Richard Bults

Mobile patient monitoring: The MobiHealth system

The emergence of high bandwidth public wireless networks and miniaturized personal mobile devices give rise to new mobile healthcare services. To this end, the MobiHealth system provides highly customizable vital signs tele-monitoring and tele-treatment system based on a body area network (BAN) and a mobile health care (m-health) service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signs to healthcare providers as well as real-time feedback to the patient. Since 2002 the system has undergone substantial development in consecutive EU and national research projects. Diverse trials with different healthcare scenarios and patient groups in different European countries have been conducted in all projects. These have been performed to test the service and the network infrastructure including its suitability for m-health applications.

Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study

Background Previous review studies have suggested that computer games can serve as an alternative or additional form of treatment in several areas (schizophrenia, asthma or motor rehabilitation). Although several naturalistic studies have been conducted showing the usefulness of serious video games in the treatment of some abnormal behaviours, there is a lack of serious games specially designed for treating mental disorders. Aim The purpose of our project was to develop and evaluate a serious video game designed to remediate attitudinal, behavioural and emotional processes of patients with impulse-related disorders. Method and results The video game was created and developed within the European research project PlayMancer. It aims to prove potential capacity to change underlying attitudinal, behavioural and emotional processes of patients with impulse-related disorders. New interaction modes were provided by newly developed components, such as emotion recognition from speech, face and physiological reactions, while specific impulsive reactions were elicited. The video game uses biofeedback for helping patients to learn relaxation skills, acquire better self-control strategies and develop new emotional regulation strategies. In this article, we present a description of the video game used, rationale, user requirements, usability and preliminary data, in several mental disorders.

Mobihealth: Mobile Health Services Based on Body Area Networks

In this chapter we describe the concept of MobiHealth and the approach developed during the MobiHealth project (MobiHealth, 2002). The concept was to bring together the technologies of Body Area Networks (BANs), wireless broadband communications and wearable medical devices to provide mobile healthcare services for patients and health professionals. These technologies enable remote patient care services such as management of chronic conditions and detection of health emergencies. Because the patient is free to move anywhere whilst wearing the MobiHealth BAN, patient mobility is maximised. The vision is that patients can enjoy enhanced freedom and quality of life through avoidance or reduction of hospital stays. For the health services it means that pressure on overstretched hospital services can be alleviated.

A scenario guideline for designing new teletreatments: a multidisciplinary approach

Lack of user acceptance of telemedicine services is an important barrier to deployment and stresses the need for involving users, i.e. medical professionals. However, the involvement of users in the service development process of telemedicine services is difficult because of (a) the knowledge gap between the expertise of medical and technical experts; (b) the language gap, i.e. the use of different terminologies between the medical and the technical professions; and (c) the methodological gap in applying requirement methods to multidisciplinary scientific matters. We have developed a guideline in which the medical and technical domains meet. The guideline can be used to develop a scenario from which requirements can be elicited. In a retrospective analysis of a myofeedback-based teletreatment service, the technically-oriented People-Activities-Context-Technology (PACT) framework and medically-oriented principles of evidence-based medicine were incorporated into a guideline. The guideline was developed to construct the content of a scenario which describes the new teletreatment service. This allows the different stakeholders to come together and develop the service. Our approach provides an arena for different stakeholders to take part in the early stages of the design process. This should increase the chance of user acceptance and thus adoption of the service being developed.

Biosignal and context monitoring: Distributed multimedia applications of Body Area Networks in healthcare

We are investigating the use of body area networks (BANs), wearable sensors and wireless communications for measuring, processing, transmission, interpretation and display of biosignals. The goal is to provide telemonitoring and teletreatment services for patients. The remote health professional can view a multimedia display which includes graphical and numerical representation of patientspsila biosignals. Addition of feedback-control enables teletreatment services; teletreatment can be delivered to the patient via multiple modalities including tactile, text, auditory and visual. We describe the health BAN and a generic mobile health service platform and two context aware applications. The epilepsy application illustrates processing and interpretation of multi-source, multimedia BAN data. The chronic pain application illustrates multi-modal feedback and treatment, with patients able to view their own biosignals on their handheld device.

Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa.

Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED.

The Facial and Subjective Emotional Reaction in Response to a Video Game Designed to Train Emotional Regulation (Playmancer)

Several aspects of social and emotional functioning are abnormal in people with eating disorders. The aim of the present study was to measure facial emotional expression in patients with eating disorders and healthy controls whilst playing a therapeutic video game (Playmancer) designed to train individuals in emotional regulation. Participants were 23 ED patients (11 AN, 12 BN) and 11 HCs. ED patients self reported more anger at baseline but expressed less facial expression of anger during the Playmancer game. The discrepancy between self-report and non-verbal expression may lead to problems in social communication.

Context-aware QoS provisioning in an m-health service platform

Inevitably, healthcare goes mobile. Recently developed mobile healthcare (i.e., m-health) services allow healthcare professionals to monitor mobile patients vital signs and provide feedback to this patient anywhere at any time. Due to the nature of current supporting mobile service platforms, m-health services are delivered with a best-effort, i.e., there are no guarantees on the delivered Quality of Service (QoS). In this paper, we argue that the use of context information in an m-health service platform improves the delivered QoS. We give a first attempt to merge context information with a QoS-aware mobile service platform in the m-health services domain. We illustrate this with an epilepsy tele-monitoring scenario.

Measurements Based Performance Evaluation of 3G Wireless Networks Supporting m-health Services

The emergence of 3G networks gives rise to new mobile services in many different areas of our daily life. Examples of demanding mobile services are mobile-healthcare (i.e. m-health) services allowing the continuous monitoring of a patient’s vital signs. However, a prerequisite for the successful deployment of m-health services are appropriate performance characteristics of transport services offered by an underlying wireless network (e.g. 3G). In this direction, the EU MobiHealth project targeted the evaluation of 3G networks and their ability to support demanding m-health services. The project developed and trialled a patient monitoring system, evaluating at the same time the networks performance. This paper presents measurements based performance evaluation methodology developed and applied to assess network performance from an end-user perspective. In addition, it presents the (selected) speed-related evaluation (best-case scenario) results collected during the project. Our measurements show the dynamicity in the performance of 3G networks and phenomena negatively influencing this performance. Based on the evaluation results, we conclude that in-spite of certain shortcomings of existing 3G networks, they are suitable to support a significant set of m-health services. A set of recommendations provide a road map for both operators and service developers for design and deployment of m-health services.

Power- and delay-awareness of health telemonitoring services: the mobihealth system case study

Emerging healthcare applications rely on personal mobile devices to monitor and transmit patient vital signs to hospital-backend servers for further analysis. However, these devices have limited resources that must be used optimally in order to meet the application user requirements (e.g. safety, usability, reliability, performance). This paper reports on a case study of a Chronic Obstructive Pulmonary Disease telemonitoring application delivered by the mobihealth system. This system relies on a commercial mobile device with multiple (wireless) Network Interfaces (NI). Our study focuses on how NI activation strategies affect the application end-to-end data delay (important in case of an emergency situation) and the energy consumption of the device (important for device sustainability while a patient is mobile). Our results show the trade-off between end-to-end delay and battery life-time achieved by various NI activation strategies, in combination with application-data flow adaptation for realtime and near real-time data transmission. For a given mobile device, our study shows an increase in battery life-time of 40- 90 %, traded against higher end-to-end data delay. The insights of our studies can be used for application-data flow adaptation aiming to increase battery life-time and device sustainability for mobile patients; which effectively increases the healthcare application usability.