TESTING AND CONTROL MULTIMEDIA METHOD OF HOME-CARE REHABILITATION ACTIVITY AND INFORMATIC SYSTEM FOR ITS IMPLEMENTATION

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The present invention relates to a method of analysis and control of rehabilitative activity conducted on persons with impairments, handicaps, or disabilities, as well as disadvantages of an existential, physical, psychological or psychiatric, sensorial, or mixed nature of any origin, the treatment of said conditions calling for multidisciplinary intervention in the context of the rehabilitative- therapy session. More precisely, said method of analysis and control is aimed at home-care therapy, where an interdisciplinary approach is necessary both at the start and/or during and/or at the end of the rehabilitation session.

The invention also regards the computer system for implementation of said method.

According to the invention, a rehabilitative model is proposed that does not replace traditional methods but implements them in so far as it envisages interaction between the patient and the provider of rehabilitative care or therapist, with recourse to computer systems connected via a network, through which there is made possible intervention in support of other specialists, as well as remote control, by the competent health structures, of the results obtained at the patient's home.

As is known, rehabilitation of disabled persons on a home-care basis whenever this is possible, is in

all cases desirable, given that it is evident that the need to travel to receive treatment at a health centre is frequently the source of considerable inconvenience and even distress. Major problems may include: the impossibility for the patient to move freely; the time wasted, which in large towns by now can amount to several hours and constitutes a severe handicap to re- integration in normal social and working activities, this being a particularly desirable factor both at a normative level and, even more important, from the medical standpoint; the stress involved, which, in the case of certain pathological conditions, may itself be the cause of a deterioration both of the physical conditions and of the disability; and dependency of the patient upon his or her own family. Such inconvenience and distress frequently transform a need for assistance into a health need proper, with a consequent considerable aggravation of health budgets that cannot be ignored. The latest directives of the European Health Organization and World Health Organization show how the increase in the number of patients in need of health care typical of a technologically advanced and industrialized society is due principally to two factors: the increased demand for intervention in support of a better quality of life, and the ageing of the population. Rehabilitation, including long-term therapy, deserves special attention because the number of patients that have need thereof has considerably increased over the last few years, and any delay in current interventions could lead to conditions of

permanent disabilities in otherwise reversible situations. In this context, home care is considered a necessary revolution that is bound to change traditional assistance not only as regards optimization of the cost/benefit ratios, due to limited resources, but also for creating a permanent link between the patient and the medical centres specialized in their disabilities and disorders.

The need for a multidisciplinary approach during the rehabilitative-therapy session can emerge for a series of reasons, principally linked to the type of pathological condition with which the disabled person is affected and to his or her psychological and social conditions . With reference to -the type of pathological condition, we may basically consider two motivations that may either coexist or be present separately:

1) in the case where the disabled person, owing to problems linked to his or her pathological condition, incurring in frequent and sudden bouts of deterioration that may last for a few hours or even days, and hence an aggravation of his or her disability, there arises the need for timely and targeted intervention on the part of the medical rehabilitation equipe, which must each time tailor the rehabilitation program to the patient's specific needs, examples of this being the "on-off" phenomenon of persons affected by Parkinson's disease or, in disabled persons undergoing substitutive dialysis therapy, the sudden processes of articular inflammation, due to an accumulation of amyloid substances, which lead to

sudden increases in functional limitations;

2) in the case where before, during, and at the end of the rehabilitation session it is necessary to have available data such as pressure, oximetry, pulse, glycaemia, etc. that need to be analysed as a whole in a multispecialist manner for the purpose of enabling a proper development of the treatment, rehabilitative intervention on the disabled persons in substitutive dialysis therapy being an example of this case. The purposes that the invention proposes are substantially the following:

I) "computerizing" the therapist, i.e., providing him, by the aid of computer technigues, and techniques of communication, analysis and control, with a multispecialist backing and assistance: guidelines for rehabilitation, indications for kinesio-physiotherapy treatments, as well as other modes of intervention, including automatic reception by the server of alert signals and suspension of the treatment following upon entry of a specific input (e.g., a vital datum that exceeds the assigned threshold value) inserted by the same therapist;

II) promoting the remote evaluation of the quality, appropriateness, and results of the care provided at the patient's home, making available to the subjects enabled to carry out controls (local health-care centres, clinics, and other bodies) on the rehabilitative treatment envisaged by national health rules currently in force, a simple and fast verification of the results of the progress of the therapy, and in this way enabling a control over proper

entry of the patients at the tariff level envisaged for their particular treatment;

III) integrating current testing procedures for assessment of the disability, with the addition of filmed tests, which are recorded in the form of video clips in a database connected or belonging to a server;

IV) creating a central database common to all the health structures that operate in the sector; and

V) providing a multidisciplinary approach during the rehabilitation session so as to enable carrying-out thereof in a home environment also for those disabled persons who, on account of the complications deriving from their pathological conditions, can at present be treated only in residential, i.e., in-patient, structures.

All the purposes referred to above have been achieved by providing:

- a computer network, preferably consisting of portable computers, connected in a known way telematically to a central server, which is equipped with, or connected to, a database, said computers being designed to send, receive and analyse data in the form of hypertext, video, and audio data; in particular, each computer, if enabled, can query the database via the server for control of the recorded data; and

- automatic systems, generated by an appropriate software residing in the server, for sending to one or more of the computers connected, in response to hypertext, video, and audio data (obtained from the patient) , received by the same server, other hypertext, video, and audio data, constituted by guidelines for

rehabilitation, indications for kinesio-physiotherapy treatment, and other modes of intervention.

A peculiar characteristic of the present invention is the entry, in current testing and examination procedures on disabled persons undergoing rehabilitative treatment, of the film of a test at the start of, during, and at the end of the therapy in question. This film is recorded, in the form of a video-audio clip, in a purposely provided user directory in the database connected or belonging to the central server. The interpretation of the visual information gleaned from a film sums up at a glance the set of an amount of data otherwise obtainable only with lengthy testing procedures, which frequently depend upon the subjective judgement of the person testing. Hence, the film of the walk of a disabled person tells us immediately, in a clear and objective way, about the patient's sense of balance, gait, points of rest, muscular stiffness, etc. Furthermore, the comparison between two video clips of the subject's walk at successive times enables the person carrying out the check to evaluate any possible improvement or deterioration in a simple and unmistakable way, thanks precisely to the possibility of remote monitoring of the progress of the patient, and to intervene in the treatment at the most appropriate times.

A second embodiment of the invention envisages the use of a software that is able to vectorize the film so that the comparison will not be a subjective comparison between images, but an objective comparison between vector values and the mathematical

relationships between them.

The method described finds application in all procedures of filing, testing and control in which the information in the form of video clips enables simplified and fast control and analysis. The simplification of the control procedures, in the case where these are necessary, produces in any field, and for obvious reasons, savings for public administration, which frequently is unable to carry out the necessary checks because they are complicated and costly.

A specific application of the invention is in the health field of rehabilitation, where it can be used:

- for checking, on the part of a local health- care centre, that the user is in fact entered in the modality of treatment corresponding to the level of complexity of his or her effective health needs, a check which is currently obtainable only by means of a visit made by medical officers sent by said health-care centre to the patient's home; in fact, testing of a patient in the form of video clips or the comparison of successive video clips regarding the state of a patient enables confirmation or, if necessary, modification of the type of treatment that the patient is undergoing: extensive or maintenance therapy, said forms of treatment having a different price list; and

- for providing a multidisciplinary intervention during the rehabilitation session, thus making possible conduct thereof at the patient's own home also for those disabled persons for whom multispecialist care becomes necessary in the framework of the therapy and

who would otherwise require treatment in residential structures of an in-patient nature.

The description of the invention will be more readily understood from the annexed plate of drawings, which illustrate a non-limiting example of a preferred embodiment thereof. In the plate of drawings:

- Figure 1 is a schematic illustration of the architecture of the computer system, comprising a server, connected to which are a database and a plurality of client computers, one of which is a control computer;

Figure 2 is a schematic illustration of the architecture of the system at the moment in which the server automatically sends data to the computers connected in response to data received from the computer A and/or computer B or, upon specific request, from the control computer P; and

- Figure 3 is an overall view of the computer system. With reference to the figures, according to the invention there is provided a network of client computers A, B, etc., each of which is connected to a central server S, which is in turn equipped with or connected to a database DB, preferably of a NAS (network-attached storage) type, i.e., a device the function of which is to share, between the users of the network, a storage area (disk) . Each computer is designed to send, receive, and analyse data in the form of hypertext, video, and audio data, and at least one of these computers is a remote computer P, enabled to carry out control and designed to access said data on

said database following upon a pre-defined request arriving through the server.

In the figures, the double-headed black arrows refer to normal sending of data; the single-headed ones refer to automatic sending.

As may be seen in Figure 3, the data that each provider of rehabilitative care, for example through the computer A, sends to the central server S, are sent automatically to at least one computer, for example B, belonging to a specialist who will see to analysing them.

The method basically envisages the steps listed below. a) Sending to the server, at the start of the rehabilitative therapy, demographic data and/or medical history, and/or data on the disability, and/or hypertext, video, and audio data, regarding the patient, through at least one computer of the network; a peculiar characteristic is that of accompanying the demographic and/or anamnestic data with a film in the form of a video-audio clip of a test conducted on the patient . b) Transmission of said data from the server to the database and possibly to one or more computers of the network for recording thereof in a purposely provided directory dedicated to the patient. c) Automatic response of the server, upon receipt of input in the form of data or of a multimedia nature, with sending, to one or more computers of the network, of an output in the form of data or of a multimedia nature, constituted by alert signals for the

specialists, or other indications, for example indications of treatment, for the therapist

(rehabilitation programs, guidelines, suspension of treatment, etc.) Following upon the comparison with statistical data corresponding to the standard vital data of a patient suffering from the same pathological condition, which have previously been filed in the database, or upon verification of whether the data themselves fall within the range of the vital data (arterial pressure, oximetry, heart rate) already present in the patient' s directory, within which range the therapist can carry out the therapy.

We shall provide here two illustrative examples. Example 1 : Input: entry by the therapist of a vital datum that exceeds the assigned threshold value;

Output: automatic response of the server with an alert signal to the specialist that warns him to intervene urgently. Example 2 :

Input: entry by the therapist of a datum regarding a finding based upon an objective evaluation (sudden swelling of the knee in a neuropathic patient with motor disability) in ICD9-code format; Output: automatic response of the server to the therapist with the indication, in text, hypertext or multimedia format, of a new and detailed therapeutic program to be adopted. d) Comparison, in one and the same screen of a computer of the network or of the computer enabled to carry out control, of two or more video clip films,

each obtained by filming the patient while the latter is moving at successive times of the therapy. e) Recalling, on one and the same screen, to enable comparisons and analyses, of video clips and data, recordings of clinical, laboratory and instrumental examinations, etc.; f) Automatic sending of the hypertext, video, and audio data from the database of the server to a computer enabled to carry out control, and connected thereto, following upon a pre-defined request. g) Conversion of the filmed image into vectors; this can be obtained either using systems already available on the market that are able to identify given points on a film and to process in mathematical terms their spatial relationships and relationships of movement, or applying kinesthetic sensors on the patient, which will detect the variables that describe the kinetics and the dynamics of the movement of the anatomic segments, without any need to use external reference structures. Already known, for example, are kinesthetic sensors that can be worn, constituted by piezoresistive polymeric extensometers spread on a elastic-fabric substrate. The signals coming from the sensors are translated into vector reality, directly on the client computer or on the server, via a system operating software, which integrates the acquisition, processing and display of said signals, furnishing a representation of the movement in the form of configurations of vectors corresponding to the decomposition into phases of the movement detected. h) Filing, in the database of the server, of the

catalogues of the configurations of vectors corresponding to the decomposition into phases of the normal movement and of movements that depart more or less from the norm in the various types of disability of the different anatomic segments. i) Comparison between the configuration of vectors corresponding to the decomposition into phases of the movement detected by the therapist with the configurations of vectors corresponding to the decomposition into phases of the movement of the same anatomic segment present in the directory for evaluating the degree or type of disability and the improvement or deterioration obtained via the therapy.

1) Recording of the video-clip films, on the results of the treatments, with different colour intensity to indicate: improvement, no improvement, deterioration . m) Chat-line communication between the computers of the network using a program of recognition of handwriting or by typing in from the keyboard. n) Communication between the computers of the network in video-conference.

The first function performed by the resident software is that of warning the specialist with a signal when there are data waiting for him, and then warning the provider of rehabilitative care that reports have arrived from the specialists that have analysed the data sent by him. In practice, the provider of rehabilitative care will be put in direct touch with the specialists, who will assist him by sending hypertext, video, and audio data. The need for

a communication of a "verbal" type will be met by a chat-line communication using a program of recognition of handwriting or by typing in from the keyboard, said systems being "discreet" in regard to the patient. In the subsequent steps, automatic software procedures begin to be used, which enable the server to send, in response to the receipt of data (hypertext, video, and audio) , other data (hypertext, video, and audio) on guidelines for rehabilitation, indications of kinesio-physiotherapy treatments, and other indications of intervention.

Provided hereinafter is a practical example of the method illustrated with reference to a procedure of rehabilitative intervention. A visit is made by the multispecialist equipe to the patient to collect demographic data, medical history, and data on the physical, psychological or psychiatric, social or environmental disability.

The same equipe conducts the test on the patient filmed using a digital camcorder.

A rehabilitation counselling equipe:

- draws up a program of rehabilitation;

- compiles the patient's file;

- sends data to the health authorities for approval of the treatment;

- assigns the therapist to the patient; and

- makes the choice of the specialists that are to back up the therapist in his work.

The demographic data, medical history, and data on the disability, recorded on the patient, along with the film of the test made on the patient, are sent to

the database of the server, where they are recorded in a purposely provided directory dedicated to the patient. Defined in said directory is the range of the vital data (arterial pressure, oximetry, heart rate) detected on the patient, within which range the therapist can carry out the therapy.

The provider of rehabilitative care starts the therapy, which is spread over a number of sessions ???j_ 1st session, 2nd session, ... , final session. At the start of the rehabilitative therapy, the provider of rehabilitative care gathers the instrumental data obtained from the patient (blood pressure, pulse, oximetry etc.), from the preliminary physical examination, from laboratory examinations, and from clinical examinations not possessed by the patient at the moment of the initial examination made by the multispecialist equipe (because they are subsequent thereto) and sends them on line via computer to the specialists assigned to the patient and to the database of the server, where they will be recorded in the directory dedicated to the patient, awaiting confirmation by the specialist for starting the therapy.

In the event of need for a consultation, the provider of rehabilitative care will communicate with the specialist in chat-line using a program of recognition of handwriting or by typing in from the keyboard.

If necessary, or if established first during consultation by the rehabilitation equipe, he may send data gleaned from the patient (blood pressure, etc.) and

data from the physical examination made during the therapy session.

At the end of the therapy session he sends instrumental data (blood pressure, etc.) and data from the physical examination, and notifies entry thereof to the specialists.

Each month, or at intervals set previously by the multispecialist equipe, the therapist sends the film on the test of the patient's disability, to record his or her possible improvement, to the specialists and to the server database.

If necessary, in the case of deterioration of the patient' s condition, he can send to the specialists and to the server database a filmed recording of the deterioration of the patient's disability, also in the course of the month.

At the end of the last session, the provider of rehabilitative care:

- draws up a final report on the patient, which he will send to the health centre accredited for the treatment in question; and

- sends the film of the final test on the patient's disability, which testifies to his or her improvement, to the specialists and to the server database.

At this point, the rehabilitation counselling equipe draws up the part of the patient file corresponding to the closure of the rehabilitation project, and sends it to the competent health authorities.

The aim of the present invention falls within

the framework of numerous projects that are studying and developing instruments of telemedicine to meet the increasing requirements of the health service and to implement the directives appearing in the latest National Health Plan, which envisage a complete reorganization of the entire network of health care, consolidating and potentiating the synergy between the world of health and ICT (Information and Communication Technology) . In conclusion, the method forming the subject of the present invention envisages the setting-up, through a telematic infrastructure, of an assisted semiautomatic "co-operation" between the actors that intervene in the rehabilitation process. In particular, said method is dedicated to solving problems involved in home-care rehabilitation of patients by providing a computer support to the provider of rehabilitative care to overcome the effective fragmentation of the diagnostic and therapeutic procedures, thus enabling an immediate multidisciplinarity of intervention and rendering the process of remote health care readily controllable and appraisable by the health structures provided.

The invention finds its specific field of implementation in the rehabilitative health activities that necessarily call for global clinical taking-into- care of the person through a multidisciplinary medical approach, and the provision of an individual rehabilitation project. Finally, it should be noted that the computer network described herein, which preferably consists of

portable computers, can comprise or consist of palmtops, cellphones or other devices designed to be connected in wireless mode.