Download WiSense Seminar #125, Body Area Network Implications for

Body Area Network: Implications for
Rehabilitation
Dr. Lori Maria Walton, PhD, DPT, MPH(s)
Professor & Director of Research
Andrews University
Michigan, USA
Introduction
Body Area Networks have numerous applications in
medicine and rehabilitation:
Cardiopulmonary
Vascular
Endocrine
Neurological
Physical Medicine
Perioperative monitoring
Clinical Application of
Body Area Networks
Augmentation of Provider-Patient Relationships
Remote health/fitness monitoring
Improve patient autonomy
Remote monitoring systems may be more efficient and cost-effective for
the healthcare industry (if sensor cost can be minimized)
Injury Prevention & Sport Training
Feedback systems may be utilized to provide “real time” body position and
biomarker information to the patient for self-correction and prevention of
injury & rehabilitation from injury
Biomarker diagnosis of disease
Health Care
Expenditures
Canada spends 68 billion dollars per year and USA
spends 75% of $2 trillion dollar budget on chronic
diseases such as diabetes, cardiovascular disease,
pulmonary disease, etc.
One third of Canadians have at least one chronic
health condition (Brief to House of Commons, 2011)
Patients who are well informed about their medical
condition are able to take action to correct it and
make behavioral changes accordingly.
Type of Body Data
Monitored
Blood pressure, Heart Rate, Respiratory Rate
Body Movements according to specified anatomical
landmarks
Biomarkers for acute and chronic disease process
Placement of Body Area
Sensors
Subcutaneous (biomarkers)
Clothing (external temperature, vital signs, etc.)
Body Part Accessory (Heart monitors, pace makers)
Includes: accelerometers, gyroscopes, smart fabrics and
actuators, wireless communication networks, and data
capture technology
BAS for
Accelerometers
Electrochemical sensors
Measure acceleration of objects in motion
Monitors posture, walking, running, etc
Reference axis landmarks
Provide information on basic steps and activity counts
Quantitative measurement
Velocity and displacement measurement
Triaxial accelerometers (3-D)
Provide information on movement 3-dimensions
Posture
Gait analysis
Gyroscopes
Based on angular momentum (3-D)
Body Chemical Sensors
Glucose Monitors
Infrared sensors
Blood pressure
Oscillometric
CO2 Gas Sensors
Monitors changes in CO2 and O2
ECG Sensors
EMG Sensors
EEG Sensors (Chen et al, 2011)
Pulse Oximetry
Humidity and
temperature
Placement of the Body
Area Sensors
Wrist
Ankle
Waist
Chest
Arm
Legs
Subcutaneous and superficial placement depending upon the utilization
*speed, distance, steps taken, floors climbed, calories burned, ambulation,
and posture, SpO2, HR, body temps, , ECG, RR, gait, biomarkers such as
lactate, glucose, etc..
WBAN
Monitoring
Patient reported outcomes (PRO)
Telemonitoring
Quantifying self-hybrid model (QSHM)
Utilization of BAS in
Cardiopulmonary Rehabilitation
Cardiopulmonary & Vascular Monitoring
30% of worldwide deaths are attributed to CVD (WHO, 2014)
BP continuous measurement utilizing US and an actuator
Blood O2 Saturation, Body temperature, and ECG, optical
absorption of hemoglobin proteins for blood O2 levels, exercise
stress and fatigue levels
Diagnosis of cardiac abnormalities, atrial fibrillation
Electrochemical sensors (in progress) to determine
prothrombin time for patients on Warfarin (blood thinner)
Diabetes
EMG (long and short sensors) monitor glucose levels
(Chen et al, 2011)
Contact lens remotely monitor glucose levels (in progress)
Monitoring of exercise glucose levels for patients with
diabetes could potentially create a more individualized
specific exercise routine
Peripheral neuropathy
Balance rehab utilizing a visual biofeedback system similar
to video gaming and body sensors at the ankle and hip to
correct motor learning strategies was shown to improve
proprioception and postural stability (Grewal et al, 2013)
Neurologic Diagnosis
Gait & Posture Analysis Analysis
Parkinson’s Disease (Conceptual model by Cassimassima et al, 2014)
Limb Paralysis
Meulen et al, 2015 Optimal guidance of rehab for 13 subjects with
stroke utilized 17 sensors in full body ambulatory system to track
measurements for maximal reaching distance, vertical reaching range,
hand movement relative to sternum & pelvis
Cerebral Palsy
Two sensors placed on low back and R ankle to monitor gait in children
with CP (reliability and validity was more predictable in the minimod vs
AMP sensors) (Kuo et al, 2009)
Another study (Baram et al, 2011), showed a 21% residual improvement
in walking speed & 8% improvement in stride length for children w/ CP
and sensor feedback.
Other Measurement
Exercise progression to maximize therapeutic
recovery
Pulmonary rehabilitation
Graded exercises
Self-management education
Strength & flexibility training
Physical activity
Monitoring of home exercise program
Subcutaneous
Biomarker Detection
Electrochemical biochips
Bajj-Rossi et al (2014) proposed utilization of multiwalled carbon nanotubes w/enzyme catalyst to assure
sensitivity and specificity of biosensing
Lactate (SN: .77)
glucose (SN: .64)
pH (SN: .75)
temperature (SN=1.08)
Inflammation (C-Reactive Protein) (Fakanya et al, 2014)
Glucose Sensors
Amperometric sensor
utilizing enzyme-electrochemical sensors & thick
film technology
Fibre Optic fluorometric glucose sensor
based on O2 measurement
Spectroscopic glucose sensor
utilizing mid-infrared spectroscopy
Implications for Women’s Health
Rehabilitation
Prenatal/Postpartum Diagnosis
Magnetoencephalogram for fetal and maternal monitoring (during
activity) (Vairavan et al, 2010)
Brain growth in the fetus
Cardiac anomolies in mother
Obstetrics
Early detection of preeclampsia biomarker predictors including
Corticotropin Releasing Hormone and Vitronectin (Song et al, 2015)
Cancer (Hunter et al, 2014)
Subcutaneous temperature sensors in mice sample utilized to detect
lymph tumor progression (EMu Mic Lymphoma) (r=.68, p<.001)
Common Prenatal
Problems
Placenta Previa
Preeclampsia to Eclampsia
Placenta Abruptio
Subchorionic Hemorrhage
Gestational Diabetes
Placenta previa
Placenta Abruptia
Preeclampsia
3rd Most common cause of maternal mortality world wide
(12% all deaths)
May be reduced by up to 55% in women who begin 20 min
of exercise 5 X per week in first trimester
Symptoms: High blood pressure and protein in the urine
(due to kidney failure) after 20th week in pregnancy
Caused by autoimmune disorders, diet, lack of exercise,
blood vessel problems
Risk factors: first pregnancy, twins, obesity, > 35 y/o,
diabetes
Testing for
Preeclampsia
Protein lab tests (urinalysis)
Weight gain greater than 2 lbs/week
BP > 140/90
Elevated liver enzymes
Swelling hands/face/feet
Decreased platelet count (less than 100,000)
Preeclampsia
Monitoring
2010 Study of 50 women by Callaway and Colditz
showed improvements in fasting glucose at 28 weeks and insulin at 36 weeks for
those who exercised greater than 900 cal/week
2003 Study showed Magnesium sulfate to reduce risk of preeclampsia more
than 50% for women and is “drug of choice” above any hypertensives or other
treatment
2003 Sorensen et al found a 54% reduction in pre-eclampsia diagnosis for
women who exercised vigorously in the year preceeding pregnancy and in
early pregnancy.. 34% reduction for those with ANY form of physical activity
that was regular, and 24% reduction for women who reported light to
moderate (less than 6 METS) compared with non-exercise group
Saftlass et al (2004) suggested that women who engaged in any Leisure
time physical activity regardless of caloric intake were significantly
decreased their chance of getting preeclampsia
Caesarean-Section
Urinary incontinence
Bowel/bladder scar tissue symptoms
Endometriomas
Placenta previa and abruptio in subsequent pregnancies
Pain
Hypotonia & Hypertonia
Postpartum Infections
Pelvic Floor Spasticity
Pelvic and Abdominal floor Flaccidity,Levator Abnormalities
Normal Delivery
Perineal Trauma
Coccygeal Fracture
Pubic Diastasis
Neuropathy
Post Epidural Pain
Low Back Pain & Pelvic Girdle Pain
Urinary Incontinence
Postpartum Evaluation
Uterus changes in size, location, and volume
Pelvic Floor changes
Urogenital and GI Changes
Wound Healing
Superficial Nerve Entrapment at site of C-Section
Pain
Low Back & Pelvic Girdle Instability
Postpartum
Cardiomyopathy
1 out of every 1,300 deliveries
Mortality Rate is 25-50%
Weak heart diagnosed within fifth month post delivery
Risk Factors: obesity, alcohol, cardiac diagnosis prior to pregnancy,
smoking, multiple pregnancies, undernourished
Symptoms: fatigue, increased nocturia, racing or skipping beats, SOB lying
flat, swollen ankles
Complications: CHF, Embolism (Pulmonary), Arhythmias
Treatment: Hospital/ER, immunosuppressive treatment and aortic balloon,
heart transplant, medications, fluid restrictions,activity limitations
Venous Air Embolism
More commonly associated with C-section
Incidence 50-95%
1% of all maternal deaths
Occurs more often with Steep Trendelenburg positions
Symptoms: Hypotension, hypoxemia, chest pain
Treatment: Change position, 100% forced O2, IV fluids,
encourage fast delivery without CS
BAS Applications
Quality and efficiency
Visual Analysis
Video
Gait Analysis Tools
BAN Applications
Special Diagnostic Tests
SLR (SN=.98; SP= .61)
ASLR (SN= .25; SP=.86)
Gaenslen’s (SN=.71; SP= .26)
FABER (SN> .82, SP>.60)
SIJ ant distraction (SN=.60;SP=.81): post compression
(SN=.69; SP=.69)
Hip Scour
Anterior labral
Barriers to BAN
implementation
Reliability and efficiency of sensor systems
Many sensor systems had same authors for system
developers (bias)
Expensive
Accelerometers should be utilized with more than
one sensor…
One accelerometer (65% accuracy)
Two accelerometers (87% accuracy)
Legal & Ethical Issues
Personal Data safety
Technology for elders may be seen as a limit to their
independence (constant monitoring of symptoms
that may impact social and community movement)
Future Research
Evidence for reliability, validity, and responsiveness
of wireless network body sensors must be
established for each protocol
Collaborations between health care provider experts
in diagnostics and rehabilitation, patients, computer
and bioengineers, and wireless industry
Examination of this type of BAN system to be utilized
in countries of challenged socio-economic needs and
where access to health care is limited.
Thank You!
“The doctor of the future will give no medicine, but
will interest his patients in the care of the human
frame, in diet, and in the cause and prevention of
disease.” -Thomas Edison, Inventor
References
Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Gabbe SG, Niebyl JR, Simpson JL,
eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill
Livingstone; 2007:chap 18
Houry DE, Salhi BA. Acute complications of pregnancy. In: Marx J, Hockberger RS, Walls RM, et al, eds.
Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby
Elsevier; 2009:chap 176
Cunningham FG, Leveno KL, Bloom SL, et al. Obstetrical hemorrhage. In: Cunningham FG, Leveno KL,
Bloom SL, et al., eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill: 2010:chap 35.
Rosmans C, Holtz S, & Stanton C. Socioeconomic differentials in caesarean rates in developing
countries: a retrospective analysis. The Lancet. 2006;368: 1516–1523.
Dumont A, de Bernis L, Bouvier-Colle MH, Breart G (2001). Caesarean section rate for maternal
indication in sub-Saharan Africa: a systematic review, Lancet, 358: 1328-1333.
De Brouwere V, Dubourg D, Richard F, Van Lerberghe W (2002). Need for caesarean sections in west
Africa. Lancet, 359: 974–75.
Rosmans C, Holtz S, & Stanton C (2006). Socioeconomic differentials in caesarean rates in developing
countries: a retrospective analysis. The Lancet, 368: 1516–1523.