PHYSIO PANTS KYLE ROSS s3433915
1
CONTENTS 5 . A B ST R AC T 6. INTRODUCTION 8 . L I T E R AT U R E R E V I E W 8. EXPLORING SUCCESSFUL AGING 10. IMPROVING MOBILITY 12. ENGAGING WITH TECHNOLOGY 14. KEY FINDINGS 1 5 . D E S I G N G OA L S 1 6 . D E S I G N OV E RV I E W 1 7. P R O D U C T U S E R M A P 18. DESIGN COMPONENTS 20. DESIGN FUNCTIONS 2 0 . MEASURING AND RECORDING MOBILITY 25. PHYSIO SUBSTITUTE AND EXERCISE PROGRAMS 26. IMMEDIATE FEEDBACK CORRECTING MOVEMENTS 2 7. C O N C L U S I O N 28. BIBLIOGRAPHY
3
ABSTRACT With time; the proportion of our aged population grows across Australia and much of the world, and so does our need to develop and expand technologies focused on improving quality of life as we enter our later years. Focusing on developing assistive technology to improve the core function of mobility, increasing dependent factors such confidence, independence, falling risk and social engagement. With substantial research showing increased movement and physical therapy sessions helping with balance, strength and coordination, improving mobility and reducing risk of falling. Therefore using assistive technology in the form of wearable pants to improve mobility in the aging population, through increased movement and correcting movements. This is achieved by measuring and displaying mobility data for tracking of results, immediate movement feedback and data communication tool between patients and physiotherapists. Focusing on incorporating these balance, strength and flexibility exercises into everyday life with assistive technology. This need for enhanced assistive technology, also dictates a prerequisite to better understand how older adults interact and manage using tech in everyday life. With this understanding we can improve assistive technology to a point where it not only enhances the lives of older adults but is inviting and engaging for them to use.
5
INTRODUCTION With a growing aged population in Australia and much of the world, the need to develop and improve how we age and the quality of life in our later years continues to all so grow. As we age, we are faced with many challenges, as our bodies become frail; simple tasks can become very difficult and can lead to other problems such as isolation and discontent in life. So as our aged population increases, so does the market to improve and focus technology for this area grows. Assistive technology addresses these issues across many different aspects of an older adults life, from increasing independence to improving their social lives. However, developing technology for older adults requires an understanding of how they will interact and engage with it for it to be truly beneficial. Often advancements in technology for the elderly focus on extending life seen with an
increasing life expectancy, however not addressing how we can continue to lead fulfilling lives into our later years. Assistive technology should focus on the core difficulties that come with aging while still considering every aspect of their lives, thus also improving the consequential problems that core problems cause. Mobility as we age can be drastically reduced form many age related symptoms or diseases leading to many physical and social problems such as isolation, anxiety or even more physical problems such as incontinence. Through balance training programs, the mobility of the elderly can be greatly increased while reducing risk of falling (M. M. Madureira, 2007). Subsequently we can explore ways to use assistive technology to increase mobility through more time spent being active and correcting bad habits while moving.
7
L I T E R AT U R E R E V I E W EXPLORING SUCCESSFUL AGING To understand and achieve the task of improving older adult’s lives through developing technology specifically for them, we must first look at the problems they face and what it means to age well. The forum report ‘Successful Ageing’ (John W. Rowe, 1997) breaks the definition of successful aging in to three categories; low risk of disease and disability, high cognitive and physical functional capacities, and an active participation in life. Arguing that all three are needed to some degree to be consider aging successfully and have quality of life. However, many would consider avoiding disease and disability to be aging well, Seen in figure 1 where 854 people were asked to define aging successfully (Bowling, 2005) with around 65% stating health as the most important. This popular idea is most likely caused by the two categories, engagement with life and cognitive and physical functionality, are general considered to be some what dependent on health. An example of this; Zelma an elderly lady we interviewed from Nari talked about, how her daily activates had to have purpose, and would use walking as an example. Walking to Zelma had a purpose of
Figure 1- (Bowling, 2005)
increasing her mobility, reducing risk of mobility diseases and disabilities while also giving her social connectivity, Leisure and independence which may not be achieved without her increased mobility from walking. Never the less, Zelma’s social connectivity, Leisure and independence is very much part of why she is could be consider aging successfully. Reinforcing the need for all three categories to successfully age even if they may be highly dependent on each other. Mobility is one of the largest core problems faced by aging people,
caused by many age related impairments. It can be seen as measure of independence with 92% of community dwelling people between the ages of 65-85 were able to complete the ‘up and go’ test in under 12 seconds while only 9% of individuals in nursing homes of the same age could. This lack of mobility of people in aged care, may be symptom of a larger issue however it does result in lack of independence amongst over things.
9
IMPROVING MOBILITY A decline in mobility as we age, can be caused by many factors, however there are multiple ways to improve mobility balance and reduce the risk of falling. Looking at Bischoff (BISCHOFF, 2003) paper he explores the point at which should be considered ‘normal’ mobility. Finding that the TUG test (‘timed up and go test’) where the subjects would rise from a standardized chair walk around an obstacle 3 meters away then return to sitting in the chair with a measured time. This is a simple but effective way to measure mobility covering most aspects of mobility including balance, strength walking speed and ability to maneuver. Bichoff concluded that 12 seconds was the cut-off point where someone was considered to have abnormal mobility and were no longer able to easily be independent. Therefore, using this universal test that anyone can easily perform, we can identify someone’s level of mobility. Subsequently our goal is to help prevent elderly people improve their mobility and prevent reaching this 12 second mark in the TUG test. A strong correlation between balance training over extended periods of time and an improved TUG test has been shown in
Madureira experimental report (M. M. Madureira, 2007). Also showing a reduction the amount of falls individuals have. With individuals of an average age of 74, participating in 40, one hour supervised physiotherapist balance training sessions over the course of one year. These sessions included warm up and stretching exercises, static and dynamic movements designed to gradually improve balance. The people who participated in these classes saw an average decrease of 3.65 seconds on their TUG test, reduced fall rate from 1.2 to 0.5 per year and improved scores across the rest of the balance tests. In addition, the control group had an average increase of 2.27 seconds in their TUG test across the year. Furthermore, Rubenstein paper also shows improvements in mobility and flexibility when subjects that were prone to falling, were involved with community exercise sessions (Laurence Z. Rubenstein, 2000). Again individuals participated in 90 minute classes, supervised by physiologists three times a week, over a 12-week period, with focus on light exercise and flexibility. Seeing many positive results across strength, flexibility and endurance tests. Overall the exercise group had a
fall rate of 6.0 falls to 1000 hours of activity after the 12 weeks, where the control group had 16.2 falls per 1000 hours of activity. As seen by these papers a reduction in mobility balance and flexibility may be caused by many different factors as we age, however an increase in movement, exercise and stretching will significantly help stay mobile and independent. Nevertheless, as we age, social, physical and physiological factors can restrict the amount of activity we participate in. Using assistive technology will hopefully reengage and interact older adults with activates and exercises to improve mobility.
Figure 2- Visualization of TUG test http://portal.mhealth.uah.edu/public/Upload/Applications/SmartButton/TUGphases.png
11
ENGAGING WITH TECHNOLOGY To explore how older adults could benefit from using assistive technology to improve their mobility we must first look how they will generally interact technology in their everyday lives and what engages them to use it. Older adults will generally have technological barriers as they may have not been exposed to this level of computing from a young age and will generally be used to going about their daily tasks such as communicating, gaining information or even paying the bills, in a very different way to what is now the normal. With Schulz stating in his forum report many older individuals are historically very late to adapt technologies such as the internet, smart phones or even pc’s (Richard Schulz, 2015). Furthermore, stating with an ever increasing technological industry they will inevitably increase penetration into the elderly market developing technology suited to them and helping them improve their quality of lives. This requires a certain level of adaption on both parties, adapting the technology to the specific market of the elderly, while older adults learn and engage, adapting to the technology. Elderly people; will often have a lack of knowledge, might have some physical disabilities
such as arthritis and can have some prior hesitation and fear when it comes to technology. Therefore it is these problems assistive technologies need to address, so that they will truly engage with it, observing how the user’s capabilities will affect the tools required to perform the given task. The technology must find a balance between being useful so that it will still give beneficial information and perform its given task efficiently while also accommodating their needs. This is shown when
Figure 3- (Wyeth, n.d.)
Wyeth talks about flow theory on the flow of activities “When action opportunities are perceived by a person to be beyond his or her capabilities, the resulting stress is experienced as anxiety. The state of flow is felt when opportunities for action are in balance with a person’s skills. When the skills of the user are greater than opportunities for using those skills, the state of boredom results.” (Wyeth, n.d.). The goal is to maintain this balance when elderly people use assistive technology. In Schulz’s report he explored how assistive technologies could be used in the 5 core life domains and the functions performed in each. Stating assistive technology for mobility would have the functions of; monitoring variables like speed and daily exercise, also diagnose problems such as risk of falling and work along with guidance assistance (Richard Schulz, 2015).
13
KEY FINDINGS Mobility is a core issue amongst the aging population Impacting -Independence -Confidence -Falling Risk -Everyday life tasks -Social engagement Research shows mobility can improved through increased movement especially when supervised in structured exercise programs. Mobility can be measured through a series of simple movements including walking, standing and balance Using assistive technology to improve mobility must be engaging and serve a clear purpose to be truly helpful
DESIGN GOALS To improve mobility of the elderly through increased movement and amending of incorrect movements
USEABILITY GOALS - - - - -
Must be simple to engage with Be able to accurately determine someone’s level of mobility and areas they need to improve on. Provide useful and meaningful data to the user Give immediate feedback to correct general movements and planned exercises Motivate to increase movement
15
DESIGN OVERVIEW From the stated research, a device that will personally and social push people to become more active with correct movements through monitoring can be shown to have great benefits to older individual’s mobility, balance and flexibility. This solution of focusing to help elderly people with a core problem of reduced mobility will also allow them to be more independent, be more social, reduce risk of falling and gain confidence. This would greatly improve their quality of life across a fields stated to age successfully. Doing so using wearable assistive technology such as pants or device measuring balance, joint movement, while giving feedback through small vibrations to correct movements. This would serve a number of functions; first by monitoring joint movement, flexibility, and balance, progress can be visualised through graphs and visual data on a simple tablet application or even shared amongst friends. Secondly by measuring joint movements, feedback can be given through usual movements such as walking in the form vibrations, if twisting or off balance helping to correct movements the same a physiotherapist would. Lastly through the same application, flexibility balance and strength exercise programs recommend by their physiotherapist, can be run. Guiding older individuals through movements
prescribed to them, where it will learn their ability and again give feedback on movements through vibrations. These pants would help them to prevent loss or even gain mobility and reducing their risk of falling through greater balance and strength. With visual feedback along with hopefully improved mobility this will engage older adults to maintain interaction with the device, as it serves a purpose in their life allowing them to have similar results as having light physical therapy at home or even amongst friends. However, the Initial limited learning curves of how to use the product including the simplistic single paged tablet application will need to be overcome, this should come from the desire for better mobility, with the ease of staying at home and without the costs of physical therapy. Furthermore with many seniors, ever increasing their basic abilities with devices such as the IPad and all wireless information this learning curve will be very small. The device would work using variable resistor fabrics to measure joint movements in the legs and lower back along with an accelerometer for balance. All connections will be wireless with little to no set up besides installing the application.
PRODUCT USER MAP
Going about everyday life with pants measuring mobility Aging natural decreases mobility
Visual feedback of improvements motivates to continue
Physiotherapist prescribes programs to increase and improve mobility Vibrations correct bad movements
Tablet app runs tailored phyiso exercise programs
17
Centralized pocket for removable custom slim processing unit and accelerometer
Vibration points position around lower body, for gesturing to correct movements
Conductive material to measure joint angles, in knees and hips
DESIGN COMPONENTS
The wearable technology solution, will be tight pants that would be worn as an under garment. They will stretch when moving, therefore changing the conductivity and of the material and accurately measuring the angle of joints in multiple axis, as seen in Asada’s paper ‘Wearable Conductive Fibre Sensors for Multi-Axis Human Joint Angle Measurements’ (Asada, 2005). Along with a centralized accelerometer to measure when someone is swaying or moving off balance through measuring acceleration in a horizontal plane. These measurements are alone enough to assess and display someone’s progression of mobility, speed balance and flexibility. However, using the same measurements, immediate feedback will be given through small vibrations in targeted spots. Vibrations can often feel like pressure on the skin, resulting in a similar feel of a trained physiotherapist positioning your body through touch. For example, if an individual was to sway slightly right a small vibration on their left hip would occur causing them to correct their balance, or if they were not extending their knee enough while taking a step a small vibration on the back of your calf will happen letting them know. All of these will help train their body to correct muscle movements and excel their mobility.
Analyzing the the lower body, it is made up of four main joints two knees and hips. This makes up 6 variables that need to be measured to know the overall position of the lower body. As knees can only rotate in one plane while the hip can on two. Meaning conductive material is needed on the front and back of the knees and hip, while the hip also requires material on the inside of the leg and outside to cover all variables. Vibration points are positioned in strategic places to control rotation in each joint with front and back gesturing across each movement plane. In addition four vibration points will be situated around the waste for balance gesturing.
19
DESIGN FUNCTIONS MEASURING AND RECORDING MOBILITY In Ruckensteins (Ruckenstein, 2013) paper, where he explores the impact of having our well being monitored through personal devices and how we engage with the visually represented data. He concludes that “The playfulness and creativity of people interacting with measuring devices suggests that tracking promotes “numerical living” that can be fun and engaging”. In addition adding that this data being visually represented can drastically influence and modify people’s behaviors and engagement with various activities. Further emphasizing measuring and recording mobility, with visual data representation will push and motivate people to better themselves through tacking their improving mobility. While the stand up and go test used in many of the studies is an easy way to measure mobility that anybody can perform. It requires interruption out of daily activities to perform, needing added motivation for constant intervention to acquire viable data. Breaking the TUP test into its components determining level of mobility, through the factors such as, walking speed, leg extension, standing and sitting speed, swaying amount, and agility. Measuring these factors can be done through daily routine, with sensors.
While multiple sensors could determine these factors such as gps for walking speed. Dealing with such small speeds and rate of change it is much more accurate to take data measurements relative to a person’s own body rather than outside factors such as a satellite for mobile devices. By measuring joint angles in the lower body, this data can then accurately calculate larger factors for interpreting level of mobility (Asada, 2005). Ideally to do this the following variables need to be able to be measured to accurately calculate data that can be then easily visualized and interpreted. The following are the mobility factors calculated and their dependent variables measured with the wearable pants
MOBILITY Walking speed -Step length -Hip angle -Knee angle -Length of leg -Rate of steps -Hip angle rate of change -Knee angle rate of change
Lower body flexibility -Max hip angle -Max knee angle Balance -Swaying -Horizontal plane acceleration -Step size, rate and foot height
The pants will measure joint angles in the knees and hip, through using conductive material. As seen in the figure 4 when conductive material stretches it proportionately decreases in resistance. From this change in resistance as the conductive material lengthens when bending around joint such as the knee the angle of the knee can be determined. As built into the application a base line needs to be set using the calibrate button when first putting the pants on to get a datum point. With similar technology used in many sporting applications to measure and athletes joint movement in movements, this is one of the most accurate simplistic therefor non-intrusive ways to measure joint angles.
Standing and sitting time -hip angle rate of change from 90oto0o -Knee angle rate of change Agility Balance -Horizontal plane acceleration Step twist -Rotation of hip -Step size Time spent Mobile Figure 4- (Asada, 2005)
21
While also including an accelerometer for measuring the change of acceleration on the horizontal plane around the hip, where the center of balance roughly is giving a good indication of balance if moving. With acceleration being constantly changing detecting balance or amount of saying can be done through averaging acceleration in the x and y axis when performing differing tasks such as standing still or walking determined by measuring the angles of joints. With the given raw data of changing resistance the application will use formulas to calculate the different factors of mobility providing useful data. An example of this is calculating walking speed. Knowing average change of x level of resistance to y level of resistance in 0.33 seconds and given predetermined correlation in percentage of stretch in the conductive material on the hip we know that this means the leg has gone from an example average of -10o to 10o. With this and a reasonably accurate estimation of the 800mm leg length from size of pants; using trigonomic ratios calculating they moved forward 280mm in 0.33 seconds or 3 km/h.
Then calculating an average of these differing factors for an individual determining mobility level, As weeks go on this average will be compared to the previous level determining percentage change that can be visual represented in a graph versus time. In addition as the results only get compared to themselves to see percentage change, it will not be badly influence if data if it is off by a constant factor such as leg length is off by a few centimeters. These percentage changes in differing factors and overall mobility is what will be visually represented in the one page tablet application. This will clearly show the individuals progression which is what will provide motivation through ‘numerical living’ pushing them to better themselves. Keeping the application a single home page making it clear and easy to understand without all the background data. Providing only what is important to the older individuals which is their progression in mobility. However this data will not only motivate, but provide a tool for physiotherapists and health care workers, that will be able to see more complicated data through their own connecting website so they can analysis areas for improvement and keep note of their patients progress allowing them to tailor exercise programs.
U S E R I N T E R FAC E HOME PAGE DATA VISUALISATION https://marvelapp.com/6157a6g For application prototype
23
U S E R I N T E R FAC E PRESCRIBED EXERCISE PROGRAMS
PHYSIO SUBSTITUTE AND EXERCISE PROGRAMS The research from both Bischoff’s paper (BISCHOFF, 2003) and Madureira’s experimental report (M. M. Madureira, 2007) showS the greatest improvement in mobility for the aging population when participating in group physiotherapist programs running through strength, balance and flexibility exercises. With the pants being able to precisely measure factors of mobility including flexibility of individual joints, balance and walking speed, this allows a greater insight for physiotherapists to prescribe tailored programs. In combination with the tablet application this provides a great communication tool for health care workers and patients. With data sent to the medical practitioner through an online log in, they can determine what areas of their patient lacks mobility. Prescribing exercise programs directly to the patients tablet application for that area such as stretches for the left knee if its max angle is low. Reducing the need for constant checkups, while seeing similar results of constant professionally guided exercise programs. One of the benefits of having a physiotherapist present during these programs is the immediate feedback positioning the body to move in correct way to best increase and maintain mobility.
25
IMMEDIATE FEEDBACK CORRECTING MOVEMENTS Given the pants can accurately measure joint angles, in the lower body and identify an individual’s baseline level of flexibility and balance; comparing this to a known ideal in certain movement’s immediate feedback can be given. This feedback is designed into the pants in the form of vibration all points around the lower body. Working in both everyday life activities and the prescribed programs from the physiotherapist. When performing everyday activities, the pants would be able to determine when walking, standing or sitting through pattern recognition of joints movement and acceleration. Limiting to these activities in everyday life knowing the correct angles each joint should be at in these three activities. When preforming small vibrations will occur where pressure is need to push the body into position when outside a specified limit of what is correct, considering their average abilities. Improving their muscle memory in correct behavior to improve mobility. Within the prescribed programs since the tablet can identify which movement the patient should be doing, the pants can give immediate feedback with customized limits for that movement and abilities. Also tracking repetitions.
CONCLUSION Assistive technology needs to address real issues for older people, so that it will serve a purpose and they will engage in it. Mobility is fundamental for maintaining every aspect of older adults lives, without it many will become dependent, isolated and effect how they live. As seen balance, flexibility and strength exercise when guided by a physiotherapist are greatly beneficial to elderly people to improve mobility and reduce risk of falling gaining confidence and better quality of life. The suggested solution eliminates the need for constant sessions of physical therapy but incorporates them into everyday life or allows for home sessions as prescribed. This wearable device helps elderly people to age better by addressing all three of Rowe’s categories outlined to age successfully. It minimises risk of disease and falling, improves physical function and will help people continue to engage in life through more independence. These benefits subsequently give them a purpose and reward them to interact with this device out waying any negatives associated with a potential small learning curve.
27
BIBLIOGRAPHY Asada, P. T. G. a. H., 2005. Wearable Conductive Fiber Sensors for Multi-Axis Human Joint Angle Measure ments. [Online] Available at: https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-2-7 [Accessed April 2016]. BISCHOFF, H. A., 2003. Identifying a cut-off point for normal mobility, s.l.: British Geriatrics Society. Bowling, A., 2005. What is successful ageing and who should define it?. [Online] Available at: http://www. bmj.com/content/331/7531/1548?variant=full [Accessed March 2016]. John W. Rowe, R. L. K., 1997. Succesful aging, s.l.: The Gerontological society of america. Laurence Z. Rubenstein, K. R. J. P. R. T. S. L., 2000. Effects of a Group Exercise Program on Strength, Mobility, and Falls Among Fall-Prone Elderly Men, s.l.: Journal of Gerontology: MEDICAL SCIENCES. M. M. Madureira, L. T. A. L. G. V. F. C. &. R. A. C. &. R. M. R. P., 2007. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly, s.l.: International Osteoporosis Foundation and National Osteoporosis Foundation 2006. Richard Schulz, P., 2015. Advancing the Aging and Technology Agenda in Gerontology, s.l.: The Gerontogist. Wyeth, P., n.d. Understanding Engagement with Tangible User Interfaces, s.l.: Queensland University of Technology. Ruckenstein, M. (2013). Visualized and Interacted Life: Personal Analytics and Engagements with Data Doubles. Helsinki, Finland: National Consumer Research Centre.
29