Jul 09, 2014
Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial
The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).
Full text paper available at: http://www.jmir.org/2014/7/e167/
Apr 29, 2014
Actually, according to my experience, citizens and public stakeholders are not well-informed or educated about mHealth. For example, to many people the idea of using phones to deliver mental health programs still sounds weird.
Yet the number of mental health apps is rapidly growing: a recent survey identified 200 unique mobile tools specifically associated with behavioral health.
These applications now cover a wide array of clinical areas including developmental disorders, cognitive disorders, substance-related disorders, as well as psychotic and mood disorders.
I think that the increasing "applification" of mental health is explained by three potential benefits of this approach:
- First, mobile apps can be integrated in different stages of treatment: from promoting awareness of disease, to increasing treatment compliance, to preventing relapse.
- Furthermore, mobile tools can be used to monitor behavioural and psychological symptoms in everyday life: self-reported data can be complemented with readings from inbuilt or wearable sensors to fine-tune treatment according to the individual patient’s needs.
- Last - but not least - mobile applications can help patients to stay on top of current research, facilitating access to evidence-based care. For example, in the EC-funded INTERSTRESS project, we investigated these potentials in the assessment and management of psychological stress, by developing different mobile applications (including the award-winning Positive Technology app) for helping people to monitor stress levels “on the go” and learn new relaxation skills.
In short, I believe that mental mHealth has the potential to provide the right care, at the right time, at the right place. However, from my personal experience I have identified three key challenges that must be faced in order to realize the potential of this approach.
I call them the three "nEEEds" of mental mHealth: evidence, engagement, enactment.
- Evidence refers to the need of clinical proof of efficacy or effectiveness to be provided using randomised trials.
- Engagement is related to the need of ensuring usability and accessibility for mobile interfaces: this goes beyond reducing use errors that may generate risks of psychological discomfort for the patient, to include the creation of a compelling and engaging user experience.
- Finally, enactment concerns the need that appropriate regulations enacted by competent authorities catch up with mHealth technology development.
Being myself a beneficiary of EC-funded grants, I can recognize that R&D investments on mHealth made by EC across FP6 and FP7 have contributed to position Europe at the forefront of this revolution. And the return of this investment could be strong: it has been predicted that full exploitation of mHealth solutions could lead to nearly 100 billion EUR savings in total annual EU healthcare spend in 2017.
I believe that a progressively larger portion of these savings may be generated by the adoption of mobile solutions in the mental health sector: actually, in the WHO European Region, mental ill health accounts for almost 20% of the burden of disease.
For this prediction to be fulfilled, however, many barriers must be overcome: thethree "nEEEds" of mental mHealth are probably only the start of the list. Hopefully, the Green Paper consultation will help to identify further opportunities and concerns that may be facing mental mHealth, in order to ensure a successful implementation of this approach.
Apr 15, 2014
A post-stroke rehabilitation system integrating robotics, VR and high-resolution EEG imaging.
IEEE Trans Neural Syst Rehabil Eng. 2013 Sep;21(5):849-59
Authors: Steinisch M, Tana MG, Comani S
We propose a system for the neuro-motor rehabilitation of upper limbs in stroke survivors. The system is composed of a passive robotic device (Trackhold) for kinematic tracking and gravity compensation, five dedicated virtual reality (VR) applications for training of distinct movement patterns, and high-resolution EEG for synchronous monitoring of cortical activity. In contrast to active devices, the Trackhold omits actuators for increased patient safety and acceptance levels, and for reduced complexity and costs. VR applications present all relevant information for task execution as easy-to-understand graphics that do not need any written or verbal instructions. High-resolution electroencephalography (HR-EEG) is synchronized with kinematic data acquisition, allowing for the epoching of EEG signals on the basis of movement-related temporal events. Two healthy volunteers participated in a feasibility study and performed a protocol suggested for the rehabilitation of post-stroke patients. Kinematic data were analyzed by means of in-house code. Open source packages (EEGLAB, SPM, and GMAC) and in-house code were used to process the neurological data. Results from kinematic and EEG data analysis are in line with knowledge from currently available literature and theoretical predictions, and demonstrate the feasibility and potential usefulness of the proposed rehabilitation system to monitor neuro-motor recovery.
Apr 06, 2014
The effects of augmented visual feedback during balance training in Parkinson's disease - trial protocol
The effects of augmented visual feedback during balance training in Parkinson's disease: study design of a randomized clinical trial.
BMC Neurol. 2013;13:137
Authors: van den Heuvel MR, van Wegen EE, de Goede CJ, Burgers-Bots IA, Beek PJ, Daffertshofer A, Kwakkel G
Abstract. BACKGROUND: Patients with Parkinson's disease often suffer from reduced mobility due to impaired postural control. Balance exercises form an integral part of rehabilitative therapy but the effectiveness of existing interventions is limited. Recent technological advances allow for providing enhanced visual feedback in the context of computer games, which provide an attractive alternative to conventional therapy. The objective of this randomized clinical trial is to investigate whether a training program capitalizing on virtual-reality-based visual feedback is more effective than an equally-dosed conventional training in improving standing balance performance in patients with Parkinson's disease.
METHODS/DESIGN: Patients with idiopathic Parkinson's disease will participate in a five-week balance training program comprising ten treatment sessions of 60 minutes each. Participants will be randomly allocated to (1) an experimental group that will receive balance training using augmented visual feedback, or (2) a control group that will receive balance training in accordance with current physical therapy guidelines for Parkinson's disease patients. Training sessions consist of task-specific exercises that are organized as a series of workstations. Assessments will take place before training, at six weeks, and at twelve weeks follow-up. The functional reach test will serve as the primary outcome measure supplemented by comprehensive assessments of functional balance, posturography, and electroencephalography. DISCUSSION: We hypothesize that balance training based on visual feedback will show greater improvements on standing balance performance than conventional balance training. In addition, we expect that learning new control strategies will be visible in the co-registered posturographic recordings but also through changes in functional connectivity.
Mar 03, 2014
Virtual reality for the assessment of frontotemporal dementia, a feasibility study.
Disabil Rehabil Assist Technol. 2014 Feb 14;
Authors: Mendez MF, Joshi A, Jimenez E
Abstract Purpose: Behavioral variant frontotemporal dementia (bvFTD) is a non-Alzheimer dementia characterized by difficulty in documenting social-emotional changes. Few investigations have used virtual reality (VR) for documentation and rehabilitation of non-Alzheimer dementias. Methods: Five bvFTD patients underwent insight interviews while immersed in a virtual environment. They were interviewed by avatars, their answers were recorded, and their heart rates were monitored. They were asked to give ratings of their stress immediately at the beginning and at the end of the session. Results: The patients tolerated the head-mounted display and VR without nausea or disorientation, heart rate changes, or worsening stress ratings. Their insight responses were comparable to real world interviews. All bvFTD patients showed their presence in the VR environment as they moved their heads to face and respond to each avatar's questions. The bvFTD patients tended to greater verbal elaboration of answers with larger mean length of utterances compared to their real world interviews. Conclusions: VR is feasible and well-tolerated in bvFTD. These patients may have VR responses comparable to real world performance and they may display a presence in the virtual environment which could even facilitate assessment. Further research can explore the promise of VR for the evaluation and rehabilitation of dementias beyond Alzheimer's disease. Implications for Rehabilitation Clinicians need effective evaluation and rehabilitation strategies for dementia, a neurological syndrome of epidemic proportions and a leading cause of disability. Memory and cognitive deficits are the major disabilities and targets for rehabilitation in Alzheimer's disease, the most common dementia. In contrast, social and emotional disturbances are the major disabilities and targets for rehabilitation in behavioral variant frontotemporal dementia (bvFTD), an incompletely understood non-Alzheimer dementia. Virtual reality is a technology that holds great promise for the evaluation and rehabilitation of patients with bvFTD and other non-Alzheimer dementias, and preliminary evidence suggests that this technology is feasible in patients with bvFTD.
Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury
Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury.
Neuropsychol Rehabil. 2014 Feb 24;
Authors: Canty AL, Fleming J, Patterson F, Green HJ, Man D, Shum DH
The current study aimed to evaluate the sensitivity, convergent validity and ecological validity of a newly developed virtual reality prospective memory (PM) task (i.e., the Virtual Reality Shopping Task; VRST) for use with individuals with traumatic brain injury (TBI). Thirty individuals with severe TBI and 24 uninjured adults matched on age, gender and education level were administered the VRST, a lexical decision PM task (LDPMT), an index of task-friendliness and a cognitive assessment battery. Significant others rated disruptions in the TBI participants' occupational activities, interpersonal relationships and independent living skills. The performance of the TBI group was significantly poorer than that of controls on event-based PM as measured by the LDPMT, and on time- and event-based PM as measured by the VRST. Performance on the VRST significantly predicted significant others' ratings of patients' occupational activities and independent living skills. The VRST was rated as significantly more reflective of an everyday activity, interesting and was afforded a higher recommendation than the LDPMT. For the TBI group, event and total PM performance on the VRST significantly correlated with performance on measures of mental flexibility and verbal fluency, and total PM performance correlated with verbal memory. These results provide preliminary but promising evidence of the sensitivity, as well as the convergent and ecological validity of the VRST.
Virtual Reality for Sensorimotor Rehabilitation Post-Stroke: The Promise and Current State of the Field.
Curr Phys Med Rehabil Reports. 2013 Mar;1(1):9-20
Authors: Fluet GG, Deutsch JE
Developments over the past 2 years in virtual reality (VR) augmented sensorimotor rehabilitation of upper limb use and gait post-stroke were reviewed. Studies were included if they evaluated comparative efficacy between VR and standard of care, and or differences in VR delivery methods; and were CEBM (center for evidence based medicine) level 2 or higher. Eight upper limb and two gait studies were included and described using the following categories hardware (input and output), software (virtual task and feedback and presentation) intervention (progression and dose), and outcomes. Trends in the field were commented on, gaps in knowledge identified, and areas of future research and translation of VR to practice were suggested.
Mar 02, 2014
Reblogged from Medgadget
People unfortunate enough to lose an arm or a leg often feel pain in their missing limb, an unexplained condition known as phantom limb pain. Researchers at Chalmers University of Technology in Sweden decided to test whether they can fool the brain into believing the limb is still there and maybe stop the pain.
They attached electrodes to the skin of the remaining arm of an amputee to read the myoelectric signals from the muscles below. Additionally, the arm was tracked in 3D using a marker so that the data could be integrated into a moving generated avatar as well as computer games. The amputee moves the arm of the avatar like he would if his own still existed, while the brain becomes reacquainted with its presence. After repeated use, and playing video games that were controlled using the same myoelectric interface, the person in the study had significant pain reduction after decades of phantom limb pain.
Here’s a video showing off the experimental setup:
Feb 09, 2014
A high-fidelity virtual environment for the study of paranoia.
Schizophr Res Treatment. 2013;2013:538185
Authors: Broome MR, Zányi E, Hamborg T, Selmanovic E, Czanner S, Birchwood M, Chalmers A, Singh SP
Abstract. Psychotic disorders carry social and economic costs for sufferers and society. Recent evidence highlights the risk posed by urban upbringing and social deprivation in the genesis of paranoia and psychosis. Evidence based psychological interventions are often not offered because of a lack of therapists. Virtual reality (VR) environments have been used to treat mental health problems. VR may be a way of understanding the aetiological processes in psychosis and increasing psychotherapeutic resources for its treatment. We developed a high-fidelity virtual reality scenario of an urban street scene to test the hypothesis that virtual urban exposure is able to generate paranoia to a comparable or greater extent than scenarios using indoor scenes. Participants (n = 32) entered the VR scenario for four minutes, after which time their degree of paranoid ideation was assessed. We demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment. We suggest that this study offers evidence to support the role of exposure to factors in the urban environment in the genesis and maintenance of psychotic experiences and symptoms. The realistic high-fidelity street scene scenario may offer a useful tool for therapists.
Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial
Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial.
NeuroRehabilitation. 2014 Jan 28;
Authors: Viana RT, Laurentino GE, Souza RJ, Fonseca JB, Silva Filho EM, Dias SN, Teixeira-Salmela LF, Monte-Silva KK
Abstract. BACKGROUND: Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies.
OBJECTIVE: This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals.
METHODS: Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data.
RESULTS: Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID.
CONCLUSIONS: These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.
Dec 21, 2013
Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review.
Age Ageing. 2013 Dec 17; Authors: Miller KJ, Adair BS, Pearce AJ, Said CM, Ozanne E, Morris MM
BACKGROUND: use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity. OBJECTIVE: to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation. METHODS: a systematic review searching 12 electronic databases from 1 January 2000-10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality. RESULTS: fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported. CONCLUSIONS: existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.
Nov 20, 2013
inFORM is a Dynamic Shape Display developed by MIT Tangible Media Group that can render 3D content physically, so users can interact with digital information in a tangible way.
inFORM can also interact with the physical world around it, for example moving objects on the table’s surface.
Remote participants in a video conference can be displayed physically, allowing for a strong sense of presence and the ability to interact physically at a distance.
Nov 16, 2013
Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application.
Clin EEG Neurosci. 2013 Jul;44(3):193-202
Authors: Hillard B, El-Baz AS, Sears L, Tasman A, Sokhadze EM
Abstract. Neurofeedback is a nonpharmacological treatment for attention-deficit hyperactivity disorder (ADHD). We propose that operant conditioning of electroencephalogram (EEG) in neurofeedback training aimed to mitigate inattention and low arousal in ADHD, will be accompanied by changes in EEG bands' relative power. Patients were 18 children diagnosed with ADHD. The neurofeedback protocol ("Focus/Alertness" by Peak Achievement Trainer) has a focused attention and alertness training mode. The neurofeedback protocol provides one for Focus and one for Alertness. This does not allow for collecting information regarding changes in specific EEG bands (delta, theta, alpha, low and high beta, and gamma) power within the 2 to 45 Hz range. Quantitative EEG analysis was completed on each of twelve 25-minute-long sessions using a custom-made MatLab application to determine the relative power of each of the aforementioned EEG bands throughout each session, and from the first session to the last session. Additional statistical analysis determined significant changes in relative power within sessions (from minute 1 to minute 25) and between sessions (from session 1 to session 12). Analysis was of relative power of theta, alpha, low and high beta, theta/alpha, theta/beta, and theta/low beta and theta/high beta ratios. Additional secondary measures of patients' post-neurofeedback outcomes were assessed, using an audiovisual selective attention test (IVA + Plus) and behavioral evaluation scores from the Aberrant Behavior Checklist. Analysis of data computed in the MatLab application, determined that theta/low beta and theta/alpha ratios decreased significantly from session 1 to session 12, and from minute 1 to minute 25 within sessions. The findings regarding EEG changes resulting from brain wave self-regulation training, along with behavioral evaluations, will help elucidate neural mechanisms of neurofeedback aimed to improve focused attention and alertness in ADHD.
Aug 07, 2013
Using avatars to model weight loss behaviors: participant attitudes and technology development.
J Diabetes Sci Technol. 2013;7(4):1057-65
Authors: Napolitano MA, Hayes S, Russo G, Muresu D, Giordano A, Foster GD
BACKGROUND: Virtual reality and other avatar-based technologies are potential methods for demonstrating and modeling weight loss behaviors. This study examined avatar-based technology as a tool for modeling weight loss behaviors. METHODS: This study consisted of two phases: (1) an online survey to obtain feedback about using avatars for modeling weight loss behaviors and (2) technology development and usability testing to create an avatar-based technology program for modeling weight loss behaviors. RESULTS: Results of phase 1 (n = 128) revealed that interest was high, with 88.3% stating that they would participate in a program that used an avatar to help practice weight loss skills in a virtual environment. In phase 2, avatars and modules to model weight loss skills were developed. Eight women were recruited to participate in a 4-week usability test, with 100% reporting they would recommend the program and that it influenced their diet/exercise behavior. Most women (87.5%) indicated that the virtual models were helpful. After 4 weeks, average weight loss was 1.6 kg (standard deviation = 1.7). CONCLUSIONS: This investigation revealed a high level of interest in an avatar-based program, with formative work indicating promise. Given the high costs associated with in vivo exposure and practice, this study demonstrates the potential use of avatar-based technology as a tool for modeling weight loss behaviors.Abstract
May 06, 2013
With the rapid adoption of mobile technologies and the proliferation of smartphones, new opportunities are emerging for the delivery of mental health services. And indeed, psychologists are starting to realize this potential: a recent survey by Luxton and coll. (2011) identified over 200 smartphone apps focused on behavioral health, covering a wide range of disorders, including developmental disorders, cognitive disorders, substance-related disorders as well as psychotic and mood disorders. These applications are used in behavioral health for several purposes, the most common of which are health education, assessment, homework and monitoring progress of treatment.
For example, T2 MoodTracker is an application that allows users to self-monitor, track and reference their emotional experience over a period of days, weeks and months using a visual analogue rating scale. Using this application, patients can self-monitor emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, life stress, depression and anxiety. Self-monitoring results can be used as self-help tool or they shared with a therapist or health care professional, providing a record of the patient’s emotional experience over a selected time frame.
Measuring objective correlatives of subjectively-reported emotional states is an important concern in research and clinical applications. Physiological and physical activity information provide mental health professionals with integrative measures, which can be used to improve understanding of patients’ self-reported feelings and emotions.
The combined use of wearable biosensors and smart phones offers unprecedented opportunities to collect, elaborate and transmit real-time body signals to the remote therapist. This approach is also useful to allow the patient collecting real-time information related to his/her health conditions and identifying specific trends. Insights gained by means of this feedback can empower the user to self-engage and manage his/her own health status, minimizing any interaction with other health care actors. One such tool is MyExperience, an open-source mobile platform that allows the combination of sensing and self-report to collect both quantitative and qualitative data on user experience and activity.
Other applications are designed to empower users with information for making better decisions, preventing life-style related conditions and preserving/enhancing cognitive performance. For example, BeWell monitors different user activities (sleep, physical activity, social interaction) and provides feedback to promote healthier lifestyle decisions.
Besides applications in mental health and wellbeing, smartphones are increasingly used in psychological research. The potential of this approach has been recently discussed by Geoffrey Miller in a review entitled “The Smartphone Psychology Manifesto”. According to Miller, smartphones can be effectively used to collect large quantities of ecologically valid data, in a easier and quicker way than other available research methodologies. Since the smartphone is becoming one of the most pervasive devices in our lives, it provides access to domains of behavioral data not previously available without either constant observation or reliance on self-reports only.
For example, the INTERSTRESS project, which I am coordinating, developed PsychLog, a psycho-physiological mobile data collection platform for mental health research. This free, open source experience sampling platform for Windows mobile allows collecting self-reported psychological data as well as ECG data via a bluetooth ECG sensor unit worn by the user. Althought PsychLog provides less features with respect to more advanced experience sampling platform, it can be easily configured also by researchers with no programming skills.
In summary, the use of smartphones can have a significant impact on both psychological research and practice. However, there is still limited evidence of the effectiveness of this approach. As for other mHealth applications, few controlled trials have tested the potential of mobile technology interventions in improving mental health care delivery processes. Therefore, further research is needed in order to determine the real cost-effectiveness of mobile cybertherapy applications.
Apr 05, 2013
Researchers at Vanderbilt University are studying the potential benefits of using human-looking robots as tools to help kids with autism spectrum disorder (ASD) improve their communication skills. The programmable NAO robot used in the study was developed by Aldebaran Robotics out of Paris, France, and offers the ability to be part of a larger, smarter system.
Though a child might feel like the pink eyed humanoid is an autonomous being, the NAO robot that the team is using is actually hooked up to computers and external cameras that track the kid’s movements. Using the newly developed ARIA (Adaptive Robot-Mediated Intervention Architecture) protocol, they found that children paid more attention to NAO and followed in exercises almost as well as with a human adult therapist.
Mar 11, 2013
Is virtual reality always an effective stressors for exposure treatments? Some insights from a controlled trial
Is virtual reality always an effective stressors for exposure treatments? Some insights from a controlled trial.
BMC psychiatry, 13(1) p. 52, 2013
Federica Pallavicini, Pietro Cipresso, Simona Raspelli, Alessandra Grassi, Silvia Serino, Cinzia Vigna, Stefano Triberti, Marco Villamira, Andrea Gaggioli, Giuseppe Riva
Abstract. Several research studies investigating the effectiveness of the different treatments have demonstrated that exposure-based therapies are more suitable and effective than others for the treatment of anxiety disorders. Traditionally, exposure may be achieved in two manners: in vivo, with direct contact to the stimulus, or by imagery, in the person’s imagination. However, despite its effectiveness, both types of exposure present some limitations that supported the use of Virtual Reality (VR). But is VR always an effective stressor? Are the technological breakdowns that may appear during such an experience a possible risk for its effectiveness? (...)
Full paper available here (open access)
Nov 11, 2012
Thanks to the accellerated diffusion of smartphones, the number of mobile healthcare apps has been growing exponentially in the past few years. Applications now exist to help patients managing diabetes, sharing information with peers, and monitoring mood, just to name a few examples.
Such “applification” of health is part of a larger trend called “mobile health” (or mHealth), which broadly refers to the provision of health-related services via wireless communications. Mobile health is a fast-growing market: according to a report by PEW Research as early as in 2011, 17 percent of mobile users were using their phones to look up health and medical information, and Juniper recently estimated that in the same year 44 million health apps were downloaded.
The field of mHealth has received a great deal of attention by the scientific community over the past few years, as evidenced by the number of conferences, workshops and publications dedicated to this subject; international healthcare institutions and organizations are also taking mHealth seriously.
For example, the UK Department of Health recently launched the crowdsourcing project Maps and Apps, to support the use of existing mobile phone apps and health information maps, as well as encourage people to put forward ideas for new ones. The initiative resulted in the collection of 500 health apps voted most popular by the public and health professionals, as well as a list of their ideas for new apps. At the moment of writing this post, the top-rated app is Moodscope, an application that allows users to measure, track and record comments on their mood. Other popular apps include HealthUnlocked, an online support network that connects people, volunteers and professionals to help learn, share and give practical support to one another, and FoodWiz.co, an application created by a mother of children with food allergies that which allows users to scan the bar codes on food to instantly find out which allergens are present. An app to help patients manage diabetes could not be missing from the list: Diabetes UK Tracker allows the patient to enter measurements such as blood glucose, caloric intake and weight, which can be displayed as graphs and shared with doctors; the software also features an area where patients can annotate medical information, personal feelings and thoughts.
The astounding popularity of Maps and Apps initiative suggests the beginning of a new era in medical informatics, yet this emerging vision is not without caveats. As recently emphasized by Niall Boyce on the June issue of The Lancet Technology, the main concern associated with the use of apps as a self-management tool is the limited evidence of their effectivenes in improving health. Differently from other health interventions, mHealth apps have not been subject to rigorous testing. A potential reason for the lack of randomized evaluations is the fact that most of these apps reach consumers/patients directly, without passing through the traditional medical gatekeepers. However, as Boyce suggests, the availability of trial data would not only benefit patients, but also app developers, who could bring to the market more effective and reliable products. A further concern is related to privacy and security of medical data. Although most smartphone-based medical applications apply state-of-the-art secure protocols, the wireless utilization of these devices opens up new vulnerabilities to patients and medical facilities. A recent bulletin issued by the U.S. Department of Homeland Security lists five of the top mobile medical device security risks:
- Insider: The most common ways employees steal data involves network transfer, be that email, remote access, or file transfer;
- Malware: These include keystroke loggers and Trojans, tailored to harvest easily accessible data once inside the network;
- Spearphishing: This highly-customized technique involves an email-based attack carrying malicious attack disguised as coming from a legitimate source, and seeking specific information;
- Lost equipment: A significant problem because it happens so frequently, even a smartphone in the wrong hands can be a gateway into a health entity’s network and records. And the more that patient information is stored electronically, the greater the number of people potentially affected when equipment is lost or stolen.
In conclusion, the “applification of healthcare” is at the same time a great opportunity for patients and a great responsibility medical professionals and developers. In order to exploit this opportunity while mitigating risks, it is essential to put in place quality evaluation procedures, which allow to monitor and optimize the effectiveness of these applications according to evidence-based standards. For example, iMedicalApps, provides independent reviews of mobile medical technology and applications by a team of physicians and medical students. Founded by founded by Dr. Iltifat Husain, an emergency medical resident at the Wake Forest University School of Medicine, iMedicalApps has been referred by Cochrane Collaboration as an evidence-based trusted Web 2.0 website.
More to explore:
Read the PVC report: Current and future state of mhealth (PDF FULL TEXT)
Watch the MobiHealthNews video report: What is mHealth?
Sep 03, 2012
Telemed J E Health. 2012 Jul 23;
Authors: Yellowlees PM, Holloway KM, Parish MB
Abstract. Background: As virtual reality and computer-assisted therapy strategies are increasingly implemented for the treatment of psychological disorders, ethical standards and guidelines must be considered. This study determined a set of ethical and legal guidelines for treatment of post-traumatic stress disorder (PTSD)/traumatic brain injury (TBI) in a virtual environment incorporating the rights of an individual who is represented by an avatar. Materials and Methods: A comprehensive literature review was undertaken. An example of a case study of therapy in Second Life (a popular online virtual world developed by Linden Labs) was described. Results: Ethical and legal considerations regarding psychiatric treatment of PTSD/TBI in a virtual environment were examined. The following issues were described and discussed: authentication of providers and patients, informed consent, patient confidentiality, patient well-being, clinician competence (licensing and credentialing), training of providers, insurance for providers, the therapeutic environment, and emergencies. Ethical and legal guidelines relevant to these issues in a virtual environment were proposed. Conclusions: Ethical and legal issues in virtual environments are similar to those that occur in the in-person world. Individuals represented by an avatar have the rights equivalent to the individual and should be treated as such.