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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 1  |  Issue : 2  |  Page : 121-126

Design a new home-based multifunctional physiotherapy device for musculoskeletal pain relief


1 Department of Biomedical Engineering, Faculty of Medical Sciences and Technologies, Islamic Azad University, Science and Research Branch, Tehran, Iran
2 Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
3 Department of Electrical, High Education Institute of Hatef, Branch of Zahedan, Zahedan, Iran
4 Department of Mechanics on Mechatronics Engineering, Faculty of Engineering, Islamic Azad University Central Tehran Branch, Tehran, Iran
5 Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6 Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7 Department of Computer Engineering, Payame Noor University, Tehran, Iran
8 Strategic Planning and Executive Office Management, International Federation of Inventors Associations, Geneva, Switzerland

Date of Submission23-Feb-2022
Date of Acceptance12-May-2022
Date of Web Publication15-Jun-2022

Correspondence Address:
Dr. Masoud Shafaghi
Strategic Planning and Executive Office Manager, International Federation of Inventors Associations, Geneva
Switzerland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpdtsm.jpdtsm_15_22

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  Abstract 


BACKGROUND: COVID-19 has affected public health and the patients suffering from musculoskeletal pain have little chance to receive medical care to reduce the burden of musculoskeletal pain with no definitive treatment, the need for home remedies is felt more than ever for such patients. This research is presented a new kind of home physiotherapy device by three different therapeutic functions including transcutaneous electrical nerve stimulation (TENS), vibration, and heat to provide patients with remote services.
MATERIALS AND METHODS: The conceptual map of the system, including the mechanical, electrical, and software parts, as well as the location and connection of electrical components used in the system, is presented. Then, after programming the device and designing a mobile application layout tree for creating an account, the device is turned on, and therapeutic values are entered into the device. Finally, the results of the initial use are displayed on a mobile phone.
RESULTS: In this section, we present several screenshots of the mobile application's screen and a picture of the primary prototype of the device. The first item includes the main menu, which allows the user to enter the application. On first use, the patients will have to register themselves by selecting the “register” option. Another page provides details about the therapeutic methods of TENS, heat, and vibration.
CONCLUSION: This system is a cost-and-time-effective strategy and helps physiotherapists to cover more patients at the same time and follow patients' treatment courses through televising.

Keywords: Chronic pain, heat, osteoarthritis, physical therapy equipment, transcutaneous electrical nerve stimulation, vibration


How to cite this article:
Eskandari M, Hosseini-Baharanchi FS, Moghaddam MH, Delisnav A, Shafaghi S, Ghorbani F, Taherkhani N, Shafaghi M. Design a new home-based multifunctional physiotherapy device for musculoskeletal pain relief. J Prev Diagn Treat Strategies Med 2022;1:121-6

How to cite this URL:
Eskandari M, Hosseini-Baharanchi FS, Moghaddam MH, Delisnav A, Shafaghi S, Ghorbani F, Taherkhani N, Shafaghi M. Design a new home-based multifunctional physiotherapy device for musculoskeletal pain relief. J Prev Diagn Treat Strategies Med [serial online] 2022 [cited 2022 Jun 26];1:121-6. Available from: http://www.jpdtsm.com/text.asp?2022/1/2/121/347540




  Introduction Top


Chronic neck or back pain, which is also called mechanical pain, is caused by mechanical factors, not by the main nerves. Degenerative disc disease is the most common example of mechanical pain.[1] Osteoarthritis is also a common problem globally and a major cause of disability in the elderly, leading to pain, loss of function, reduced quality of life, and many medical costs annually in the world.[2]

Various therapeutic methods are used to treat musculoskeletal pain including transcutaneous electrical nerve stimulation (TENS), which is a safe and noninvasive treatment.[3],[4] Other therapeutic methods are to locally execute vibration and heat on the pain site.[5] The use of ultrasound is also a potential way to reduce pain in patients with osteoarthritis. The effectiveness of ultrasound therapy depends on various parameters such as intensity, work cycle, frequency, duration of therapy, and the therapeutic energy dose applied.[6] All of these methods are effective for treating chronic pain; however, there are always some concerns.[3]

Patient-oriented home-based physical rehabilitation treatment is one of the common rehabilitation programs. Given the less time and resources involved in this treatment methodology, this process has received a great deal of attention from physiotherapists. Furthermore, it has been shown that patients' adherence to such programs is critical to the success of treatment. Despite the promising results of such therapeutic approaches, there are traces of evidence of patients' nonadherence to these programs.[7]

In this research, we attempted to address these needs so that patients could perform their therapeutic course, along with performing daily activities, by possessing only one device.


  Materials and Methods Top


This intelligent system was proposed to help patients with osteoarthritis, and other musculoskeletal problems conduct their physiotherapy therapeutic courses. The concept map of the proposed system is shown in [Figure 1]. The system can be divided into two main branches: the patient and physiotherapist who both can access the data cloud at the same time. The function of the device is described in three different sections that include mechanical, electrical, and software parts as well as the location and connection of electrical components used in the system.
Figure 1: The concept map of the system, including the mechanical, electrical, and software compartments

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The mechanical part

A puzzle-movement-behavior-based mechanism was used to design the device. This allows each part of the device being used according to needs and positions, and also, the weight of the device can be controlled to some extent by eliminating the need for the installation of additional accessories.

The SolidWorks software (version 2018) (Company's parametric, Massachusetts) was used for designing and modeling the system. Then, a printable 3D output file (STL prefix) was obtained from the software and finally imported into the Simplify 3D software (MankatiUM 6.5.3) for printing.

All the components (mechanical, electronic, electrical, and power supply) were placed in different locations to exert the least amount of interference or noise on each other's performance. The device was kept on the arm or leg while walking, running, and doing daily activities, and the individual was able to fasten the device to body parts through an elastic, strap, etc., to avoid any interference with routine activities.

A belt was designed for this system, having minimum weight and the highest formability. To build this belt, soft, antiallergic, highly tensile, and compressive materials were used, and all other parts related to the vibration and heating systems of the device were fixed to the belt.

The electrical part

This part included all the circuits and their functions implemented in the device and can be divided into the TENS, heat, vibration, and microcontroller sections [Figure 2].
Figure 2: Schematic representation of how the electrical components used in the home-based physiotherapy device are juxtaposed and connected together

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Transcutaneous electrical nerve stimulation

The electronic components were used to form the TENS waveform through intermittent current and stimulate nerves. An oscillator circuit with IC 7555 was used to create a waveform with a frequency range of 9.125 Hz to 1 kHz, a recurrence range of 3.4–110 ms, a current of 0–80 mA, and a running time of 50–400 μs. In addition, IC MC34063, IR2155, inductors, capacitors, diodes, and resistors were applied to convert this signal into saw-teeth, triangular, sinusoidal, and square waveforms.

Heat

The heat was generated in the belt. A 12-V 60-cm silicon element was used to protect the belt from burning and obtain an even temperature distribution. An IC LM35 was used to control the temperature of the belt and deliver the appropriate temperature as an analog signal to the microcontroller circuit. LM35 has three pins: The first and last pins control the power supply of the temperature sensor, and the middle pin, which is connected to the A0 pin of the microcontroller, is responsible for the analog signal output, along with measuring and controlling (according to given instructions) the temperature of the belt. The silicon element is connected to a relay attached to the microcontroller, which is automatically disconnected when the temperature exceeds the specified threshold and remains connected as long as the temperature is below the limit.

Vibration

In addition to the silicon element, coin-like vibrating motors with a diameter of 1 cm, a thickness of 3 mm, and a working voltage of 5 V are installed in the belt. Five vibrating motors are connected in parallel using the regulator 7805 (a 5-V positive regulator with a maximum current of 1 A). The input of this regulator is then connected to the vibration relay connected to the microcontroller.

ESP32 microcontroller

The ESP32 microcontroller, belonging to the Arduino family, consists of 30 pins and is enabled with Bluetooth, WiFi, and capacitive touch, allowing the device to be integrated with the Internet of Things. To supply power to the microcontroller and other parts of the device, a 12-V lithium polymer battery with a 4 A current is fitted into the device. To supply appropriate voltages to different parts of the device, an “DC to DC” voltage converter module (model LM2596S) is used, the output of which could be converted into 9 V (as required for the TENS circuit) from a 12 V input using a linear potentiometer built into the module. For vibrating motors, the input voltage is directly supplied from the battery to IC 7805, and a positive 5 V output is received. For the heating component, the battery directly supplies voltage to the relay connected to the silicon element.

To control the TENS, vibration, and heating parts, microcontroller pins must be specified. To control the TENS, the on/off function was assigned to PIN 14 of the microcontroller; and PINs 4 and 5 were assigned the task of increasing and decreasing the signal strength, respectively. PINs 12 and 3 were specified for adjusting the duration of the signal and determining the type of the signal, respectively. Finally, PINs 10 and 13 were aligned with the vibration and heating parts, respectively. [Figure 2] shows a diagram of the circuit used.

Software

This part includes a description of the device's software and it divides into the server, mobile application, and also the connection between the server and mobile application sections.

Server

In the microprogram written into the Arduino software (version 1.8.13), the ESP32 was coded as a web server facilitating connectivity to a phone, computer, or any web browser. The ESP32 is capable of functioning as a web server when coded to do so using HTML and JavaScript.

Wi-Fi is enabled for the ESP32, and values are set as SSID and PASSWORD so that phones and any electronic device that can connect to Wi-Fi can be coupled. Then, microcodes, according to the flowchart shown in [Figure 3], are entered into the program, and the WIFI SERVER is activated. Furthermore, for connecting the client with the server, a WIFI CLIENT command is activated stating: “If a CLIENT connected, check if any command comes from CLIENT.” For example, if the code (/POWER-) is received, PIN 4 of the microcontroller is first activated and then deactivated after 200 ms, or if the code (/MODE) is received, PIN 3 of the microcontroller is first activated and then deactivated after 200 ms.
Figure 3: The programming flowchart of the home-based physiotherapy device

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Now, based on the interpretation of the codes by the microcontroller, the results, the device's specifications, and the settings performed by the client are sent as a string followed by the output of the issued command on the user's display. This string of HTML codes could be sent to the client via the command code of Client. printLn.

HTML codes are verified using the Internet and code execution sites (3WSCHOOLS. COM in this project) before being entered into the program. The codes related to the background color, key type, size, font type, and the location of texts are determined, and their performance is assessed to ensure proper functionality before being entered into the microcontroller program.

Internal web servers are used instead of external servers to prevent hackers from breaching into the server and endangering patients' health. Among the advantages of this design is the easy accessibility of the physician to the main server by simply entering the IP of the device.

Mobile application

A mobile application is developed for this system using App Invertor. The layout tree shown in [Figure 4] depicts available layouts based on the first use of patients. The smartphone application developed in this project required the patient to register and create a user profile on first use of the device. In subsequent rounds, simply by entering the username and password, the patient can easily use the instrument based on the information stored in an electronic profile. After entering the program, the user can benefit from all medical functions simultaneously or separately. After entering specific values and making the necessary settings, the device starts to work and then automatically turns off when the designated time terminates.
Figure 4: The layout tree of the mobile application developed for the physiotherapy device to turn on/off the instrument, create an account, and enter therapeutic values

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Server–application link

The application was designed in such a way that on entering the required information and values by the client, all the data will be directly transferred to the main server and the designed web page and stored in the Cloud space provided by the system. On the other hand, by simply having the IP of the device, the physician can easily access the specific web page and Cloud space of the device and monitor the information.


  Results Top


In this section, we present several screenshots of the mobile application's screen [Figure 5] and a picture of the primary prototype of the device. The first item includes the main menu, which allows the user to enter the application by entering a username and password. On first use, the patients will have to register themselves by selecting the “register” option, which will lead them to a second page where information such as name, surname, gender, age, username, and password must be entered. A third page provides details about the therapeutic methods of TENS, heat, and vibration, where the user could adjust the intensity and time of heating, vibration duration, as well as the intensity, mode, and duration of TENS. [Figure 6] shows a prototype of the home-based remotely controlled physiotherapy device.
Figure 5: The mobile application of the home-based physiotherapy device. An account needs to be created on first use, and after that, the device can be turned on, and the type, intensity, and duration of treatment can be adjusted

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Figure 6: Prototype of the home-based physiotherapy device with remote control capability

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  Discussion Top


This study presents the prototype and details of implementing a new intelligent solution for patients suffering from musculoskeletal pain, enabling them to follow their treatment process under the remote supervision of their physiotherapist. The system is equipped with sensors and controlled by a mobile application via Wi-Fi, helping physiotherapists cover more patients at the same time and monitor their treatment without the need for in-person weekly physiotherapy sessions. Therefore, the number of patients referring to therapeutic clinics is reduced. This system helps people who need physiotherapy to receive the service without the need for regular commuting to physiotherapy centers, so it not only delivers appropriate physiotherapy programs but also provides a cheap alternative. Moreover, it is easy to learn how to use the device so that patients with a low level of literacy are also able to use the system.

One of the programmable TENS devices based on Arduino work with 9-V batteries.[8] In this project, a portable power supply was used in the system to easily use the device in any situation while performing daily activities. Therefore, the patient can use this system with a 12-V battery when there is no electricity or on the go. Otherwise, the power supply and battery can be removed to reduce the weight and directly connected to the home power supply through a built-in adapter. The battery section can be easily separated if required, and a mobile phone can be kept in the place of the battery.

These programmable models of TENS devices work in different modes, which require a frequency of up to 125 Hz and a run time of 100 μs.[8] None of the research investigates effects of frequency >100 Hz. In a study performed on mice, the results showed that frequencies above 100 Hz had positive effects on reducing pain and improving the treatment process.[9] The present device was designed in such a way as to cover a frequency of 1 kHz and a running time of 50–400 μs, as well as all modes, delivering a more powerful instrument than the existing models. In one of the previously designed models, a Bluetooth module was used to establish a connection between the TENS device and the mobile phone,[10] limiting the applicability of the device to the Bluetooth coverage area. The device designed in this project, has WiFi built into it and can also be transformed into an internal server, thus enhancing the coverage area as well as bolstering the security of the device against being hacked.

Furthermore, due to the separate arrangement of TENS pads and the vibration–heat belt, it was possible to use all three therapeutic functions simultaneously and independently in different parts of the body without any concern about functional interference. On the other hand, considering the Cloud space provided in the system and the possibility of two-sided access (physicians and patients) to patients' information, concerns about inappropriate and incomplete therapeutic courses, which are always raised by physicians about home-based care, were resolved.

Limitations

One of the limitations of this project was that the prototype device was not tested on patients due to ethics-related issues. Hence, the efficiency of the system should be evaluated by clinical trials in future studies.


  Conclusion Top


COVID-19 virus has affected public health and the patients suffering from musculoskeletal pain have little chance to receive medical care also there is always the concern whether the treatment process is being carried out properly or there is a need for a change in the intensity and duration of treatment. To address these concerns, one should refer to physiotherapy centers for more guidance on the treatment course, which is time-consuming and requires multiple sessions, sometimes exhausting patients and making them leave the process midway. In this paper, we have presented a prototype to treat musculoskeletal pain and try to reduce pain via a device, equipped with a sensor, controlled by a mobile application over a WIFI connection. It makes the use of several common medical treatments to follow the patient's needs. This system can be easily marketed and used as an alternative to the conventional methods of treating mechanical pains. Especially during the pandemic, it obviates concerns about the risk of COVID-19 transmission in medical centers and upgrades patients' quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Sulaiman NA, Ibrahim AA, Mohd Zaman MH. A programmable transcutaneous electrical nerve stimulation device based on arduino and remote control using a smartphone. Int J Adv Technol Eng Explor 2021;8:75,320-7.  Back to cited text no. 8
    
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Hsiao HT, Chien HJ, Lin YC, Liu YC. Transcutaneous electrical nerve stimulator of 5000 Hz frequency provides better analgesia than that of 100 Hz frequency in mice muscle pain model. Kaohsiung J Med Sci 2017;33:165-70.  Back to cited text no. 9
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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