Using mobile health assessments to improve outcomes for ... · The HAPI prototype includes three...
Transcript of Using mobile health assessments to improve outcomes for ... · The HAPI prototype includes three...
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Elizabeth Brokaw1, Michael Fine1, Tony Donadio1, Sahana Kukke2
1. MITRE, McLean, VA
2. The Catholic University of America, Washington, D.C.
Health Datapalooza
April 27, 2018
Using mobile health assessments to
improve outcomes for individuals
with chronic neurological conditions
©2018 The MITRE Corporation. ALL RIGHTS RESERVED. Approved for public release, distribution unlimited, MITRE case number 18-0844.
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The timing of therapy is typically dictated by the self-reporting of
symptoms, or parental observations.
▪ Cerebral Palsy (CP) affects over 500,000 individuals under the age of 18
in the US
▪ Although CP is not a progressive disorder, deficits commonly change over
time due to both the nature of the chronic condition and the effects of
childhood development
▪ Rapid initiation of therapy after change in impairments can reduce the risk
of falls and the need for surgical intervention
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Background
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Home Assessment for Prompt Intervention (HAPI)
HAPI aims to have:
Clinical Relevance by using tests
derived from conventional clinical
assessments for CP
An Engaging Interface to encourage
compliance and maximize effort to
gain an accurate measure of
impairment (target ages 10-12)
Good Usability for individuals with
CP to understand and enjoy the
system without confusion or frustration
HAPI allows for frequent, quantitative assessments of impairment that
could be completed in the home or school.
HAPI utilizes the Microsoft Kinect, a low
cost ($100), vision-based sensor, for
joint tracking. It does not require sensors
to be placed on the user, which allows
for quick and easy setup.
© 2018 The MITRE Corporation. All rights reserved.
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HAPI Promotes Engagement
Interactive avatar selection
Story Image
Piper guides the user through the tasks
The user can select their avatar to
promote engagement
A fox friend named Piper provides in-
game guidance to help ensure the
user does the tasks correctly
© 2018 The MITRE Corporation. All rights reserved.
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Clinical Relevance
▪ The HAPI prototype includes three clinically motivated tests
Test Clinical Metric HAPI Metrics
Standing Posture/Balance Mini-BESTest measuring
success standing still with
feet together for 30 s (0-2
score)
If the individual is
successful, and postural
metrics
Sit to Stand 5x sit to stand measuring
time to complete, and use of
arms for assistance
Time to complete,
postural sway, use of
arms
Seated or Standing Reach Pediatric Reach or
Pediatric Balance Scale
measuring reach distance, or
0-4 score
Reach distance, postural
sway, arm kinematics
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HAPI Tests
Five Times Sit to Stand :
Copy CatsStanding or Seated Reach:
Butterfly enchanting
Standing Balance/Posture:
Invisibility
▪ Each clinical test is built
into a “mini-game” to
make it more engaging
Insert screenshot
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▪ Usability is an important part of technology adoption, but is
commonly overlooked when developing systems for
individuals with disabilities
▪ We performed a case study investigation of the system:
– Clinical assessments
– HAPI assessments
– System usability
▪ System usability scale
▪ Self-reported motivation and engagement with the system
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System Evaluation
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▪ A 10 year old with left-affected CP completed the protocol
– Good sensitivity to CP related impairments
– Good reported usability and engagement
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Case Study Results
© 2018 The MITRE Corporation. All rights reserved.
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Additional Quantitative AnalysisStanding balance
Standing Metrics HAPI Value for Participant Interpretation
Trunk angle 83° ± 0.79°
Leaning slightly forward but low
variability indicating reasonable
stability.
Shoulder angleLeft: 20.9° ± 0.71°
Right: 59.7° ± 1.7°
Shoulder angle lower on left.
Potentially due to weakness.
Trun
kFor
war
dFle
xion
Ang
le(D
eg)
0 10 20 30 40 50 60 70
Time (Sec)
50
60
70
80
90
Trunk angleTask startTask stop
Trunk
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Additional Quantitative Analysis5x Sit to Stand
Sit To Stand Metrics HAPI Value for Participant Interpretation
Conventional Clinical Metric:
Time to Complete9.60 s
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Additional Quantitative AnalysisReach
Reach Metrics HAPI Value for Participant Interpretation
Trunk lateral flexionLeft: 14.3°
Right: 15.5°
Reduced movement to the left,
which indicates increased
challenge to balance
Mean elbow angle during
movement
Left: 19° ± 7.6° (max 34°)
Right: 16.9° ± 1.6° (max 19°)
Increased elbow angle and
variability on left indicating
potential abnormal tone
1 2 3 4 5 6 7 8 9 10
Time (Sec)
75
80
85
90
95
100
Tr u
nk
La
t er a
l Fl e
xi o
nA
ng
l e( D
eg
)
Left Reach
Right Reach
© 2018 The MITRE Corporation. All rights reserved.
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▪ Findings indicate that conventional metrics of impairments could be
captured remotely through serious gaming
▪ HAPI is a low-cost system that could be used at home, in school, or
in the clinic to help improve health monitoring. This could provide
consistency across clinics, and could help evaluate treatment
strategies across patients.
▪ Additional development, such as additional tests to provide a more
complete clinical picture, and additional clinical research is needed,
but initial findings indicate the significant potential benefits of the
technology.
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Summary
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