Medical technology goes digital: real-time feedback and gamification in the treatment of spinal disorders, smart

Digital helpers in scoliosis therapies: Relieving therapists, optimising patient care
Scoliosis refers to a structural three-dimensional deformity of the spine and is the most common spinal disorder in children and adolescents. Up to 80 per cent of all children in Germany have a postural deformity that can develop into scoliosis during puberty. Therapies are often very stressful for the children and adolescents affected, and for the therapists they involve a great deal of time and organisation. Innovative technologies can now relieve the burden on both sides - with apps that explain treatment steps, provide real-time feedback and gamification to show patients whether a treatment has been carried out correctly and what progress has been made; doctors and therapists through recommendations for therapy, instructions for patients that no longer require the presence of a carer at all times and transparency about exercises carried out by the patient (adherence control).

iScoolio - patient-individualised, holistic and digitally assisted scoliosis therapy system
Physiotherapeutic treatments focus on posture correction through segmental movements actively performed by the patient. One example of this is Schroth therapy, which is particularly widespread in Germany. This therapist-led method is based on targeted movements of the paravertebral target muscles and so-called rotation-angle breathing. The aim is to achieve an upright posture independently. These active therapy exercises require patients to be able to understand and implement demanding movement sequences. This usually requires direct supervision by a therapist or doctor. The time required is correspondingly high.

In the iScoolio project, Fraunhofer IWU developed the technological basis for holistic and individualised scoliosis therapy with physical exercises to build up the postural muscles in idiopathic scoliosis; the project partners were Protronic Innovative Steuerungselektronik GmbH, Fuzz Tech IT Solutions GmbH and Jena University Hospital. The system ensures comprehensive patient monitoring, real-time feedback and long-term control of the success of the therapy. Visual feedback messages in the app give patients the assurance that therapeutic exercises performed without professional monitoring have been carried out correctly. In addition, a digital user profile and gamification elements increase motivation.nbsp;

During their exercises, patients wear a waistcoat equipped with sensors. The sensors perform motion tracking and monitor breathing. This means that no camera system is required to track movement sequences. Additional modules enable the simulation of a wall bar in the door frame, the tracking of forces when performing the exercises or the training of deeper muscles through the targeted introduction of a wobbly base. In addition, the measurement of the COP (centre of pressure) provides a diagnostic indication of the progress of the therapy.

iScoolio could even enable therapy systems for the private environment without a therapist; however, it is primarily designed to accompany physiotherapy sessions where medical or therapeutic staff cannot personally supervise every exercise on site.

KiTS - child-friendly therapy device and simulation platform for scoliosis treatment
Forms of support such as brace treatment are often necessary if the scoliosis is already more advanced. In many cases, the FED method (fixation, elongation, derotation) can provide good treatment results. With the FED method, the scoliotic spinal curvature is corrected by intermittent phases of pressure and release. The patient consciously perceives the straightening achieved and should maintain it independently during the pressure breaks. The therapy is therefore a combination of passive and active treatment.
Together with the Institute of Biomedical Engineering at Dresden University of Technology and the Institute of Physiotherapy at Jena University Hospital, the Fraunhofer IWU has developed a multifunctional therapeutic-diagnostic system based on the FED method that focuses primarily on young patients. The partners therefore placed particular emphasis on an appealing design.
Skolio-FED uses sensors to register the patient's movements and creates the data basis for therapy recommendations: Based on an FED visualisation, the doctor can develop a therapy adapted to the patient's needs. Like iScoolio, Skolio-FED also provides patients with visual training feedback and uses gamification functions to increase motivation - an important prerequisite for successful therapy, especially for very young patients.

SensO-FeeT - Sensory active ankle orthosis with feedback function
When ankle injuries are treated with supports or orthoses, incorrect assessments of the load-bearing capacity often lead to renewed injuries. This could be remedied by a system that warns patients of overloading.

In the SensO-FeeT project funded by the Federal Ministry of Education and Research, the Fraunhofer IWU is therefore working with other partners to develop a smart ankle orthosis that is linked to an app. By combining various sensors on this orthosis, forces, angles and accelerations in the ankle joint are measured during walking. The aim is to determine the loads on the injured joint as accurately as possible. The measured sensor data is continuously analysed and recorded. Small vibration motors on the orthosis and additional feedback via the app indicate overloading of the foot joint so that patients can react by adopting a protective posture. The recording of load curves also makes it possible to track and evaluate the therapy.

The Fraunhofer IWU's project partners in SensO-FeeT are Sporlastic GmbH, MCG motion capture GmbH, 4K ANALYTICS GmbH, imbut GmbH and WESOM Textil GmbH.

Patient-specific orthoses that follow the course of treatment 
Finger orthoses are usually used to immobilise individual fingers and should be customised for the best possible effect for the patient. With WEAM (Wire Encapsulation Additive Manufacturing), orthoses can first be printed in 2D and pre-dimensioned for the individual finger size; thanks to printed-in wires, they can then be optimally adapted to the ergonomics of the finger. To do this, the integrated wire is heated via electrical resistance, which heats the plastic coating to 35 - 40 degrees Celsius. Plastic is then as easy to mould as modelling clay; after cooling, it is so rigid that it can optimally fulfil its intended support function. The advantage over prefabricated standard orthoses is that they can be customised, even during the course of treatment: reheating of the plastic is sufficient. Compared to three-dimensionally printed products, WEAM orthoses require less printing time and are less prone to errors thanks to their flexible customisability.

Press release by "idw - Informationsdienst Wissenschaft" from 2 March 2023