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MCS: Modular, Cross-platform and Secure application for Remote Assistance and Monitoring Tasks Xavier Vallejo Eusebi Calle Antonio Bueno Jose L. Marzo Institute of Informatics Institute of Informatics Institute of Informatics Institute of Informatics and Applications and Applications and Applications and Applications University of Girona University of Girona University of Girona University of Girona 17071 Girona 17071 Girona 17071 Girona 17071 Girona [email protected] [email protected] [email protected] [email protected] Abstract using basic broadband Internet connections and readily available hardware. It is the MCS is a multimedia tool for rehabilitation continuation of the work carried out in the specialists, that allows remote assistance and TRiEM project, a joint effort in Girona in monitoring of patient’s activities. This tool 2005-06 between the BCDS research group of is the evolution of the work done in 2005- the UdG [1] and the Multiple Sclerosis Foun- 06 between the BCDS research group of the dation (FEM in Spanish and Catalan), to de- UdG and the Multiple Sclerosis Foundation velop a tool for MS telerehabilitation.1 (FEM in Spanish) in Girona under the TRiEM project. Multiple Sclerosis (MS) is a neu- 1.1 The Illness rodegenerative disease (ND) that can provoke significant exhaustion in patients even by the Multiple sclerosis (MS) is a chronic, inflam- simple act of going to the medical centre for matory disease that affects the central nervous rehabilitation or regular check ups. The tool system. MS can cause a variety of symptoms, presented in this paper allows the medical including changes in sensation, visual prob- staff to carry out distance patient consulta- lems, muscle weakness, depression, difficulties tions and other activities from their home, with coordination and speech, severe fatigue, minimizing house calls and travel time for the cognitive impairment, problems with balance, medical consultant. It has been enhanced by uncontrollable rises in body temperature, and developing new components to improve mod- pain. MS will cause impaired mobility and ularity and security. MCS also has a hybrid disability in more severe cases [2]. The name P2P architecture and consists essentially of "multiple sclerosis" refers to the multiple scars a cross-platform videoconference system, with (or scleroses) on the myelin sheath (the fatty audio/video recording capabilities. The sys- layer that surrounds and protects neurons, tem can easily be extended to include new ca- helping them carry electrical signals). This pabilities such as, among others, asynchronous scarring causes symptoms which vary widely activities whose result can later be analyzed by depending on which signals are interrupted. the medical personnel. The prevalence of MS is significant [3]; in equatorial areas it is around 0.0001% while 1 Introduction 1This work was supported in part by the MCYT (Spanish Science and Technology Ministry) research This paper presents an application to assist project TEC2006-03883/TCM and the Generalitat of medical personnel in telerehabilitation tasks Catalonia’s research support program (SGR 00296). in southern Europe the rate is 6-14 times of the rehabilitation process. higher and in northern Europe it is 30-80 times higher. Numbers in North America are on the The paper is structured as follows: After same range as in Europe. this introduction, the development and status of the tool is discussed in Section 2 and Section 3 is dedicated to explaining the main features 1.2 TRiEM project of the application in more detail. The paper The first prototype [4] developed in TRiEM concludes with the customary conclusions and (Catalan acronym for "telerehabilitation and future work. MS") allowed medical specialists to carry out patient consultations remotely, with the 2 Development and status double objective of making a better use of the funds in order to provide longer and more Once we had the first prototype, the BCDS continuous follow-ups and to improve the group continued to work on a newer version patient’s quality of life. with more features that will be detailed in section 3. The system was also designed, at the outset to use as far as possible standard available This section is structured into two parts: low-cost infrastructure; both in terms of First, the architecture of the application is ex- computer equipment (CPU, graphic cards, plained in a general view. After that, we will webcams) and communication systems. For introduce the technology that MCS uses. example, the prototype can sustain accept- able two-way audio and video quality with a 2.1 Architecture basic broadband connection, which in Spain currently consists of 6 Mbps downstream and The MCS application uses a hybrid P2P 300 kbps upstream. architecture (see figure 1): a server-centric component for session management, infor- The tool was built on top of an open source mation and remote control messages, and a instant messaging application [5] and started peer-to-peer component for the higher band- as a standard videoconference application. width consuming live audio and video streams. In the initial prototype, in order to adapt it as far as possible to specialist’s needs and patient’s characteristics, additional capabili- ties of audio/video recording and multimedia management were also included. As for related work, the field of telereha- bilitation has generated abundant literature. For example, Lauderdale and Winters [6] already explored the possibility of using the then current teleconferencing products for telerehabilitation in 2000. In contrast, the American Occupational Therapy Association expressed, in 2005 [7], concern about the lack of published research regarding the use of telerehabilitation methods for specific occupa- Figure 1: General structure of the application. tional therapy follow-up services. Nowadays, it is still difficult to find telerehabilitation Peer-to-peer connections can also be used to tools that work on more than just one aspect transmit information of other activities, apart from audio and video streams. The most sig- 3.1 Activities nificant advantage of this type of connection is One of the needs of the specialists was that a better bandwidth and less latency. However, all the activities can be done in both online one of the users has to open one or more ports and offline mode. We refer to online mode of the user’s router - a not altogether trivial when the specialist supervises in real time operation - . the patient’s activities. Additionally, with MCS the specialist can send the patient a 2.2 Technology number of activities to do. In offline mode, the patient can do the exercises whether the The application is written in Java. Java is specialist is connected or not. Once the user an Object Oriented language that facilitates does the exercise, the results are sent back to quick development for the developer and it the doctor. includes a suite of ready to use libraries. According to RIAStats [8], 68,96 % of the A brief classification of the activities that computers connected to the Internet have are implemented in MCS application, are as Java 1.5 or greater installed in their comput- follows: ers. In addition, thanks to JNI technology, Java can execute native code (for instance, • Cognitive: Memory, Labyrinth. calling a DLL library). • Speech and language therapy (SLTs): Ba- As for the communications part, MCS sic movements. makes extensive use of the XMPP open stan- • Oculomotor nerve (using a joystick with dard [9]. This protocol transmits lightweight, a hand): Road, Labyrinth, Memory, Fig- human-readable and easily understandable ures, Fruit Salad pairs. messages in XML form and it was easily extended for the additional features of the • Inferior extremities: Dance mat. TRiEM prototype. In this section, we will explain four activities Using Java as a programing language, and that we consider important to understand how XMPP as a communications library, a devel- they work. oper can create new functionalities for the ap- • Memory: The activity consists of memo- plication in a few weeks using the plugin sys- rizing a group of elements that appear on tem of MCS application. Each plugin (or ex- the screen in a limited time period. The tension) can add new possibilities to the appli- next step is to recognize and identify the cation. A plugin can work alone, or with the initial objects inside a bigger group of ele- collaboration of others plugins. An automatic ments. The user has to select the elements system for adding/updating plugins has also using a joystick. been added to our application. • Road: On screen appears a road that the patient has to drive along on the correct 3 Modularity path to the goal. There is no time limit, but how much time is needed to complete After the first prototype, the specialists of it is recorded. To create a circuit you sim- the FEM were very interested with new ideas ply need to draw it with a drawing pro- to apply in a telerehabilitation session [10]. gram. In this section, two important ideas are ex- plained: a subset of new activities to be done • Dance mat: Instead of using a joystick, in a specialist-patient session, and the use of the patient needs to have a dance mat. sensor devices to monitor patient data. The specialist sends a sequence that the patient has to reproduce. As for hard- devices. Moreover, the MCS application can ware compatibility, we have tested this be expanded to other environments such as with both PC and Playstation 2 dance the Ambient Intelligence or Tele-monitoring. mat with satisfactory results. Using different sensors, we can monitor • Labyrinth: The patient has to find the more aspects of a person (acquire and process end of the maze moving a character that data). At the moment, the BCDS group is trapped inside it. They cannot see all has been focused on monitoring inferior the labyrinth, so they have to explore it extremities.

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