Interactive Tele-health and Auto-Biofeedback Sensor System for Wheelchair Users

描述（由申请人提供）：本提案所解决的公共卫生问题是，使用轮椅的慢性残疾人的不活动导致严重且昂贵的继发性并发症，如压疮、肥胖、糖尿病、骨质疏松症和心血管合并症。我们提出了一个交互式远程健康监测和自动生物反馈系统，以促进轮椅使用者的身体活动，减压操作性能和自我管理。在这个项目中，我们专注于脊髓损伤（SCI）患者，他们因久坐而患压疮的风险特别高 (31%年发病率，85%终生发病率）。然而，所提出的技术广泛适用于基于轮椅的远程医疗。所提出的技术--不经修改地连接到任何轮椅上--有三个核心组成部分：1）活动监测系统（即，轮椅速度、行进距离和自推进次数），2）压力释放监测系统，以及3）提供关于压力释放和身体活动目标的实现的提醒和反馈的系统。生物反馈将通过安装在轮椅上的显示器在本地（向用户）传递，并通过安全的互联网接口远程（向临床医生）传递。使能技术是监测轮椅特定活动模式的创新传感器系统，但重要的价值来自于将这些新的测量集成到生物反馈系统中，该系统鼓励轮椅使用者积极避免不活动的继发性并发症，并允许护理提供者识别风险患者并进行有效干预。现有技术无法与建议的解决方案相比。存在用于监测轮椅座椅压力的产品，但是这些产品昂贵、笨重，并且不是为家庭使用而设计的。存在用于监测轮椅特定身体活动的产品，但这些设备无法区分被动轮椅运动和主动轮椅运动。现有技术没有将这些措施与自动生物反馈和远程保健功能相结合。我们为这个合作项目组建的团队包括来自BioSensics（一家私营生物医学技术开发公司）和Rancho Los Amigos国家康复中心（美国最大的综合康复中心之一）的工程师，临床医生和科学家。此外，该项目还受益于世界知名的 她是身体活动监测方面的专家（Bijan Najalan博士，亚利桑那大学），也是SCI护理方面的领先专家和关键决策者（Sophia Chun博士，退伍军人健康管理局SCI主任）。该团队在以前的项目中成功合作。第一阶段的具体目标是：1）通过利用先前NIH SBIR奖项商业化的现有BioSensics技术，改进拟议系统的原型和试点测试版本; 2）使用包括高密度压力垫和基于相机的运动捕捉的最先进的工具来验证所提出的系统的测量，以及3）在社区使用期间评估局部生物反馈（通过安装在轮椅上的显示器向用户反馈）的功效。通过证明生物反馈增加了身体活动和压力缓解的实现将证明NIH对拟议技术的进一步投资是合理的。在第一阶段完成后的6个月内，我们预计将有一个商业可用的测试版系统（BioSensics已成功地将几个产品推向市场，在这个时间范围内）。在第二阶段，我们将通过增加自动无线数据传输功能（通过移动的和Wi-Fi网络）和开发一个安全的网站来远程访问活动数据并向轮椅上的显示器发送远程健康提醒，从而开发拟议系统的远程监测和远程健康方面。

DESCRIPTION (provided by applicant): The public health problem addressed by this proposal is that inactivity in individuals with chronic disabilities who use a wheelchair results in signifiant and costly secondary complications, such as pressure ulcers, obesity, diabetes, osteoporosis, and cardiovascular comorbidities. We propose an interactive telehealth monitoring and auto-biofeedback system to promote physical activity, pressure relief maneuver performance, and self-management among wheelchair users. In this project we focus on patients with spinal cord injury (SCI) who are at particularly high risk for developing pressure ulcers from sitting too long (31% annual incidence, 85% lifetime incidence). However, the proposed technology is broadly applicable to wheelchair based telehealth. The proposed technology - which attaches to any wheelchair without modification - has three core components: 1) an activity monitoring system (i.e., wheelchair speed, distance travelled, and number of self-propulsions), 2) a pressure relief monitoring system, and 3) a system that provides reminders and feedback regarding the achievement of pressure relief and physical activity goals. Biofeedback will be delivered locally (to the user) via a wheelchair mounted display and remotely (to the clinician) via a secure internet interface. The enabling technologies are innovative sensor systems to monitor wheelchair specific activity patterns but the significant value comes from integrating these novel measurements within biofeedback system that encourages wheelchair users to actively avoid secondary complications of inactivity and allows care providers to identify at risk patients and intervene efficiently. Existing technologies do not compare with the proposed solution. Products exist to monitor wheelchair seat pressure but these products are costly, cumbersome, and not designed for home use. Products exist to monitor wheelchair specific physical activity but these devices cannot distinguish passive from active wheelchair movement. No existing technology combines these measures with auto-biofeedback and telehealth functionality. The team we have assembled for this collaborative project includes engineers, clinicians, and scientists from BioSensics (a privately held biomedical technology development company) and Rancho Los Amigos National Rehabilitation Center (one of the largest comprehensive rehabilitation centers in the United States). In addition, this project benefits from the consultation of a world-renowned expert in physical activity monitoring (Dr. Bijan Najafi, University of Arizona), as well as a leading expert and critical decision maker in SCI care (Dr. Sophia Chun, Chief of SCI, Veterans Health Administration). This team has collaborated successfully on prior projects. The Specific Aims of Phase I are to 1) improve prototyped and pilot tested versions of the proposed system by leveraging existing BioSensics technologies commercialized through prior NIH SBIR awards; 2) validate the measurements of the proposed system using state-of-the-art tools including a high-density pressure mat and camera-based motion capture, and 3) evaluate the efficacy of local biofeedback (to the user via a wheelchair mounted display) during community usage. By demonstrating that biofeedback increases physical activity and achievement of pressure relief will justify further NIH investment in the proposed technology. Within 6 months of the completion of Phase I, we anticipate having a commercially available beta release of the system (BioSensics has successfully brought several products to market in this timeframe). In Phase II we will develop the remote monitoring and telehealth aspects of the proposed system by adding automatic wireless data transfer capabilities (via mobile and Wi-Fi networks) and developing a secure website for remotely accessing activity data and sending telehealth reminders to the wheelchair mounted display.