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Wearable Rehab Technology

24/01/2012


Dr Kevin Curran, Dr Joan Condell and James Connolly of the University of Ulster in collaboration with Dr Philip Gardiner at Altnagelvin Hospital have developed a system for automatic measurement of hand movement for patients with rheumatoid arthritis.

Digit-Ease is a multi-disciplinary research team from the University of Ulster and the Western Health and Social Care Trust hospital in Altnagelvin, Northern Ireland. The team seeks to address issues around care and treatment of patients with rheumatoid arthritis (RA). Its core concept is the development of an intelligent computing system that consists of a wearable glove measurement tool and a 3D interface. The system is designed to enable more accurate measurement of movement in the human hand than current techniques provide. 

Objective measurement of disease activity and disability is acknowledged as helpful in optimal management of patients with arthritis, but joint deformity and stiffness have always been difficult to document and monitor. The severity of joint stiffness (as reported by patients) correlates with disease activity, therefore, accurate measurement may help to improve existing assessment tools. Measurement of joint range is used to establish a baseline and to record progress. This is a particular challenge in the hand, where deformity is rarely measured in the clinical setting. The aim of Digit-Ease was to develop a solution that is accurate, easy to use and delivers useful data to the clinician through a user interface.

Scope of the need
A sad fact is that up to 50% of RA patients lose jobs within five years of diagnosis. If exercise can be increased through less intrusive monitoring (by remotely recording movement and exercises undertaken) this could lead to more RA patients being economically active for longer than five years.

The annual medical cost of an RA patient was estimated at £3,600 in 1992. It is feasible to suggest that this is nearer £4,000 per annum in 2011. If RA patients can continue to be economically active for longer as a result of better monitoring, they are helping to offset this economic burden on the NHS and are greatly improving their own self-confidence and self-worth during a difficult period of their lives.

In 2010, RA affected up to 500,000 people in the UK population. It starts between the ages of 40 and 50 is most common in women.1 Approximately 20,000 new cases of RA are diagnosed every year in the UK. It has been estimated that RA may be costing the UK economy almost £8 billion a year.2

Currently there is no cure for RA. It is vital to begin treatment for RA as soon as the condition is diagnosed to minimise joint damage. The prediction and prognosis of the disease varies for each individual and its course can detrimentally affect the psychosocial condition of the patient.

Current detection techniques
RA is currently diagnosed by clinicians and therapists using X-ray and manual evaluation methods, including a goniometer, tape measure and visual evaluation. They measure flexion, extension, abduction and adduction of finger joints. Goniometric measurement techniques have changed little over the past 80 years. The tape measure measures thumb-index finger web space. Kapandji Score grades the range of movement of the patient’s thumb against each fingertip. All measurements are recorded in handwritten form. The outcomes are easily influenced by clinicians training and experience.

The Digit-Ease system
Digit-Ease provides increased accuracy of movement for analysis by consultants and eliminates the need for manual measurement or dependence on patient’s memory. This will lead to reduced time spent by all medical staff in assessing patients and taking measurements and allow increased time to care for/talk with patients. It delivers the potential for increased efficiency savings in the NHS. It is also less stressful for a patient because measurements are recorded at home during everyday living and are less intrusive. The Digit-Ease team also believes that the monitor–evaluate exercise can be done by patients between visits to the doctor, potentially reducing the rate of progression of RA.






Figure 1: Graphical user interfaceof 3D glove and measurements


Design features
In November 2010 Digit-Ease won the Innovative Idea of the Year 2010 award from HSC Innovations, the Technology Transfer Office for Health and Social Care in Northern Ireland. The design provides unobtrusive measurements of finger postures across all ability levels in persons with hand dysfunction through an intuitive system that employs a wearable data hand glove.

The system consists of a wearable glove measurement tool and a 3D interface. Real time data captured from each glove sensor is displayed numerically and graphically. It accurately quantifies patients’ flexion, extension, adduction and abduction of finger and thumb joint movements in degrees, and maximum and minimum joint range. It compares joint range with normal ROM values to determine the degree of deformity of the hand and stiffness of moving finger joints.



Figure 2: Glove on patients hand


Digit-Ease simultaneously records angles from multiple fingers to detect previously unidentifiable movement patterns. It measures a shift in the position of fingers in relation to the direction of the thumb by measuring web space and records the minimum, maximum and average values during a number of tests to analyse joint movement and identify areas for Joint Protection benefit. Data is recorded and used for future comparison analysis. It is the first ambulatory system to detect joint stiffness at home and will help quantify and understand the symptom of "early morning stiffness.”

Next steps
The system is a niche product that requires further product development, pilot testing in a clinical environment and CE approval. Now at the clinical trial stage, the researchers want to hear from companies interested in the new technology and in cooperating for mutual benefit through alliances, joint venture or acquisition. Currently the team is investigating ways to exploit the intellectual property (IP). This may be through licensing the product to a company with established market channels to sell into the complex and bureaucratic NHS. Another approach is to establish a core technology/marketing team to develop partnerships with distributors into NHS. Its final objective is to sell the IP/business as trade sale to an established company in market.

References
1. J.Y. Reginster, "The Prevalence and Burden of Arthritis,” Rheumatology, 41 (suppl. I), 3-6, British Society for Rheumatology (2002).
2. www.independent.co.uk/life-style/health-and-families/health-news/rheumatoid-arthritis-costs-up-to-pound8bn-a-year-1931969.html

Dr Kevin Curran is Reader in Computer Science in the Intelligent Systems Research Centre, University of Ulster, Magee College, Derry, Northern Ireland BT48 7JL, UK,
tel. +44 (0)2871 675 565,
http://isrc.ulster.ac.uk



   

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