A Wearable Platform for the Monitoring of Health Condition and Sport Performance and the RealTime Prevention of Sport

Injuries

Dimitrios I. Fotiadis
University of Ioannina, Dept. of Computer Science Unit of Medical Technology and Intelligent Information Systems

Contents
Objectives Architecture Design System Evaluation

Objectives
DROMEAS aims at developing a wearable platform for the monitoring of the athletes health condition, during training. The system will recognize possible health problems and communicate them to experts in order to prevent possible sport injuries. Our aim is to develop a real-time monitoring system that will enable athletes to rapidly regain their normal functionality by avoiding injury relapses.

Technical Objectives
Design of a real-time wearable monitoring platform for athletes during rehabilitation Synchronized physiological (vital signs) and motion signal collection during exercise Real-time processing and feedback Multi-modal signal processing Rehabilitation and Performance assessment by intelligent multi-signal processing techniques (information fusion)

Monitoring
Medical Evaluation for the assessment of:
Orthopedic rehabilitation and for the relative reduction of the rehabilitation period by preventing injury relapses Overall health condition Effectiveness of physiotherapy

Performance evaluation for:

Adjusting training programs Assessing endurance and sporting condition Evaluating performance

System Users
Professional Athletes Habitual Athletes Patients in Rehabilitation after Serious Injury Trainers Medical and Paramedical Professionals

Architecture
WEARABLE PLATFORM REHAB STATION DROMEAS PORTAL

Athlete Trainer Medical Professionals Researchers: Medical Prof. Trainers

Sub-Systems
Athlete Sub-System Rehab Station DROMEAS Portal

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DROMEAS Portal: Rehab Station: Athletes Sub-System: Collects and processes the medical measurements. Analyses and evaluatesinformation from the Rehab Stations over Collects information from the athlete, through the motion and large periods processed information to the users. Presents the of time. medical sensors Provides the communication link between the athlete and the rehabilitation experts. Makes a preliminary medical analysis.

Components

Athlete Subsystem
Evaluation Unit
Evaluator Module Preliminary Diagnosis Module

Medical data Collector Athlete

Alert Generator

Motion data Collector

Rehab Station
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REHAB Station
Movement Sensors Medical Sensors Evaluator Unit Laptop/PC Earphones PDAs

Glasses Wireless Communication

Medical Input Knowledge Base

Movement Input

User Profiles Synchronize

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Movement Simulator Anthropometric Profiles

VISUALISATION MODULE

Medical Profiles

TRAINING REPOSITORY

DIAGNOSIS MODULE

TRACKING MODULE

Portal
PDAs Laptop/PC Network

Update Service

User Profile s

Mobile Agents

RESEARCH REPOSITORY

Network

TRAINING REPOSITORY

TRAINING REPOSITORY

TRAINING REPOSITORY

Rehab Stations

Communication Links
Rehabilitation advisors group outdoors Rehabilitation advisors group indoors

High speed Network REHAB station Athletes transceiver BLUETOOTH IEEE 802.11 technologies over LAN DROMEAS portal IP Core Network

Gateway

Preliminary

Information Flow
Medical

Sensing System

ATHLETE SUBSYSTEM

Diagnosis Module
Medical Signal Classification Module

REHAB STATION

Wearable Medical Sensors Module Measurements Buffer

Evaluation Unit

Evaluator

users thresholds Medical Profiles Training Repository

Medical Signals Collector

Preliminary Diagnosis module

users high-risk factors

Medical Measurements DB

Communication Module

Tracking Module

Synchronization module

Alert generator module

Anthropometrics Profiles DB Motion Measurements DB

Visualization Module

Motion Signals Collector

Movement Simulator Module

User Profiles

Wearable Motion Sensors Module Communication Module

Motion Sensing System PORTAL

Visualization Module

Update Service

Research Repository

User Profiles

Signals Acquisition
Athlete monitoring includes: Cardiovascular measurements
ECG Blood Pressure (before and after exercise)

Breath rate
Respiratory effort Breath patterns

Temperature
Measurement at site of injury and contralateral site for detecting deterioration of injury

Signals Acquisition
Pain Assessment
Pain characterizations
None Occasional and slight pain during activities Always present but bearable (slight restriction) Present and unbearable (unable to continue)

Through direct input (pain button)

Motion measurements
Joint angles with 6 Electrogoniometers (for both legs at hip, knee and ankle) Speed

Signals Acquisition

Signals Acquisition

All signal inputs are fed to the Wearable Computer for further processing. Pain descriptions are directly logged to the Wearable Computer through the Athlete / System interaction components The synchronized data are wirelessly transmitted to the Rehab Station

Signal Analysis
Thresholding
Application of signal thresholds to generate alerts

Comparison / Correlation of Signals

Comparison of signals and application of thresholds to generate alerts / assessments (temperature, joint angle measurements) Correlation of Signals for indirect assessment

Medical Rules
Use of rules provided by medical experts to provide assessments Combination of rules to provide assessments

Signal Analysis
Multi-Modal Signal Analysis
Combined use of medical knowledge / rules and heuristic knowledge

Information fusion
Use of inputs from many sensors through a fuser to provide a better assessment than with any individual sensor. Use of medical knowledge for designing fuser rules

Signal Analysis
Information / Decision Fusion layer
Composed of a number of fusion objects Fusion objects are responsible to fuse decisions from local decision objects to decide on diagnosis Fusion objects incorporate intelligent functions such as:
Rule-Based Systems Fuzzy Logic Neural Networks

Output: Diagnosis / Assessment vector

Signal Analysis
(Decision Process)

Decision Process
Sensor #1 Sensor #1 Feature estimator #1 Analysis/local decision #1 Sensor #2 Feature estimator #2 Analysis/local decision #2 Sensor #N Feature estimator #N Local Decision Global Decision Decision fusion

Signals

Features

(Preliminary Diagnosis)
S ig n a l P re -p ro c essin g M o d u le
S e n so r # 1 F ea tu re estim ato r # 1 F ea tu re estim a to r # 2 A n aly sis/lo ca l d ecisio n # 2 S en so r # N F e atu re estim a to r # N

Signal Analysis

P relim in a r y D ia g n o sis
D ecisio n P ro cess
A n aly sis/lo ca l d ecisio n # 1 D ec isio n fu sio n

S e n so r # 2

U se rs T h resh o ld s

A lert

ECG Analysis
Detection of Heart Rate (HR) Detection of Heart Rate Variability (HRV)
HRV Analysis
Statistical Analysis Time- Frequency Analysis

Feature Extraction Neural Network Training Use of Decision Criteria

Classification
RR-interval duration signal analysis Rule based System

ECG Analysis
Preprocessing
Extraction of HRV of each ECG Partition of HRV in 32-point segments (3.426 segments)

Detection using HRV Features

Extraction of HRV statistical characteristics (SDNN, r_MSSD, SDSD, pNN5, pNN10, pNN50) 63 combinations of characteristics NN training for each combination

ECG Analysis
DETECTION with HRV Time-Frequency Analysis
Computation of Time-Frequency distributions (STFT and 18 distributions belonging to Cohen class) Feature extraction form STFT and each distribution Neural Network Training for STFT and each distribution

DECISION CRITERIA
Mean Value Voting Selective Voting

(Detection Results)
Detection with Statistical Analysis
CRITERION Mean value Voting Selective Voting SENSITIVITY 80.68% 82.60% 87.53% SPECIFICITY 78.18% 78.43% 89.48%

ECG Analysis

Detection with Time-Frequency Analysis

CRITERION Mean value Voting Selective Voting SENSITIVITY 87.64% 86.84% 89.95% SPECIFICITY 88.65% 89.25% 92,91%

Analysis of Other Signals

Joint Angle Signals
Input: Joint angles from hip, knee and ankle for each leg Processing: Detection of characteristic angles in pre-selected points of the gait cycle Analysis: Detection of Abnormalities in Walking Running comparing healthy injured legs Output: Assessment of rehabilitation / recovery

Analysis of Other Signals

Breath Rate
Input: Respiratory Effort Processing:
Detection of Breath Rate Detection of Breath Patterns

Analysis:
Assessment of Breath Pattern alterations during physical activity rehabilitation Indirect estimation of VO2 max

Output: Breath Rate and Breath Pattern assessments to be correlated with cardiovascular assessments for assessing physical condition

Analysis of Other Signals

Temperature Measurements
Input: Temperature inputs of injury site and contralateral site Processing and analysis: Comparison of temperature levels between sites Provide an assessment when difference exceeds a threshold Output: Assessment of improvement / deterioration of injury

Technical Considerations
Signal distortion in real-time ECG
Baseline wandering Distorted morphology

Desired Signal

) Baseline wandering B) Distorted morphology

Technical Considerations
Wearability (size, weight, comfort) Noise from overlying tissues Distortion of signals due to movement Accurate positioning and repositioning of sensors (repeatability of measurements) Algorithm selection
Minimize pre-processing Unsupervised Training Amount of Sensor data

System Evaluation
System evaluated according to standard clinical protocols
Heart Stress testing Gait analysis Controlled environment