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Ubiquitous Health: Wearable Computing Systems that Promote Healthy Living and Transform Health Care
Prof. Bjoern Eskofier, PhD Endowed Professorship of the adidas AG Digital Sports & Health Lab December 1, 2016
Introduction
The Medical Valley of Germany
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Digital Sports in Erlangen
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Digital Sports Group
Digital Sports Group
Data Mining Biomechanics Physiology
Wearable Systems Sensors Algorithms
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Sports Applications
Biomedical Applications
“… to increase human health …”
Research Environment
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Sports Science
Medical Experts
Industry
Dr. B. Krabbe
Prof. M. Lochmann Prof. J. Klucken
Digital Sports Group
Prof. B. Eskofier Team: 14 PhDs / 1 PDoc
Hi!$
Wearable Computing Systems
Origins – adidas_1 (2008)
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Eskofier et al.: Embedded Surface Classification in Digital Sports. Pat Rec Let 30(16), 2009
Internet
Human-Machine-Interface (Speech, Display, Vibration,…)
M.D. Athlete Coach
Apps for Live-Feedback, Updates miFitness
miTeam
Web 2.0
miHealth
miCoach Bluetooth
ZigBee
ANT
ANDROID Mobile Sensor Framework ASTRUM miLife
WebService
Feedback, Monitoring and Social Networking Feedback Training
Sensor Integration
Synchronization Communication
Volume'2'280'000'€' ' ''
European'Fund'for'Reg.'Devt.'
Follow;up'project'(2015;2018):'
“Urban'Sports”,'1'558'000'€''
miLife Research Project: 2011
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Wearable Computing Results
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Running$Analysis$Schuldh.$et$al.,$2012$
Synchroniza<on$Kugler$et$al.,$2012$
Research$Sensor$Blank$et$al.,$2014$
Golf$PuDng$Jensen$et$al.,$2015$
Swimming$Classifi.$Jensen$et$al.,$2016$
ECG$Classifica<on$Gradl$et$al.,$2012$
Sleep$Monitoring$Gradl$et$al.,$2013$
eGaIT$System$Rampp$et$al.,$2015$
Nykturia$Monit.$Huppert$et$al.,$2015$
Wearable$ECG$Richer$et$al.,$2016$
Cycling$System$Richer$et$al.,$2015$
Skateboard$Classif.$Groh$et$al.,$2016$
Beach$Volleyball$Kautz$et$al.,$2016$
Ski$Jumping$Groh$et$al.,$2016$
Soccer$System$Zhou$et$al.,$2016$
Gradl, S.; Kugler, P.; Lohmüller, C.; Eskofier, B.: Real-time ECG monitoring and arrhythmia detection using Android-based mobile devices. In: Proc. of the Int. Conf. of the IEEE EMBS (EMBC2012). Elgendi, M.; Eskofier, B.; Dokos, S. Abbott, D.: Revisiting QRS Detection Methodologies for Portable, Wearable, Battery-Operated, and Wireless ECG Systems. PLoS ONE 9(1), e84018, 2014.
HRV
QRS detection
ECG signal classifcation
HR features
Hearty – realtime ECG analysis & arrythmia detection
Biosignal Analysis
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The FitnessSHIRT
12 H Leutheuser, [...], BM Eskofier. Textile Integrated Wearable Technologies for Sports and Medical Applications. Springer, Berlin, Germany, 2016
Smart shoes reach the clinic: Wearable sensor-based instrumented gait analysis in Parkinson’s disease
Movement Disorders
0
10.000
20.000
30.000
40.000
50.000
60.000
2002 2004 2006 2008
21.559 22.293 23.609 24.780
18.677 19.411 20.481
22.546
6.508 6.612 6.541
6.577
Cost of Movement Disorders (Mio Euro/ Year)
weitere ambulant stationär
Federal statistical office, Germany 14
The patient view
‘Just imagine what we could achieve if we start working together – as equals with different but complementary areas of expertise!’
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Care scenario Sy
mpt
om S
ever
ity
Disease Progression
DiagnosKcs'
Therapy'D TD TD TD TD
Chronic Disease
DiagnosKcs'
Therapy'
Acute Illness
Incomplete Remission
Complete Remission
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PDXNurse$Pa<ent$
Physician'Expert'
Physician'MDU*'
*Movement Disorder Unit
Sectors'of'Care'
Care scenario
Chronic Disease: Parkinson Syndrome
Telemedicine'
Medical'
InformaKon'Medical''
Technology'
IT'PlaUorm''
CommunicaKon'
Individualised'PaKent'History'
GxP,$Data$safety,$Privacy,$Security,$etc.$
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$$
„Pa#ent'needs“$Technically$&$Medically$Validated$Technology$
Nurse Patient
Care Scenario – Clin. Application
IT'PlaUorm''
CommunicaKon'
Individualised'PaKent'History'
GxP,$Data$safety,$Privacy,$Security,$etc.$
Technology'
EMG ECG, Respiration, Temperature
Instrumented Gait Analysis
Video based
Diagnostics
Activity
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Embedded Gait Analysis using Information Technology Specific focus on Parkinson‘s Disease
Funding source
Bavarian Research Foundation
Volume 878 000 €
New funding source
FAU Emerging Fields Project Volume 860 000 €
eGaIT Research Project: 2011
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1000 PD-Specific Datasets eGaIT shoes IMMU sensors
Movement exercises
Clinical routine assessment
Barth, [...], Eskofier; EMBC 2011 / Klucken, Barth, [...], Eskofier, Winkler; PLoS ONE 8(2), 2013
25.03.2015: Bayerischer Innovationspreis Gesundheitstelematik 2015 für eGAIT
22.10.2014: Erlanger Medizintechnikpreis 2014 (Kategorie Versorgung) für eGAIT
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Analysis Paradigm Movement recording
Robust Stride Segmentation Barth, [...], Klucken*, Eskofier*; EMBC 2013 & Sensors 2015
Stride Signatures Machine Learning: Waveshape
Klucken, [...], Eskofier, Winkler; PLoS ONE 8(2), 2013
Stride Parameters Signal Analysis: Biomechanics
Rampp, Barth [...], Klucken, Eskofier; TBME 2015
× TO + HS ! MS
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Signal-processing-driven Stride Parameter Calculation
Rampp, Barth [...], Klucken, Eskofier; TBME 62(4), 2015
IMU DataAccelerometer
Gyroscope
NormalizationCalibration Invert Axes
Stride Segmentation
msDTW
Gait Event DetectionMid Stance (MS)
Heel Strike (HS)
Toe Off (TO)
Spatial Gait ParametersOrientation Estimation (MS to MS)
Gravity Cancellation
Zero Velocity Update
Angle Course
De-Drifted Integration
DistanceEstimation
Sensor Clearance Estimation
(SC)
Sensor-Toe-Distance
Estimation
Stride Length
Angle Heel Strike
Angle Toe Off
Temporal Gait ParametersStride Time
Stance Time
Swing Time
Time HS to HS
Time HS to TO
Time TO to HS Max Toe Clearance
Toe Clearance Estimation
Angle Dependent Correction of SC
Stride Parameters
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Timed-Up & Go Instrumentation
Angular velocity [°/s]
First Turn Walking
Second Turn Turn-to-Sit Walking
Sit-to-Walk
Time [s]
TUG-Phases in PD patients
n = 265 PD patients, * ANOVA (0.05), post-hoc Bonferroni. Mean time (+/- SEM)
* *
* *
Results of the analysis
Reinfelder, S.; […]; Klucken, J.; Eskofier, B.: Timed Up-and-Go Phase Segmentation in Parkinson's Disease Patients using Unobtrusive Inertial Sensors. EMBC 2015. 24
This$is$great,$but…$
C I II III C 1 2 3 C L M H
Minimum foot clearance
Monocenter IIT 193 PD patients 145 controls
C I II III C 1 2 3 C L M H
Stride length
Gait parameter changes in PD
Schlachetzki, J.; […]; Eskofier, B.; Klucken, J.: Smart shoes reach the clinic: Wearable Sensor-based Instrumented gait analysis in Parkinson’s disease. Lancet Neurol, under review, 2015.
H&Y UPDRS-GAIT UPDRS-III
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Gait parameter changes in PD
Longitudinal measurement – intra-individual Long term monitoring
Stride length Stance phase Swing phase
UPDRS-III Change at follow-up visit
Schlachetzki, J.; […]; Eskofier, B.; Klucken, J.: Smart shoes reach the clinic: Wearable Sensor-based Instrumented gait analysis in Parkinson’s disease. Lancet Neurol, under review, 2015. 26
This$is$fantas<c!$
Need To Go Ambulatory
Stationary lab systems Mobile sensor systems
Non-natural scenario Limited subject numbers
Home and everyday life Big Data!
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Espay, A.; [...]; Klucken, J.; Eskofier, B.; [...]; Papapetropoulos, S.: Technology in Parkinson disease: Challenges and Opportunities. Submitted to Movement Disorders 12/2015. On behalf of the MDS Taskforce on Technology. Pasluosta, C.; Gassner, H.; Winkler, J.; Klucken, J.; Eskofier, B.: An Emerging Era in the Management of Parkinson’s disease: Wearable Technologies and the Internet of Things. IEEE J Biomed Health Inform 19(6), 1873-1881, 2015.
8 hours of unsupervised gait of PD patients
Unsupervised Gait Analysis
Single'strides'&'
Individual'raKngs'
Gait'signatures'&'
Gait'parameters'
Daytime [hour]
Reinfelder, Marxreiter, Klucken*, Eskofier*; Unpublished, in preparation for TBME 28
Time Sync
Sensor Data
Patient Rating
Unsupervised Gait Analysis
ON OFF INTERMED. Motor Fluctuations
Gait parameters Stride length (cm)
Freezing Gait Pattern
Daytime [hour]
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Transforming Healthcare
New reimbursement paradigm: • At present: reimbursement per prescription & treatment • In future: reimbursement per objectively measured
treatment success? New chronic disease management concepts: • Present concept:
• Future concept:
6 months 6 months
variable, dep. on needs variable
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Digital Biobank
Biobank of individual signatures from a diversity of movement disorders: • Neurologic: Parkinson, … • Musculoskeletal: OA, ... Signatures consist of: • Inertial sensor data • Biomechanical data • Imaging data • Clinical scales
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EU Data Platform?
Comprehensive Center for Movement Medicine
Physician / Patient Pharma / Industry
Database
Provide Data
Controls Access
Engage Organize
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EIT Health
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Our Vision:
EIT Health is a catalyst for change. Our community creates novel
solutions that make healthy lives a reality for all.
Funding by EU:
2 billion / 10 years
EIT Health – Partners
Menno$Kok$Interim$CLC$Director$Belgium/Netherlands$
CLC'UK/Ireland'
CLC'France'CLC'Spain'
CLC'Belgium/Netherlands'
InnoStars'
CLC'Germany'
CLC'Scandinavia'
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Future Synergies
Fitness'and'sport'Disease'and'early'
detecKon'Chronic'disease'
Morbidity
Mortality'
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Fall 2015
Summer 2014
Digital Sports Group
See$you!$
Thank You!