Tracking, Analysis and Sonification of Movement and Breathing for Supporting Physical Activity in Chronic Pain Using The Go-with-the-flow Framework
Background
Chronic pain (CP) is a prevalent condition where pain persists for more than six months without tissue damage [1], which results from changes in the nervous system that lead to pain amplification; it affects 7.8 million people in the UK costing the national health service about £12 billion per annum [2]. Clinical resources cannot meet demand and many people do not get the help they need. Psychological factors such as fear and anxiety about activity exacerbating pain or damage restrict lives [3]. While technology has been used to monitor activity, it lacks the necessary psychological support. Technology modeled on other conditions such as stroke has also been developed for CP rehabilitation but ignores psychological factors particular to CP.
Aims
In this work, we present and evaluate a new sonification framework, Go-with-the-Flow [4,5], informed by studies with physiotherapists and people with CP implemented through an app to track and give feedback on movement and breathing. The evaluation aimed to understand how the sonification of movement and breathing based on the Go-with-the-flow framework facilitates both physical exercise and everyday functioning in people with CP.
The framework proposes articulation of user-defined sonified exercise spaces (SESs) tailored to psychological needs and physical capabilities to enhance body and movement awareness and rebuild confidence in physical activity. Sonification feedback shifted focus to an external pleasurable and informative representation of the body as it moves rather than pain or feared movement. The sonification was designed to address various important factors that emerged from the qualitative studies with people with chronic pain and physiotherapists:
• Increase awareness of body movement to increase confidence in doing feared exercises: Sound is used to define an exercise space characterised by anchor points, points where the sonification rules change. These anchor points give information about body position with respect to the movement being executed and can be used by people to set targets.
• Skills acquisition to take control of their own physical rehabilitation: Anchor points and sonification intervals are calibrated through exploring a person’s own body movement. To set an anchor point, the person performs the movement to the specific point and then stores it through a button connected to the app. The calibration phase is a body exploration phase (as done by physiotherapist) before the person starts to fully engage in the exercise. The app can be recalibrated any time, as needed, to address change in capability even for the same individual (e.g. daily variability in level of pain). Self-calibration can help people to discover physical capabilities and psychological needs, tailor activity to physical and psychological resources and gradually build capabilities.
• Increase perceived value in moving to increase self-efficacy and reward: Sonification steps (e.g., distance between two notes) are calibrated to the psychological and physical capability of the person to do a movement. This ensures that even when people have restricted physical capability, small movements are still rewarded and they are motivated to continue the movement. For example, in a reaching forward stretch, the interval between two consecutive notes is reduced to reward a very limited bending of the trunk. These steps are calibrated based on anchor points set by the individual.
• Provide sense of achievement and reward through the shape of the sound (e.g. ascending scale indicates climbing and achieving) to mark target attainment.
• Increased awareness of protective movement: Protective behaviour may indicate increased anxiety towards the movement being performed or automaticity reached over time. Alterations to the sonification are implemented when the sensor detects protective behaviours. For example, adoption of an asymmetric position to avoid using a stiff or painful body part, alters the sound feedback to only play in one ear. Two protective behaviours are currently detected by the app: increased or decreased speed of movement and asymmetry of the movement.
• Focus on neutral or pleasurable sensations when anxiety is detected: Sonification feedback and reminders to breathe to address anxiety detected by shallow breathing, holding breath or breathing change from abdominal breathing to increased thoracic breathing.
Methods
We iteratively designed and evaluated a wearable app that used smartphone kinematic and sensors to sense movement and Arduino-based respiration chest belts to detect breathing patterns related to anxiety (see Figure 1). Studies were conducted to evaluate the framework with people with CP: a control study (n=15), a focus group (n=5), observation of people with CP using the device at home (n=9) and finally a 2-week self-directed use of the device (n=4).
Results
Our studies indicated that increased body movement awareness through sound feedback increased self-efficacy and confidence. Using their own body as a tool to set fine-grained goals/targets and tailoring feedback to self-calibrated psychological and physical capability and rewarding even small movements increased self-efficacy and perceived value of movement.
The evaluation showed that people reported increased perceived efficacy, control, motivation and pleasure in carrying out feared exercises when using the app [4]. The results of the control study reveal that people found that the sonification framework tailored to specific psychological and physical needs increased self-efficacy, performance, and motivation. More informative sound feedback scored significantly higher on all the scales except relaxation. Also, people showed a preference for less complex but more informative sonifications and these aided self-directed activity. In addition, sonification alterations that increase awareness of people’ use of protective behaviour information such as guarding movement were found to be very useful by both people with CP and physiotherapists for their potential in improving efficacy of physical activity sessions. In addition, the wearable device demonstrated the possibility of skills transfer from exercise to functional movements (i.e., every day activity). Figure 2 shows the results from the control study.
Conclusions
Our studies show that a self-defined SES calibrated to individual psychological needs helps to increase awareness, motivation, performance and relaxation in physical activity and can support people to gain confidence in activity and transfer gains to their everyday lives. This approach could be useful in other chronic conditions where progress in physical activity rehabilitation and self-management is undermined by anxiety about physical vulnerability.
References
REFERENCES:
[1] International Association for the Study of Pain, “Introduction”, Pain, vol. 24(Supplement 1), S3–S8, 1986.
[2] The Health and Social Care Information Centre, Chronic Pain [Online] http://www.hscic.gov.uk/catalogue/PUB09300/HSE2011-Ch9-Chronic-Pain.pdf Accessed: 15 October 2015. 2011
[3] D. Turk and A. Okifuji, “Psychological factors in chronic pain: evolution and revolution”, J Cons & Clin Psychol, vol. 70, p. 678, 2002.
[4] A. Singh, S. Piana, D. Pollarolo, G. Volpe, G., Varni, A. Tajadura- Jiménez, A.Williams,A. Camurri, and N. Bianchi-Berthouze. “Go-with-the-flow: Tracking, Analysis and Sonification of Movement and Breathing to Build Confidence in Activity Despite Chronic Pain.” in HCI, in press
[5] A. Singh, A. Klapper, J. Jia, A. Fidalgo, A. Tajadura-Jimenez, N. Kanakam, N.Bianchi-Berthouze, A. Williams (2014). “Motivating People with Chronic Pain to do Physical Activity: Opportunities for Technology Design” in Proceedings of the 32nd ACM Conference on Human Factors in Computing Systems (ACM CHI 2014).
Keywords:
Chronic Pain,
self-management,
physical activity,
wearable app,
Digital Health,
self-efficacy,
tracking,
Sonification,
movement analysis
Conference:
2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016.
Presentation Type:
Poster presentation
Topic:
Academic
Citation:
Singh
A,
Bianchi-Berthouze
N and
Williams
A
(2016). Tracking, Analysis and Sonification of Movement and Breathing for Supporting Physical Activity in Chronic Pain Using The Go-with-the-flow Framework.
Front. Public Health.
Conference Abstract:
2nd Behaviour Change Conference: Digital Health and Wellbeing.
doi: 10.3389/conf.FPUBH.2016.01.00087
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Received:
27 Nov 2015;
Published Online:
09 Jan 2016.
*
Correspondence:
Ms. Aneesha Singh, UCL, London, United Kingdom, aneesha.singh.10@ucl.ac.uk