Within the ExO-Zorg framework, knowledge is gained considering modeling, design and control of ambulatory health care processes, with the help of ICT applications focused on supplying direct automated feedback, and giving the opportunity for professional support on a distance.

This presentation focuses on the field of mechanical joint load. Modeling of joint load can be approached from several points of view, varying from postural loading to compression and sheer forces, or even at the level of internal forces in bone and ligaments, which require Finite Element Modeling (FEM). For the area of postural load a prototype system has been developed. The proposed method consists of 3D inertial motion sensors, custom calibration protocols for translating sensor to body segment kinematics, applications for the ambulatory measurement of posture and online streaming of data to a server. On the server-side online analysis takes place, and feedback parameters are generated and send back to the measuring device. With the help of online monitoring software the streaming data and results of analysis can be assessed by a clinician with a standard web browser from anywhere on the internet. Some first measurements have taken place with healthy subjects in an ergonomic assessment, to test the several functional parts of the system. Calibration of sensors to body segments showed errors less than 2º for thorax and head, to 5-7º for the upper arm.

Currently the system supplies feedback based on ergonomic guidelines, but relevant parameters can be adjusted as needed. Analysis of body segment orientation consists of distribution over several categories of posture, e.g time spent in the category of 0 to 30 trunk flexion. According to ergonomic guidelines a certain amount of time in a category is classified as green (harmless), orange (indicating risk), or red (avoid if possible).
Current work focuses on applying the method as a coaching assistant for patients suffering from low back pain. In close collaboration with clinicians there is an ongoing discussion and exploration on:

1) Relevant parameters and amount of information needed, or desired.
2) Acquiring appropriate guidelines and protocols for applying feedback.
3) Basic learning principles (frequency, modality of feedback (visual, sound, vibration), automated feedback or coaching by a clinician, obligatory or compulsory feedback.