A Home Rehabilitation Appliance That Integrates Universal Access with Personalized Interface

Abstract

One of the key challenges in home rehabilitation field is the need for more personalized protocols and interfaces. This paper presents how UniTherapy, a telerehabilitation platform developed primarily for computer-assisted motivating rehabilitation (CAMR) applications, is being turned into a home rehabilitation appliance. This includes support for emerging standards, including universal plug and play (UPnP) and the user interface socket (UI Socket) that is enables a universal remote console (URC) to fully operate and automatically generate user interfaces on various available devices. Progress and related issues are discussed

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Abstract— One of the key challenges in home rehabilitation
field is the need for more personalized protocols and
interfaces. This paper presents how UniTherapy, a
telerehabilitation platform
computer-assisted motivating
applications, is being turned into a home rehabilitation
appliance. This includes support for emerging standards,
including Universal Plug and Play (UPnP) and the User
Interface Socket (UI Socket) that is enables a Universal
Remote Console (URC) to fully operate and automatically
generate user interfaces on various available devices. Progress
and related issues are discussed.
developed
rehabilitation
primarily for
(CAMR)
I.
BACKGROUND
There is a recognized international need to move toward a
consumer-oriented healthcare
tele-supported home self-care with conventional healthcare
services such as inpatient, outpatient and home care [1-3].
One target area is neurorehabilitation, where mounting
scientific evidence demonstrates that progress in neural
plasticity and brain reorganization can be made even years
after a stroke, and where discharged patients are encouraged
to make progress on their own [4]. This has motivated the
development of new approaches toward neurorehabilitation in
the home environment [5]. One example developed by our
group is a home rehabilitation appliance called UniTherapy
which takes an alternative approach to reducing access
barriers such as cost, distance and usability by taking
advantage of emerging trends and advances in mass-market
telecommunications and information technologies (E&IT) to
develop more home-centered approaches. The aim is for the
home patient to receive therapeutic intervention at home as
easy as they use other home appliances such as a television, or
a refrigerator.
With the eventual target of home rehabilitation being to
optimize beneficial rehabilitative change [6], one of the key
challenges in home rehabilitation is the need for more
personalized protocols and interfaces. By strongly addressing
the issues of access and usability of the interfaces during
goal-directed use, we will be able to make the types of
refinements to the software and hardware components that
may be needed before we look into the rehabilitative change
question; and the enhanced usability will also help motivate
home patients, thus helping achieve better rehabilitative
system that integrates
This work is supported by grants from the Ralph and Marion Falk
Medical Trust Foundation, the Whitaker Foundation, and the Rehabilitation
Engineering Research Center on Accessible Medical Instrumentation (U.S.
Department of Education, H133E020729).
X. Feng is a biomedical engineering doctoral student at Marquette
University, Milwaukee, WI 53233 USA. (E-mail: xinfeng@mu.edu).
J.M. Winters is professor of biomedical engineering and John P. Raynor
Distinguished Chair at Marquette University, Milwaukee, WI 53233 USA.
(E-mail: jack.winters@mu.edu).
1-4244-0059-7/06/$20.00 ©2006 IEEE.
outcomes.
Increasingly, home appliances (e.g. televisions, VCRs,
refrigerators, washing machines, thermostats, light switches,
telephones, and microwave oven) have embedded processors,
and often come with remote controls. However, as appliances
add fancier features, their user interfaces can get harder to use,
especially for inexperienced users. At the same time, it is
becoming common for people to carry their own mobile
device (e.g. PocketPC, PDA, cell phone), which has better
input-output capabilities than the average home appliance
(e.g., high-resolution screens, text-entry technologies, speech
capabilities). Mobile devices are likely to maintain this
usability advantage over home appliances, because: 1) mobile
devices are personal devices, which allow them to provide
personalized interfaces (e.g., a PocketPC could provide
interfaces that are consistent with user’s preference, or it
might combine multiple appliance interfaces to create a single
interface organized around tasks rather than appliances); and
2) most of mobile devices come with built-in short range
communication capabilities (e.g., WiFi, Bluetooth) that could
enable communication/control appliances within the home
environment.
However, user interfaces for home appliances/remote
control still must be authored separately for each appliance
and each controller platform. Furthermore, many existing user
interfaces are not intuitive and natural for human users; a
personalized interface needs to be regenerated based on the
individual’s personal preferences and capabilities.
It is suggested that a standardized but flexible abstract user
interface description for each home appliance is required, and
that a remote console should be able to connect to discover,
access and control a remote device or service on top of an
existing network communication protocol. With such an
abstract user interface description, a remote console with
universal interface capabilities (e.g., speech interface, natural
language interface, tactile interface) should be able to be
supported by various computing devices, ranging from
desktop computer to handheld devices.
II.
UNIVERSAL REMOTE CONSOLE STANDARD: AUTOMATIC
GENERATION OF USER INTERFACE ON REMOTE CONSOLE
Among many of these efforts to develop a scheme for
automatically generating a user interface on a remote control
[7, 8, 9, 10], the V2 committee within InterNational
Committee for Information Technology Standards (INCITS)
and under ANSI has developed Universal Interface Socket
(UI Socket) /Universal Remote Console (URC) standards for
the discovery, selection, operation, and substitution of user
interfaces and options [11]. Our group, the Rehabilitation
Engineering Research Center on Accessible Medical
A Home NeuroRehabilitation Appliance that Integrates Universal
Access with Personalized Interface
Xin Feng and Jack M. Winters
Proceedings of the 1st Distributed Diagnosis
and Home Healthcare (D2H2) Conference
Arlington, Virginia, USA, April 2-4, 2006
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Instrumentation (RERC-AMI), is a member of the INCITS V2
workgroup and is involved in multiple V2-URC activities.
The purpose of V2's URC standard, which has become an
official national standard (ANSI/INCITS 389-393-2005) and
is under consideration to become international standard
ISO/IEC 24752, is to facilitate the development and
deployment of a wide variety of devices (from different
manufacturers) that can act as URC’s for an equally varied
range of devices and services.
As shown in Fig. 1, the URC standards specify
communications between a target device/service (e.g. home
appliance, software program, medical instrumentation, and
robotics) that a user selects to access and operate through the
UI Socket/URC that presents the user with a remote user
interface through which they can discover select, access and
operate the target. The URC includes software that is typically
hosted on the user's physical device, but a distributed
approach is also possible. Communications between the target
and URC take place over a network, the target-URC Network
(TUN). Interaction between a target and a URC consists of a
discovery phase and an optional control phase. The discovery
phase initializes the URC to locate and identify all available
targets and their sockets. The control phase is the time period
during which a target and a URC initiate, maintain and
terminate a control session. A control session is a connection
between the URC and a target's socket for the purpose of the
URC controlling a functional unit of the target. The user
interface (UI) builder in URC will generate the user interface
on URC with target information and supplemental resources
on the URC, from the target, or from a remote network.
Fig. 1. UI Socket/URC Standards Overall Framework is described within the
black frame; outside the framework is an optional performance session. The
user interface (UI) builder in URC generates the UI on URC given target
information (e.g. target document, presentation template, resources) and
supplemental User Interface Implementation Description (UIID) and
resources that are connected to URC by Resource URC Network (RUC); this
process optionally involves an intelligent agent embedded in the URC.
Besides TUN, a performance session is optionally running on Direct Link,
which is not necessarily compliant to V2 standards and transfers high
frequency performance data between URC and Target.
So how can these emerging UI-Socket/URC standards
benefit home rehabilitation applications?
?Universal Interfaces: By using URCs which support novel
interfaces such as speech interface, natural language interface,
and tactile interface and so on, the user may use those
interfaces to interact with a V2 target that may not support
these features.
? Personalized Interface: One of the important resources
URC can use to generate a user interface is User Accessibility
Resources, which include both user capability and preference.
Thus, a URC can always generate a personalized interface, for
example, in the user’s native language and a big font size for a
non-English-speaking user with visual impairments.
? Device Independency: The UI-Socket/URC standard
provides a standard mechanism for products to share their
functionality with remote controls that range from desktop PC
to PDA to cellphone. Thus it allows a manufacturer to support
all of these and other options without having to create or even
predict what the user would like. Resources under the standard
can build on the CC/PP (Composite Capabilities/Preference
Profiles) vocabularies of the W3C’s Device Independence
Activity [12].
? Intelligent Agent Programming: The URC standards
allow the intelligent agent to be in the controller. The
intelligent agent would allow the user to control home devices
in many ways we cannot do today [13]. The Task Model
Description (TMD) for an intelligent agent is one of the
substandards that the INCITS V2 committee is working on
today.
Two prototype projects developed by our group: MedURC
for medical devices [14] and interfaces for UniTherapy
technology for rehabilitative assessment and therapy. The
latter is the focus of this paper: It is built on the UPnP standard,
and allows using PocketPC as URC to control UniTherapy
software. An outgrowth of this work is MUPad software tool,
which was designed to provide a graphical user interface for
generating V2-URC compliant XML documents.
III.
EXAMPLE: UNITHERAPY TECHNOLOGY AS A HOME
REHABILITATION APPLIANCE
As discussed above, there is great potential for home
rehabilitation when an appropriate support system (both
interpersonal and technical) is available. This section presents
the development and implementation of a consumer-centered
alternative therapeutic strategy for neurorehabilitative therapy:
UniTherapy, a home rehabilitation appliance, that supports a
rich menu of diverse forms of therapy and assessment, adapted
for the home environment.
A. Conceptual Model
The design of such a personalized rehabilitation framework
starts with understanding the user needs, roles and interactive
sequences of each user involved in the rehab process. Three
roles are defined: Therapy Designer, Telepractitioner, and
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Home User. Therapy Designer has full access to design suite
to create personalized intervention protocols for home user
(patient) and optionally the Telepractitioner, with the protocol
able to be refined based on the outcome of timely assessment
of patient’s recent progress. All the tasks in protocols can be
put into two categories: Self-routine tasks, which a Home User
can run by themselves; and Interactive tasks, where a
Telepractitioner will supervise and periodically interact with
home user remotely, and evaluate results with the ability to
remotely change the intervention protocol which depends on
the protocol’s setting. A Home User participates in all aspects
of intervention sessions, and optionally can access their own
progress and history - such positive feedback may improve
their motivation. A Home User doesn’t need to design
intervention protocols, although they can design goal-directed
tasks themselves as a part of intervention. These roles may
change over the course of the stages of an iterative
rehabilitative process (e.g., a practitioner in both Therapy
Designer and Telepractitioner roles).
B. Therapeutic Devices
One requirement for home rehabilitation framework is the
support for mass-marketed devices which can be used in
computer-based therapy and assessment. By supporting
DirectX standard [15], potentially all input devices compliant
with Microsoft Windows/ DirectX platform can be used
within the framework. For instance, UniTherapy supports
force-feedback joysticks, force-feedback driving wheels,
various pointing devices (e.g. mouse, trackball, PDA stylus
pen) and windows keyboard. Some features, though, are only
relevant when using force-feedback devices. On such devices
it uses the Microsoft DirectX Software Development Kit
(SDK) to program a series of force effects such as constant,
spring, damper, and inertia.
C. Assessment, Therapy and Telerehabilitation Support
Assessment is a critical component of the framework,
important for both evaluations of performance so as to support
an iterative optimization process and as a key motivational
tool. Assessment tasks include four toolboxes: Range of
Motion (ROM), Tracking, System Identification and
Conventional Forms.
Movement data (e.g. position, timestamp, applied force) is
recorded into XML files for later analysis, with the data
structure defined by an XML schema. A data analysis module
is being developed. Results can be displayed not only in both
graphics and report form, but also stored as an XML file with
the data structure that is described by XML schema. The core
suite of assessment metrics such as movement time, reaction
time and path error are retrieved intelligently once the data are
input into the program, based on input device type (e.g.
joystick, wheel), and task type (e.g. discrete tracking,
continuous tracking, system identification).
UniTherapy supports the integration of third-party
computer game program by treating them as add-ins and
setting up shortcuts. Therapy Manager allows user to
add/remove the third-party program and change sequences. A
collection of simple arcade games (e.g. smart driver, Pong,
Pacman), are current examples of fun motivation therapy tools
where UniTherapy can run in the background to get access
through DirectX to sampling joystick port signals without
affecting the performance of most games.
A Telerehabilitation Link between patient interface (PI)
and telepractitioner interface (TI), which is supported by
TCP/IP network, has been implemented. Both PI and TI
support a view of the patient’s performance data in real-time.
The result can be viewed at either side in graph and report
forms afterwards. As an option, the user at TI can decide if the
patient can participate in the task design phase. Instant
messaging (IM) and computer-based teleconferencing is
integrated so that both users at PI and TI can communicate by
audio, video and text.
D. Usability & Accessibility Design: Home Rehab
Appliance and URC Standard Related Technologies
The home-user version is designed and implemented as a
multi-modal application with a simple user interface which
resembles Media player. As shown in Fig. 2, a Home User can
load the predefined protocol by their therapy designer as if
they load a CD into CD player; the descriptive information
such as “protocol title”, “task information”, and “status” will
display for home user in a manner that appears simple and
intuitive to use.

FIG. 2. UniTherapy home rehabilibation appliance resembling CD-player
user interface. A user can navigate through the protocol list and select the
task; simple voice commands (e.g. “start”, “stop”, “next”, “previous”) are
supported, thus home user can operate via voice command. Certain
accessibility features are implemented and ready to be used for screen-reader
application, with more planned based on usability evaluation.
By using the existing TI link, telepractitioners or caregivers
can supervise a home user, using a combination of real-time
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interaction (including through force-assist and force-resist
modes as well as videoconferencing) and asynchronous
communication. We are also investigating integrating
user-agent technology to provide context-awareness online
help (e.g., an animation character could provide some simple
positive feedback to home user after the goal-directed task is
finished).
The Home User version is also compliant with the V2-URC
standards. Our approach is to treat UniTherapy as a target
service, which we view as a home rehab appliance, and thus
provide abstract user interface information in V2-compliant
documents which are sufficient for a URC to construct a
full-function custom-tailored user interface on the remote
control. A URC prototype running on the PocketPC is
implemented and can successfully operate as a remote control;
we are using the TUN library developed by Mobile and
Wireless RERC, which is implemented on top of UPnP
(Universal Plug and Play [16]) Remote UI standard. We are
gradually adding universal interface support into the URC.
Currently we are also investigating an intelligent
context-aware UI builder with user capability and preference
support. A critical part of this process is having a user
complete a short survey on user accessibility and preferences
[17]. UniTherapy’s own assessment tools can be used to
augment information on a user’s performance capabilities.
Finally, we are developing a generic UPnP control point,
which will be embedded into home user version so that it can
naturally evolve into an Environmental Control Unit (ECU)
for UPnP compliant appliances within the home environment.
IV. DISCUSSION
In summary, a home rehabilitation appliance for
personalized CAMR has been implemented with a
consumer-centered design approach. A diverse menu of
assessment capabilities are available, and can be used together
with other services that include a protocol manager and a data
analysis tool with a telerehabilitation link. Special attention is
paid to the usability and accessibility issues associated with
using the emerging UI Socket/URC standards; while new
opportunities and issues are emerging around these standards,
we are especially interested in how to generate personalized
healthcare interfaces that establish solutions for accessibility,
and in how the home healthcare device could interact within a
ubiquitous home environment. UniTherapy has been used as a
research platform for rehabilitation and usability studies in 3-4
sites in local Milwaukee local area [18, 19, 20, 21]; based on
analysis of pre-activity and post-activity surveys which
includes more than 40 questions scored on ordinal scale [1,5],
we received positive user feedback from patients and
therapists within our initial usability research studies.
ACKNOWLEDGMENT
We thank Dr. Michelle Johnson, Ms. Laura Johnson and Mr.
Edward Maher for using UniTherapy in their research studies.
We thank V2 community, especially the help from Gottfried
Zimmermann, Jeremy Johnson, Pawan Shroff and R. Sarma
Danturthi. The opinions expressed in this chapter are only
those of the authors.
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