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Mhealth Tracker to Track Postural Stability and Pain History

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Mhealth Tracker to Track Postural Stability and Pain History MHEALTH TRACKER TO TRACK POSTURAL STABILITY AND PAIN HISTORY by JIA CHEN Submitted in partial fulfillment of the requirements For the degree of Master of Science Electrical Engineering and Computer Science CASE WESTERN RESERVE UNIVERSITY May, 2019 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Jia Chen candidate for the degree of Master of Science *. Committee Chair Ming-Chun Huang Committee Member Jing Li Committee Member Andy Podgurski Date of Defense January , 2019 �� �� *We also certify that written approval has been obtained for any proprietary material contained therein. Table of Contents List of Tables v List of Figures vi Acknowledgements vii Acknowledgments vii Abstract viii Chapter 1. Introduction 1 Chapter 2. Literature Review 7 Qualitative Balance Test 7 Quantitative Balance Test 8 Pain Measurements 9 Augmented Reality 11 Summary 13 Chapter 3. mHealth System 15 Subsystem: Wearable Gait Lab 16 Subsystem: Pain Marker 23 Chapter 4. Experiments 32 Experiments for Subsystem: WGL 32 Experiments of Subsystem: Pain Marker 36 Chapter 5. Results and Case Study 37 Subsystem: WGL System 37 iii Subsystem: Pain Marker 43 Chapter 6. Discussion 48 Compromise of Efficiency and Accuracy 48 Segmentation Rules 49 Chapter 7. Conclusion 51 Chapter 8. Suggested Future Research 53 mHealth Tracker 53 WGL: Dynamic Balance Tests and Daily Activities 53 WGL: Balance Instructions with HoloLens 54 Pain Marker: Distinguish Pain In Different Anatomy System 55 Appendix. Complete References 56 iv List of Tables 4.1 Summary of Experiments and Calculated Parameters 33 5.1 WGL: Linear Correlation Between COP and COG 40 5.2 WGL:Sway Velocities of Subject #5 in LOS Experiments 40 5.3 WGL: Statistical Data in Sit-To-Stand Tests 41 5.4 WGL: On-Axis Velocities in RWS Tests 42 5.5 Pain Marker: Comparison of Pain Marker Records and Traditional Self-Evaluation Questionnaires 44 5.6 Pain Marker: Pain Information Overview 47 v List of Figures 3.1 mHealth System Overview 15 3.2 Wearable Gait Lab Subsystem implementation flowchart 16 3.3 WGL: Wearable Underfoot Force Sensing Unit and Joint Angular and EMG Sensing Unit 17 3.4 WGL: App Overview 19 3.5 WGL: PC User Interface Overview 20 3.6 Pain Marker Subsystem Overview 24 3.7 Microsoft HoloLens Hardware 25 3.8 Pain Marker: Self-Report panel 27 3.9 Pain Marker: Mark Function Example. 28 3.10 Pain Marker: Show History Panel 29 3.11 Pain Marker: Cursor Design 31 4.1 WGL: LOS Experiment Setup 34 4.2 WGL: STS Experiment Setup 35 4.3 WGL: RWS Experiment Setup 35 4.4 Pain Marker: Questionnaire Example 36 5.1 WGL: Linear Regression Analysis 38 5.2 WGL: An Example of Center of Gravity (COG) in LOS experiments 39 5.3 Pain Marker: Correlation of App Pain Severity Word Scale and Questionnaire Numeric Scale 45 vi Acknowledgements 0.1 Acknowledgments The research had been approved by CWRU IRB Protocol Number: IRB-2016-1419 and IRB-2016-1504. vii Abstract mHealth Tracker to Track Postural Stability and Pain History Abstract by JIA CHEN Balance ability and pain are two factors often monitored at same time in actual treat- ment and medical researches. Balance has been an essential indicator of human health and is realized by the coordination and support from several body systems including the vestibular, visual, auditory, motor, and higher level premotor systems1. Pain itself can be a central feature and it can also be regarded as a symptom of some progress2. Stud- ies suggest that pain and balance ability are related, however, for further study on their relationship, a system for monitoring balance and chronic pain conditions in long term, collecting relative objective data, and providing sufficient visualization during and after is necessary. Therefore, mHealth Tracker system is proposed in this thesis for filling this gap and helping balance and pain related researches and regular treatments. The sys- tem consists two subsystems, Wearable Gait Lab (WGL) subsystem, for activities of feet monitoring during balance tests, and Pain Marker, for self-report and review pain infor- mation. The reliability of each subsystem of mHealth Tracker are tested and evaluated separately with standard tools used currently. The WGL system is evaluated with stan- dard balance tests (Limits of Stability, Sit-To-Stand, and Rhythmic Weight Shift), whereas the data collected are analyzed with data mining techniques to verify the reliability of the viii designated process. Certain parameters are computed such as Center of Gravity (COG), weight transfer time, and sway velocities. The reliability of Pain Marker subsystem is proven by comparing with traditional pain reporting questionnaires. Also, Pain Marker is highly recommenced based on user experience questionnaires. The result shows that mHealth Tracker is informational and reliable in the process of determining balance sta- tus and pain information collection with additional advantages in high portability and efficient review communications. ix 1 1 Introduction Balance ability and pain are two factors often monitored at same time in treatment and medical researches. Balance is the ability to control muscular energy in the body and maintain an even distribution of weight to remain a stable posture. Balance has been an essential indicator of human health and is realized by the coordination and support from several body systems including the vestibule, visual, auditory, motor, and higher level premotor systems.1 Pain is an unpleasant sensory and emotional experi- ence associated with actual or potential tissue damage. Pain, especially chronic pain, can be a key source of reference for diagnosis. In many cases, pain and balance dif- ficulties appeared at same time and influenced people’s living qualities. For example, research of Menz3 discussed the relation between pain, balance and knee strength in middle age females, and poole’s study4 discussed the relation between neck pain and gait parameters in elder population. Also, some researches shown that pain can per- turb one’s balance ability and postural stability. Mientjes’s research5 found chronic low back pain influences one’s balance and increasing body sway in upright standing pos- ture when reducing vision and increasing task complexity. Hamaoui’spaper6 shown that respiration perturb chronic lower back pain subjects larger than health subjects. The relation between balance and pain among several population and different pain areas Introduction 2 are studies, but more detailed and specific relation still hasn’t been investigated. There were researches aimed to find out the relation between pain and balance, however the current tools for balance evaluations and for pain recording and visualization are not satisfying, not mentioning there’s no system focusing on collection and visualization of both information together. To evaluate the patients’ postural stability systems, researchers and clinicians utilize different functional test measures to assist the patients to identify the sources of balance problems. The lab-based tests normally require the presence of patients in a clinic set- ting to perform balance tests under the supervision of clinicians. After the tests, a score of the patient’s performance is calculated based on certain institution-developed stan- dards, such as Motor Assessment Scale, Berg Balance Scale,7 and Rivermead Mobility Index.8 Due to the requirement of clinicians’ supervision, most of the tests use qualita- tive standards to evaluate balance systems for the patients and generate an overall score based on the clinicians’ opinion on how well the test subjects complete the tests. For instance, the Berg Balance Scale has 14-item scale designed to measure a patient’s bal- ance ability in a lab setting. Each scale has five levels of performance resulting a score ranging from 0 4, and the scores from all the fourteen tests add up to a total score of ° 56. One example contained in Berg Balance Scale is asking the subject to pick up an object from the floor from a standing position. A 4 is scored when the patient is able to pick up the object safely and easily; a 3 is recorded when the patient can pick up the object but needs supervision; and a 2 is recorded when the person is unable to pick the object up but reaches 2 5cm from the object and able to keep balance independently. ° However, it is relatively hard and non-objective for the clinicians to judge the extent of difficulties for the subject to pick the object up. Since those classic balance tests use Introduction 3 partially qualitative, semi-subjective standards based on clinicians’ personal judgments upon the patients’ performances, there may be inaccuracies. In addition, these tests confined in traditional gait lab environment may lead to environmental bias concerns and cannot reflect patients’ natural behaviors in their usual environment.9 For providing accurate description of pain in patients’ diagnosis, treatment and re- covery progress, methods such as 4-point scale(FPS), vocal rating scale (VRS) and vocal analogue scale (VAS) are currently applied in medical record system. Compared to FPS, VAS shows more satisfaction for patient self-rating pain process. It is judged to be more sensitive, accurate and less subject to bias, and the VAS method has been proven to be no more difficult to be understand by patients.10 Moreover, the VAS method is found to show how the patient feels more closely by comparing the F-ratios of the result from the two methods.11 Currently, VAS method is widely used in medical system; however, it usually mainly focuses only on scales, which show the intensity of pain. In many sit- uations, clinicians need to know much more information than intensity, such as pain quality, location, radiation pattern, duration, timing, etc. Further descriptions of pain history are acquired by forms12 and questionnaires13 adopted by the current medical record system.
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