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

描述(申请人提供)：这项提案涉及的公共卫生问题是，使用轮椅的慢性残障人士缺乏运动会导致严重且代价高昂的继发性并发症，如压疮、肥胖症、糖尿病、骨质疏松症和心血管并发症。我们提出了一个互动的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、压力缓解动作性能和自我管理。在这个项目中，我们将重点放在脊髓损伤(Sci)患者身上，他们因久坐易患压疮的风险特别高。 (年发病率为31%，终身发病率为85%)。然而，拟议的技术广泛适用于基于轮椅的远程医疗。这项拟议的技术无需修改就可以安装在任何轮椅上，它有三个核心组件：1)活动监测系统(即轮椅速度、行驶距离和自我推进次数)，2)压力缓解监测系统，以及3)提供关于压力缓解和体力活动目标实现情况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。启用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，该系统鼓励轮椅用户积极避免不活动的继发性并发症，并允许护理人员识别有风险的患者并有效地进行干预。现有技术无法与提议的解决方案相比较。存在监测轮椅座椅压力的产品，但这些产品昂贵、笨重，而且不是为家庭使用而设计的。存在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。目前还没有一种技术将这些措施与自动生物反馈和远程医疗功能结合起来。我们为这个合作项目组建的团队包括来自BioSensics(一家私人持股的生物医学技术开发公司)和兰乔洛斯阿米戈斯国家康复中心(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，该项目还受益于一家世界知名的 他是体力活动监测方面的专家(亚利桑那大学Bijan Najafi博士)，以及脊髓损伤护理方面的领先专家和关键决策者(退伍军人健康管理局SCI主任索菲娅·春博士)。这个团队已经在以前的项目上成功地进行了合作。第一阶段的具体目标是1)通过利用现有的通过NIH SBIR奖进行商业化的BioSensics技术来改进建议系统的原型和试点测试版本；2)使用最先进的工具验证建议系统的测量结果，包括高密度压力垫和基于摄像头的运动捕捉；以及3)评估社区使用期间本地生物反馈(通过轮椅安装的显示器向用户)的效果。通过证明生物反馈增加了体力活动和压力缓解的实现，NIH将证明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，我们预计将有该系统的商业测试版(BioSensics已经在这一时间框架内成功地将几种产品推向市场)。在第二阶段，我们将开发拟议系统的远程监测和远程保健方面，增加自动无线数据传输功能(通过移动和Wi-Fi网络)，并开发一个安全网站，用于远程访问活动数据和向轮椅安装的显示器发送远程保健提醒。

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.