Information Management System of Remote Rehabilitation for Stroke Patients

WangYue, Song Xiaofeng, Tao Ling, Li Weitao Department of Biomedical Engineering

Nanjing University of Aeronautics and Astronautics Nanjing 210016, China

wangyuesaiche@yahoo.cn; xfsong@nuaa.end.cn

Fang Qiang Medical Spectroscopy Department

Suzhou Institute of Biomedical Engineering and Technology

Suzhou , China qfang@sibet.ac.cn

Abstract—This paper describes the design and implementation of an information management system of remote stroke rehabilitation based on Internet, including the concept of the system, the composition of the system, implementation of the system, the key technologies of implementation of the system, the functional design of the system, the division of authority for the patients and doctors as well as the process of online rehabilitation. The system is in line with China’s national conditions, which will open new avenues for stroke rehabilitation. And it’s helpful to solve the problems caused by constrains of medical resource, which results in the patient is unable to timely medical treatment, and lack of professional guidance. It also contributes to promote the popularization and development of the stroke rehabilitation in China.

Keywords—Stroke; Remote Rehabilitation; Internet;

I. INTRODUCTION Stroke will result in movement disorder and disability

of the patient's limb, so that the quality of patient's life is declined, and even daily living is lost. In order to restore and rebuild the function of the disabled limb, exercise therapy and occupational therapy to alleviate the symptoms of patients with hemiplegia in the rehabilitation medicine. However, with the intensification of the extent of China's aging population, while the elderly is a high risk of stroke, resulting in the resources of hospitals and rehabilitation physician are increasingly strained. The rehabilitation for stroke patients would relieve shortages of medical resources effectively, if they train at home or in the community. Some literatures[1,2] show that, rehabilitation in the community or at home can significantly promote the recovery of motor function of hemiplegic stroke patients with activities of daily living, and improve the quality of their life. However, the rehabilitation for stroke patients in the community or at home will be faced with a lack of professional guidance, so that they can not clear the current effect of the rehabilitation program. The telemedicine technologies based on computer and Internet has gone deep into the various areas of health [3]. If the concept of telemedicine could be applied to the field of rehabilitation, it is possible

that stroke patients can take rehabilitation at home or in the community.

The goal of this project is to create an information management system of stroke rehabilitation, which is based on the technology of the Internet and computer networks, and is in line with China's national conditions. Stroke patients through the use of the system and combined stroke intelligent training system can achieve the objectives that, they take remote intelligent rehabilitation without geographical restrictions. The Rehabilitation specialists develop rehabilitation prescription in a timely manner according to the training situation, and they guide to the patients individually and professionally. The preliminary experimental results show that the system can effectively alleviate the problems such as the current tight resources of health care, and inconvenience for the patient visiting, so the stroke patients can receive professional rehabilitation timely.

II. THE OVERALL DESIGNING SCHEME The overall designing scheme and objectives of the

project is that, the technology of remote communication based on Internet, the technology of computer intelligence and medicine of rehabilitation are combined to create the human-computer interaction method for remote rehabilitation of stroke patients. Through the remote rehabilitation model, the establishment of information exchange and coaching services network (as shown in Figure 1) between experts with patients in other areas or primary hospital, or rehabilitation community

III. THE CONSTITUTE AND REALIZATION OF THE INFORMATION MANAGEMENT SYSTEM OF REMOTE

REHABILITATION FOR STROKE PATIENTS

A. The composition of the information management system of remote rehabilitaion for stroke patients

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Figure 1 Overall design philosophy

The basic framework of the information management system of remote rehabilitation for stroke patients is based on Internet, as shown in figure 2. The entire system consists of a network server platform, the rehabilitation system database and the rehabilitation site. Through the network server platform， it can release the results and the program of rehabilitation; Through the MYSQL database ，it can store the various data (patients, doctors, rehabilitation, file about rehabilitation programs, rehabilitation results, rehabilitation evaluation, as well as the links between the various tables of database), and it can realize the function that inputting and querying the information, formulating rehabilitation plan, and querying the training results, to achieve data sharing for patients or doctors in charge; Through the stroke rehabilitation sites, patients and doctors achieve a variety of operations, for example, patients take training and assessment online, and doctors manage the patients who have already registered (by creating a file of case).

Figure 2 Basic framework of information management system of

remote rehabilitation for stroke patients

B. The realization of the information management system of remote rehabilitaion for stroke patients By using Windows Server 2003, Apache, PHP, and

MySQL, we constructed the information management system of remote rehabilitation for stroke patients. The development environment is built by Windows Server 2003 operating system and web server platform is built by WAMPSERVER; the rehabilitation system database is built by using the MySQL; the stroke rehabilitation website is used by PHP, HTML and JavaScript. Evaluation system for motor function of hemiplegic upper limb of stroke patients is written in PHP.

IV. THE OVERVIEW OF STRUCTURE AND FUNCTION OF REMOTE REHABILITATION SYSTEM

A. Analysis of the roles and the division of authority The remote rehabilitation system for stroke patients

consists of three sub-systems: the training system for patients, management system for the doctors in charge and management system for administrators. On the basis of the analysis of the actual clinical workflow and the needs of the different roles or duties, a clear demarcation of the various subsystems of patients, doctors, and administrator is made. This division is to make the operation of the different roles more clearly, more targeted, more convenient to use. The three subsystems contain different functional modules in the information management system. And its classification and structure are clear, these functional modules organized organically to form their own unique functional subsystems (see Figure 3).

Information Management System For Remote Rehabilitation

Training System For Patients

Management System For Doctors

Management System For

Administrators

Module Of Basic Personal Information

Management

Module Of Querying Rehabilitation Records

Module Of Querying Rehabilitation Prescription

Module Of Querying Rehabilitation Results

Module Of Basic Personal Information

Management

Module Of Rehabilitation File Management

Module Of Rehabilitation PrescriptionManagement

Module Of Video Guidance

Module Of Managing All Patients and Doctors

Module Of Managing All Patients With Rehabilitation

Exercise Prescription

Module Of Arranging Doctors To Patients

Module Of Managing All Recovered DataModule Of Generating

Rehabilitation Report

Module Of Rehabilitation Information Feedback

Module Of Querying the Rehabilitation Results

Module Of Managing Patient

Module Of Generating Rehabilitation

Report

Module Of Managing Patients’Message

Module Of Managing All Hospitals and Communities

Module Of Audit New Doctors

Module Of Generating All Patients’ Report

Module Of Querying All Patients’ Rehabilitation

Results

Module Of Managing Doctors’ and Patients’

Messages Figure 3 Structure of system function for patients, doctors in

charge, and administrators

1) management system for doctors in charge Each doctor is confined to responsible for his own

patients, and he has no right to manage, or to access the relevant pages of other patients who is managed by other doctor. So it is effective to protect the privacy of patients, and it also can ensure the information securely. There are four kinds of functions in the management system for the doctor in charge.

a) Admin To add, query, and change patient information and

other related operations, realize the patient rehabilitation training management and supervision.

b) Management of rehabilitation training programs

To select and develop personalized rehabilitation exercise prescription based on the patient's specific situation.

c) View rehabilitation training videos

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When a patient is making rehabilitation training, he can view the ongoing training video. That can provide a real-time guidance to the patient.

d) Generate training reports According to the actual situation of the patients and

training records, it can generate a specialized rehabilitation analysis report, which is as guidance to the patients in the next phase of rehabilitation and the patients can keep abreast of their rehabilitation.

2) Management system for the administrators Administrator's duty is to ensure the normal operation

of the entire system. And in accordance with the actual situation of the rehabilitation patients belonged to the community or hospital, the administrators are divided into the administrators of total system, the administrators of hospital and the administrators of community. The administrators of total system has the highest authority, they are responsible for the managing all patients, all doctors, all the administrators of hospital and all the administrators of community, and it also contains the module of the doctor management system (including managing patients’ information, making rehabilitation exercise prescription for patients, viewing patients’ movement data and generating rehabilitation reports, etc.). A new administrator of hospital or a new administrator of community who wants to add to the remote rehabilitation system must go through the total administrator's license; the total administrator also has the highest "View" permission, which means that he can view the information of all patients and all doctors in the system. The administrators of hospital and the administrators of community can only manage the physicians and patients in their own hospitals or communities, but not view and manage the physician or patient’s information in the others’ hospitals or communities. It can make this system widely used in hospitals or communities.

3) Rehabilitation training system for patients There are many modules in rehabilitation system for

patients, including querying the file of rehabilitation, querying the training programs, querying the results of rehabilitation and generating the report of rehabilitation and other modules. After a patient logged in the home of patients, the registered user name and password need to enter before they can enter the “training system for patients”. It is able to query the latest rehabilitation exercise prescription, and take rehabilitation training according to the rehabilitation exercise prescription after landing; He also can query to the results of the current training, as well as their own the results of the conventional training and evaluation of his doctor in charge. And the patient is required to train in accordance with the rehabilitation exercise prescription made by his doctor in charge, but he can’t select the training content at liberty.

B. Using process of the stroke rehabilitation websit When using the network system of the remote

rehabilitation for stroke, the operation of the patients and the doctors are based on the actual rehabilitation process. The remote users (patients and doctors) only to visit the IE browser into stroke rehabilitation network system, and login to each system，then the operation can be carried

out in accordance with the different needs. The specific steps about how to use the system are shown in Figure 4.

Figure 4 The using process for stroke rehabilitation website

V. INTERFACE DESIGN OF REHABILITATION SYSTEM The tool of Photoshop and the programming language,

which including CSS, JavaScript, and HTML are used to design the interface, following several figures shows a part of the rehabilitation site interface.

Figure 5 The interface of managing all users

Figure 6 The part of page which shows patient’s information

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Figure 7 The page of showing patient’s motion data and results

Figure 8 The page of generating patient’s analysising report

VI. ADVANTAGEOUS FEATURES AND APPLICATING PROSPECTS OF INFORMATION MANAGEMENT SYSTEM OF

REMOTE REHABILITATION Although remote rehabilitation mode has been the

medical profession widespread concern and research, but it rarely applied to the field of rehabilitation for patients with post-stroke hemiplegia. In this study, establishing and reality of remote rehabilitation system has the following advantageous features:

1) It follows the actual rehabilitation process and the way. The roles of users in the site are divided into rehabilitation patients, doctors and administrators, and each character has explicit authority to operate, which is effective to protect the user's privacy.

2) Each rehabilitation patient has his own rehabilitation physician who is designated by administrator, and each rehabilitation doctor can simultaneously manage multiple patients. Doctors working in any hospitals can register on the site and apply for the online doctor.

3) The information and the parameters in the rehabilitation process are recorded at length, including doctor’s guidance and assessment to patient, and the number(time, score) of patients to complete the actions, and so on. Through the information recorded on the website patient can keep abreast of the patient's rehabilitation situation, the doctor in charge can update

the patient's rehabilitation program, and develop the specific rehabilitation program.

The emergence of information management system of remote rehabilitation for stroke patients makes rehabilitation patients with post-stroke hemiplegia train under the guidance of rehabilitation experts, no longer limited by time and space. And they can have several intensive training with their body circumstance permission in one day. The combination of computer network technology and modern rehabilitation can be an effective solution to the problem that stroke patients is increasing, hospital resource constraints, and the shortage of rehabilitation doctors.

The information management system of remote rehabilitation for stroke patients will not only link the rehabilitation experts and rehabilitation patients in different areas, but also establish a platform between rehabilitation specialists and primary rehabilitation community for the exchange of information and business, which may promote the medical staff in the primary health care sector raising their professional level.

VII. ACKNOWLEDGEMENTS The study was supported by grants from National

Natural Science Foundation of China (No. 61171191) and Natural Science Foundation of Jiangsu Province in China (BK2010500).

REFERENCES [1] M. L. Rao, China Guideline for Cerebrovascular Disease

Prevention and Treatment. Beijing: People's Medical Publishing House, 2007, ch. 1.

[2] X. F. Jiang, X. Y. Hu, G. X. Xiong, et al, “Related Factors of Rehabilitation Training for Stroke Residents in Beijing Community,” Chin J Rehabil Theory Pract, vol. 16, no. 11, pp. 1080-1082, 2010

[3] X. P. Hui, J. Bai, Z. Wang, et al, “The Construction of Remote Cognitive Rehabilitation System ,” Chin J Rehabil Theory Pract, vol. 13, no. 10, pp. 901-903, 2007

[4] Q. L. Deng, L. L. Pang, L. Y. Nong, “The Effect of Community Home-based Nursing Intervention on The Rehabilitation of Stroke Patients,” Internal Medicine of China, vol. 5, no. 3, pp. 250-252, 2010.

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