Introduction

There is a considerable pressure on the both the quality and the quantity of our health care system. The quality of health care is continuously challenged by the rapid development of technology which can contribute to a better quality of diagnosis and treatment but often at higher cost and not easily incorporated in the present health care system. Probably more important is the pressure due to the increasing number of subjects who need to use the health care services for a substantially longer period of time. On the other hand there is a trend to decrease the number of days people stay in the hospital. This requires a good tuning of the care when other professionals take this over at the home situation.

Information and Communication Technology can provide some relevant contributions in solving these problems. One of the solutions is to enable treatment or training outside the health care institute i.e. at the patient’s workplace or at home. To enable this, intelligent trainings tools that give continuously feedback to the subject about his performance and progress are necessary. Besides this professional guidance to adjust treatment programs and to guide the patient needs to be guaranteed.

It is the objective of the Exo-Zorg project to develop knowledge about extramural treatment programs for patients with postural and movement disorders, supervised remotely by health care professionals.

An artist impression of such a treatment, with all the required domains of knowledge is given in figure 1.

It shows a subject exercising his motor skills. His movements and other relevant characteristics are sensed and processed. Based on a comparison with training targets it is decided whether and what kind of feedback the subject gets on his performance. Simultaneously relevant data are stored and sent to an remote health care center that is able to monitor the training and to adjust the equipment anytime and anywhere. The patient will be regularly contacted to discuss the progress.

Smart sensing : different smart sensing methods are being developed to enable the ambulatory assessment of muscle activation patterns, movements using inertial sensors, heart rate and the sensing of forces without interference of the subjects daily activities
Feedback strategies : The effect of training is largely depending on the timing and way feedback is presented to the subject. As the elderly are a main target group it is investigated to what extend they are able to learn from the feedback is different from the younger subjects.
User acceptance : Essential for success is that both the patients and the caregivers accept this new approach, that the caregivers are really able to give advice on the treatment and that the patient is able to incorporate these advices in their treatment. Initial results obtained in the remotely supervised myofeedback treatment show that both the caregivers and the patients have a high level of confidence in the teletreatment service.
Demonstration activities : A first end-to-end application concerns treatment of patients with chronic neck shoulder muscles. The treatment utilises the previously developed ambulatory myofeedback treatment, which is based on the Cinderella hypothesis indicating that the pain is related to insufficient muscle relaxation. The system provides subjects private feedback when they have insufficient rest in the neck/shoulder muscles.

The ICT infrastructure developed by Atos Origin was used to transfer and store the data. The first results indicate that the remotely supervised treatment is feasible. The effect of this innovative treatment seems equal or better compared to the traditional approach.