOS and Android tablets, as well as Microsoft Windows 10, and utilize CCI's cloud services. The hardware selected for the Mobility Coach system uses commercially available 3D imaging systems and wearable Bluetooth sensor devices, mobile devices, and cloud technologies. The team believes that CCI's design incorporates support for patients with cognitive or other physical limitations. The team enhanced the 3D tracking camera-based verification After this method of tracking the exercise was completed, PTs asked for the capability to view and playback the data from a different angle than it was recorded. To support this, Daiuto (CCI) developed a 3D transformation algorithm using the Python programming language. Further enhancements to the algorithm made this 3D imaging approach device agnostic to assure a five-year supply of this module. This reduced our dependency on Microsoft maintaining production of the Kinect, and enabled us to take advantage of three other manufacturers, meaning that there are literally thousands of low-cost knock-offs available. These range from DIY kits available from Asian markets (such as VicoVR, Orbbec Astra Pro, Orbbec Persee, Stereolabs ZED, and OpenPose), as well as hundreds of units available via channels such as eBay. Several of the alternatives even offer higher quality images, enabling high-fidelity 3D representations. These units typically have a field-of-view of approximately 10 feet by 10 feet. The wearable band sensor verification method was also enhanced Multiple core areas of technology were enhanced on the CreateAbility wearable band (called The Flex). Currently, CreateAbility is utilizing a 6-axis Bluetooth Low Energy (BLE) sensor, the MetaWearC, to monitor accelerometer and gyroscope data and comparing that information to a fixed set of data. The upgraded sensor is working well with the fixed data set as well as the exercises that were predetermined by PT organizations. Testing of the sensor verified that the sensor accurately tracked every type of motion needed. By incorporating data from the magnetometer and gyroscope enabled smoother compensation for drift. More importantly, the new sensor utilized several motion fusion algorithms, to aid in determining the absolute positioning of a limb and tracks it as it moves in 3D space. The cross-platform mobile application code on the tablet was enhanced using the OpenGL Solar2D SDK framework to improve performance and enable therapy anywhere, using a wider variety of mobile devices. To stay motion sensor agnostic, all code development will directly interface to the sensor hardware over the low power Bluetooth (BLE) to interpret the raw data emitted from the sensor. Integrated and tested the emerging Mobility Coach prototype to prepare for the study participant evaluation The PD ensured that the Mobility Coach prototype hardware, software and cloud services satisfied the design requirements identified earlier. The modular design allows each section to be independently tested. To support consumers where cable, satellite or wireless internet is not available, CCI will provide a hot spot that matches the best reception in that area (typically AT&T or T-Mobile). Five of the eventual thirteen prototypes of the Mobility Coach system were assembled and tested. These will be used in the extended field evaluation (10 deployed in homes, 2 spares, and 1 for troubleshooting /replicating field issues in the lab). This first release of the software and hardware components are a dramatically enhanced version of the Phase I prototype. In this first reporting period, the team concentrated on essential features and capabilities needed to support the initial batch of the field evaluations in the next reporting period. In addition, the team completed the Commercialization Strategy Report (CSR) with Larta.
Publications
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