COGNITIVE AND PHYSICAL TRAINING MEDICAL RECORD,

A WEB SERVICE BASED ARCHITECTURE

E. I. Konstantinidis, A. Billis and P. D. Bamidis

Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Keywords: Cloud-computing, Web service, Physical training, Cognitive training, Medical record.

Abstract: Organizing, tracking, monitoring, and acting upon personal health and especially cognitive and physical

training information has nowadays become a necessary and important procedure. This is true particularly for

special groups of people with cognitive or physical impairments (or both). Elderly people with mild

cognitive impairments, autistic children and other categories of people with impairments may obtain

benefits by having their daily cognitive and physical activity been monitored. This piece of work, proposes

an approach towards a solution for a physical and cognitive medical record held upon the cloud, and

accessed through web services. In this way, various semantically described exercises and training platforms

may exchange information with the record system and access user performance results obtained in the

context of a standardized description of exercises with suitably associated results and scores.

1 INTRODUCTION

A famous ancient greek quotation has expressed the

importance of having in good health both mind and

body: “a sound mind into a sound body”; this has

praised the need for people to equally keep their

minds and bodies in good shape, so as to have a

well balanced life and overall improved well being,

that also includes their phychological status and self-

esteem.

It is common knowledge that nowadays, the

western way of life has changed dramatically, and is

mainly characterized by a complete absence of any

kind of physical activity among daily living

activities (Trost et al, 2002). This situation has led to

many severe health problems responsible for a

significant percentage of deaths among the western

world, such as obesity (Fox and Hillsdon, 2007),

coronary artery disease (Fox et al, 1972), arterial

hypertension, mobility impairments. There is

sufficient evidence that people, who try to keep fit

through exercise, are benefited to a certain extent in

several aspects of their health, including: reduced

risk of cardiovascular disease (Braith And Stewart,

2006), (Pollock et al, 2000), prevention of the

development of arterial hypertension, control of

diabetes, increased fat utilisation which can help to

control weight, lowering the risk of obesity

(Kesaniemi et al, 2001), maintenance of cognitive

functions and decreased risk of developing

depression and dementia in senior citizens (Van

Boxtel et al, 1997), (Perrig-Chiello et al, 1998) and

finally moderation of stress (Hill et al, 1993).

It is imperative that in recent years, numerous

information and communication technology (ICT)

resources have become available to facilitate

exercise and enrich a fitness training program. Apart

from the traditional gym equipment, such as plain

stationary or ergometer bikes, treadmills, dumbbells,

there are also new trends in the way physical

exercise is performed, such as “exergaming”

(Bogost, 2005). Exergaming, which has lately drawn

the attention of training experts, is a form of exercise

through the use of video games whose main focus is

the improvement and promotion of physical health

of individuals through interactive game play. The

way individuals can train themselves through a

video game, is to physically interact with its content.

Physical interaction means that a trainee via his/her

body movements can manipulate a virtual character

on the game screen, imitating this way different

kinds of sport activities, like walking or running

(Bonanni et al, 2006), (Mumford et al., 2008). Great

examples of commercial exergaming platforms are

Nintendo Wii Fit, XBOX Kinect, DDRs (Dance

Dance Revolution) like Dance Town (focus on

elderly population), ConnectAndPlay, Positive

Gaming and many others (Billis et al, 2010).

529

I. Konstantinidis E., Billis A. and D. Bamidis P..

COGNITIVE AND PHYSICAL TRAINING MEDICAL RECORD, A WEB SERVICE BASED ARCHITECTURE.

DOI: 10.5220/0003450405290534

In Proceedings of the 1st International Conference on Cloud Computing and Services Science (CLOSER-2011), pages 529-534

ISBN: 978-989-8425-52-2

 2011 SCITEPRESS (Science and Technology Publications, Lda.)

Apart from the health problems related to

physical inactivity, people are also exposed to

cognitive and mental illnesses. These might occur at

any time of the human’s lifespan, from early stages

of human life to old age. Examples of such cognitive

illnesses are attention deficit-hyperactivity disorder

(ADHD), autism spectrum disorders, schizophrenia,

dementia and stroke. Most of the above mentioned

pathological situations result to multiple cognitive

and other deficits, thereby leading to partial brain

mulfunctioning. Much research has focused on the

design and the application of cognitive intervention

and rehabilitation programs (Solberg et al., 1994),

(Merzenich et al, 1996) so to ameliorate most of the

effects that the above mentioned situations have on

human cognitive health.

Computer-assisted interventions have shown

some very promising results in several areas of

therapy and rehabilitation research (Hofmann et al,

1996), (Galante et al, 2007), (Tárraga et al, 2006),

(Barnes et al, 2009). Computer games have also

proved to be of great value for the overall brain

function in several cases (Gamberini et al, 2006),

(Green and Bavelier, 2003).

All this plethora of applications and technology

devices form a significant field of interest as their

primary goal is to promote and enhance either the

physical or cognitive human health. These

applications target to a wide range of groups with

either different or similar profiles of health

problems.

This piece of research work focuses on a service

that can support special groups of people towards

their physical and cognitive health, as well as, their

independent living. The aim of the paper is to

propose an approach towards a solution for a

physical and cognitive medical record held upon the

cloud, and accessed through web services, thus

delivering a PaaS for the development, testing and

deployment of either already existing software

solutions or future developments. So, in the

remaining of this paper the principles of the

undertaken architecture and the technical design

details of the proposed service are described, with

emphasis drawn upon the web service architecture

and the underlying database. It is shown in section 2

how the service combines structures, methods and

functionalities on cognitive exercises against

cognitive decline with physical activity in the

framework of an advanced ambient assisted living

environment (Konstantinidis et al, 2010). Section 3

presents scenarios of use, while a critical discussion

and outlook are provided in the final section.

2 MATERIALS AND METHODS

As mentioned already, the main service is comprised

of three different categories according to the training

field:

• Cognitive Training

• Physical Training

• Independent Living

The service functionalities and methods are designed

in a way that they are able to be consumed by

already existing as well as future applications and

hardware systems that deal with data related to the

above three categories. Thus, sensors that monitor

movements inside the house (movement and activity

patterns), software dedicated to cognitive training

and rehabilitation and various training equipment,

such as recumbent bikes and/or ergometers and/or

treadmills, which offer a variety of physical

exercising possibilities according to the special

needs and disabilities of each user, find a ready-to-

use and well described data layer supporting their

main functionalities.

2.1 Data Layer

The proposed service implements a model based on

the integration of independent components,

accomplishing different scopes of application, which

provide heterogeneous data and semantics.

According to these requirements the proposed

architecture supports the integration of the data and

the co-ordination of the components’ functionalities,

while acting either independently or in the

framework of an interconnected training

environment.

Independent fundamental entities in the database

provide information for the candidate applications

(the kind of the application, the available exercises,

the score algorithm, the target group, etc.) and the

type of exercises they support (description of

exercise, difficulty levels, required devices if any,

etc.). As a result, the database includes a

semantically described schema of different training

systems. This schema is updated by including new

training components and new training devices.

The upper data layer provides information about

the user interactions with the available training

components, performance, daily compliance to the

training schedule and monitoring of activities. The

proposed service acts as the heart of the training data

repository. This repository depicts the cognitive and

physical health of the user.

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530

2.2 Methods and Structures

The main functionality of the three independent

components is met by means of a server side system,

whose main component is the proposed service. The

web service is responsible for providing all methods

and functions in order to support the three

independent component functions as it is depicted in

Figure 1. Moreover, the web service is responsible

for the authentication of the system’s users

according to their role and the provision of access

rights on certain information of the database.

Figure 1: The web service supports the three independent

components.

Providing programming access to the system’s

features and services, the Web Service includes the

Simple Object Access Protocol (SOAP), Web

Services Definition Language (WSDL), and the

XML Schema Definition language (XSD). These

standards are supported by a wide range of

development tools on a variety of platforms.

The web service provides structures (an example

is given in Table 2) as inputs and outputs to all

supported methods. All structures and methods are

well described by a human readable document which

is publicly available. Moreover, each structure is

accompanied by an “error” structure in order to

facilitate appropriate message exchange with the

components.

Table 1: Structure for senior’s demographic data example.

<s:complexType name="user"> <s:sequence>

<s:element minOccurs="1" maxOccurs="1"

name="user_id" type="s:int"/>

<s:element minOccurs="0" maxOccurs="1"

name="lname" type="s:string"/>

<s:element minOccurs="1" maxOccurs="1"

name="birthdate" type="s:dateTime"/>

………………………………………...

</s:sequence>

</s:complexType>

For example, in order to add an activity

performed by a user we use the method shown in

Table 2. It behaves as a log file of the user’s

progress and activities. The required attributes that

must be provided are shown in Table 2.

Table 2: User cognitive activity attributes.

Attribute Description

user_id The ID of the user performing the activity

ctcactivityid The Cogntitive Training Activity performed

by the User

ctcid The Cognitive Training Component used by

the user in order to perform the Activity

datetimestart The date and time that the activity started

datetimeend The date and time that the activity ended

score The score achieved by the User

level The level of difficulty of the performed

Cognitive Training Activity

An example using LLM web service method to

record user’s performance to a certain CTC activity:

ctcactx = new CTCUserActivity();

ctcactx.ID = 0;

ctcactx.ctcid = 4;

ctcactx.ctcactivityid = 3;

ctcactx.user_id = 10;

ctcactx.datetimestart = new

DateTime(2010, 6, 21, 10, 00, 00);

ctcactx.score = "23";

ctcactx.level = 5;

ctcsac = AddCTCUserActivity(ctcactx,

“username”, “password”);

if (ctcsac.error.ErrorCode == 0)

ctcactx =

ctcsac.CTCUserActivityList[0];

More information on the complete list of

functionalities and data structures that are supported

by the web service can be found at

https://nosmoke.med.auth.gr/Pilotsllm/LLMWebSer

vice.asmx?WSDL.

2.3 User’s Roles

As discussed above, the web service is responsible

for the authentication of the system’s users

according to their role. Different roles accomplish

different privileges on data and methods based on

the relation link among users (supported by the

service). The main roles of the system are:

 User

 Relative

 Therapist

 Administrator

A user is performing the system’s activities and has

the privileges for his own data and methods. The

therapist is able to monitor the users related to him.

She/he is responsible for accessing the daily

COGNITIVE AND PHYSICAL TRAINING MEDICAL RECORD, A WEB SERVICE BASED ARCHITECTURE

531

schedule programme and providing special

notifications to individual users. The administrator

of the system has all the available privileges for

supporting the system and adding new

functionalities. Finally, the “relative” role is a user

that may monitor another user’s performance

without being able to modify anything.

3 SCENARIOS OF USE

The open architecture enables already developed or

future products to benefit by gaining access to

correlative results of familiar applications or

enriching their results by different types of

applications. The former strategy enables

applications to compare their results with results

from familiar applications regarding a specific user.

As the training components, their functions,

exercises and results are semantically described the

cognitive and physical performance curve is

comparable among different applications. As a

result, each application and protocol has the

opportunity to be enriched in form of several

different amounts of data results. The latter strategy,

which makes use of heterogeneous data information,

provides semantic data of different scopes for each

user. For example, a cognitive training component

for elderly people may enrich its results by having

access or correlating them with the user’s (specific

user) physical training activity. Useful results may

accrue by the type and intensity of affection or even

mood, if any, among training activities.

Figure 2: The proposed service acts as a gateway of

intercommunication among different applications on the

cloud.

Meanwhile, the semantically described training

activities and their results should be the spark for

evaluating different standards on cognitive and

physical training. As a result, a life-long physical

and cognitive medical record is to take shape.

Forming a holistic framework, the proposed

platform serves an abstract semantic communication

layer among training applications and protocols.

Cloud computing may promote this layer as a

gateway of intercommunication among applications

serving different scopes of data, as depicted in

Figure 2.

Figure 3: Indicative Cognitive Training results during an

iterative trial of the system by senior citizens within the

Long Lasting Memories European Commission Project

(see www.longlastingmemories.eu for further details).

The described service has been initially

developed for the needs of the Long Lasting

Memories European Commission Project (LLM EU

project, 2010). This project utilizes a number of

remotely operated screens, which are embedded in

the independent living environment and connected

to training equipment (like recumbent bikes,

ergometers or treadmills). Light physical exercises

are combined with a targeted set of cognitive

exercises, while the environment's sensors ensure the

safe and enduring application of this training,

adjusting, intervening or providing motivation

according to each person’s achievements and

status/situation (Frantzidis & Bamidis, 2009). Figure

3 depicts results of cognitive training during a

certain period of time. The results show summarized

scores (and not raw data – i.e. log files) during a

session of similar exercises (Cognitive Training in

this case). Thus, each score represents a meaningful

status of the user’s performance, which is available

through the cloud and may accompany each user

(senior in this case) in every aspect/step of his/her

life, thereby contributing to the continuity of care

EU policy target.

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4 DISCUSSION

The research presented in this paper focuses on the

development of an integration scheme for various

independent applications that target on the

promotion of physical and cognitive health. The

integration of the applications is tackled on the basis

of a web service and a database schema. Possible

usage extension of the proposed framework is the

creation of an application gateway, where each

application will be able to interchange information

and data through the data pool that is created and be

shared via the open web service’s architecture and

database scheme. A possible extension to the

existing infrastructure could be the introduction of

an additional web service implementing Dynamic

Decision Support System techniques in order to

provide some automation techniques and add

intelligence to the end system.

The existing framework combined with the

future developments will allow the creation of a

unique data pool that will focus on the physical and

cognitive status of possible users, envisaging to set

some standard way and technology for describing

and exploiting applications within the nowadays

chaotic field of physical and mental health.

ACKNOWLEDGEMENTS

This work is partially funded by the LLM Project

(www.longlastingmemories.eu) through the ICT

Policy Support Programme (ICT PSP) as part of the

Competitiveness and Innovation Framework

Programme of the European Commission.

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