Using mobile health assessments to improve outcomes for ... · The HAPI prototype includes three clinically motivated tests Test Clinical Metric HAPI Metrics Standing Posture/Balance

Elizabeth Brokaw1, Michael Fine1, Tony Donadio1, Sahana Kukke2

1. MITRE, McLean, VA

2. The Catholic University of America, Washington, D.C.

Health Datapalooza

April 27, 2018

Using mobile health assessments to

improve outcomes for individuals

with chronic neurological conditions

©2018 The MITRE Corporation. ALL RIGHTS RESERVED. Approved for public release, distribution unlimited, MITRE case number 18-0844.

The timing of therapy is typically dictated by the self-reporting of

symptoms, or parental observations.

▪ Cerebral Palsy (CP) affects over 500,000 individuals under the age of 18

in the US

▪ Although CP is not a progressive disorder, deficits commonly change over

time due to both the nature of the chronic condition and the effects of

childhood development

▪ Rapid initiation of therapy after change in impairments can reduce the risk

of falls and the need for surgical intervention

2

Background

© 2018 The MITRE Corporation. All rights reserved.

Home Assessment for Prompt Intervention (HAPI)

HAPI aims to have:

Clinical Relevance by using tests

derived from conventional clinical

assessments for CP

An Engaging Interface to encourage

compliance and maximize effort to

gain an accurate measure of

impairment (target ages 10-12)

Good Usability for individuals with

CP to understand and enjoy the

system without confusion or frustration

HAPI allows for frequent, quantitative assessments of impairment that

could be completed in the home or school.

HAPI utilizes the Microsoft Kinect, a low

cost ($100), vision-based sensor, for

joint tracking. It does not require sensors

to be placed on the user, which allows

for quick and easy setup.


3

HAPI Promotes Engagement

Interactive avatar selection

Story Image

Piper guides the user through the tasks

The user can select their avatar to

promote engagement

A fox friend named Piper provides in-

game guidance to help ensure the

user does the tasks correctly


4

Clinical Relevance

▪ The HAPI prototype includes three clinically motivated tests

Test Clinical Metric HAPI Metrics

Standing Posture/Balance Mini-BESTest measuring

success standing still with

feet together for 30 s (0-2

score)

If the individual is

successful, and postural

metrics

Sit to Stand 5x sit to stand measuring

time to complete, and use of

arms for assistance

Time to complete,

postural sway, use of

arms

Seated or Standing Reach Pediatric Reach or

Pediatric Balance Scale

measuring reach distance, or

0-4 score

Reach distance, postural

sway, arm kinematics


5

HAPI Tests

Five Times Sit to Stand :

Copy CatsStanding or Seated Reach:

Butterfly enchanting

Standing Balance/Posture:

Invisibility

▪ Each clinical test is built

into a “mini-game” to

make it more engaging

Insert screenshot


6

▪ Usability is an important part of technology adoption, but is

commonly overlooked when developing systems for

individuals with disabilities

▪ We performed a case study investigation of the system:

– Clinical assessments

– HAPI assessments

– System usability

▪ System usability scale

▪ Self-reported motivation and engagement with the system

7

System Evaluation


▪ A 10 year old with left-affected CP completed the protocol

– Good sensitivity to CP related impairments

– Good reported usability and engagement

8

Case Study Results


9

Additional Quantitative AnalysisStanding balance

Standing Metrics HAPI Value for Participant Interpretation

Trunk angle 83° ± 0.79°

Leaning slightly forward but low

variability indicating reasonable

stability.

Shoulder angleLeft: 20.9° ± 0.71°

Right: 59.7° ± 1.7°

Shoulder angle lower on left.

Potentially due to weakness.

Trun

kFor

war

dFle

xion

Ang

le(D

eg)

0 10 20 30 40 50 60 70

Time (Sec)

50

60

70

80

90

Trunk angleTask startTask stop

Trunk


10

Additional Quantitative Analysis5x Sit to Stand

Sit To Stand Metrics HAPI Value for Participant Interpretation

Conventional Clinical Metric:

Time to Complete9.60 s

11

Additional Quantitative AnalysisReach

Reach Metrics HAPI Value for Participant Interpretation

Trunk lateral flexionLeft: 14.3°

Right: 15.5°

Reduced movement to the left,

which indicates increased

challenge to balance

Mean elbow angle during

movement

Left: 19° ± 7.6° (max 34°)

Right: 16.9° ± 1.6° (max 19°)

Increased elbow angle and

variability on left indicating

potential abnormal tone

1 2 3 4 5 6 7 8 9 10

Time (Sec)

75

80

85

90

95

100

Tr u

nk

La

t er a

l Fl e

xi o

nA

ng

l e( D

eg

)

Left Reach

Right Reach


▪ Findings indicate that conventional metrics of impairments could be

captured remotely through serious gaming

▪ HAPI is a low-cost system that could be used at home, in school, or

in the clinic to help improve health monitoring. This could provide

consistency across clinics, and could help evaluate treatment

strategies across patients.

▪ Additional development, such as additional tests to provide a more

complete clinical picture, and additional clinical research is needed,

but initial findings indicate the significant potential benefits of the

technology.

12

Summary


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Using mobile health assessments to improve outcomes for ... · The HAPI prototype includes three clinically motivated tests Test Clinical Metric HAPI Metrics Standing Posture/Balance