Design of a Smart Physiotherapist Rehabilitation

System
[1]
N.A.R. Priyanka [2] M.S.S. Perera
[1]
Department of Electrical and Computer Engineering, The Open University of Sri Lanka,
[2]
Department of Electrical and Computer Engineering, The Open University of Sri Lanka
[1]
napri@ou.ac.lk,[2] msper@ou.ac.lk

Abstract— Physiotherapy is a branch of science that heals physical injuries through exercise and improves body movement hence,
increasing functionality, strength, and balance. The primary concern in this field is to achieve optimum results by performing the
exercises accurately without causing any further damage to strained body parts. One essential field which is used in this physiotherapy is
fractures. Fractures can occur due to several reasons.
By introducing the telemonitoring concept for physiotherapy exercises to cater to the needs of ankle fracture patients at their
doorsteps, especially those who are living in remote locations. Today, the patients are required to come back to the clinic or the hospital
for one-to-one sessions with the physiotherapist. Considering as the day-to-day life problem and suggesting an innovative interactive
physiotherapy environment beyond manual is the main target of this work. By using an inertial measurement unit, we can track the
motions of any part of the body. The final outcome of the research is to understand the difference between the affected and non-affected
movement of the leg with visual movement to the physiotherapist. Therefore, by displaying the variation of the acceleration values while
doing each exercise through an ECG Plot.
This research is also to give priority to reducing the muscle wastage in the lower limb part of the body during the fracture of main
joints. By this system, the patient can do the exercises without the assistance of the physiotherapist. In a fracture, doctors can fix it by
adding the plates inside the joint. The rest of the other things such as keeping the joints in a range of motion, reducing muscle wastage by
doing exercises correctly are some points that physiotherapist has to fulfil. The patient can secure the time to go to the hospital with the
assistance of a physiotherapist. They can learn exercises by accessing this system by tracking the facture joint movement of the lower
limb part.

Index Terms— Acceleration, ECG (Electrocardiogram), Inertial Measurement Unit, Innovative, Physiotherapy, Tele-Monitoring

observes the patient and corrects the execution of the

I. INTRODUCTION
Physiotherapy is a branch of science that heals physical
injuries through exercise and improves body movement
hence, increasing functionality, strength, and balance. The
primary concern in this field is to achieve optimum results by
performing the exercises accurately without causing any
further damage to strained body parts. One essential field
which is used in this physiotherapy is fractures [1]. Fractures
can occur due to several reasons. Such as an Accident, falls,
etc. They can occur in any bone in the body.
The signs and symptoms of a fracture vary according to
which bone is affected, the patient’s age and general health,
as well as the severity of the injury. Bone healing is a natural
process that, in most cases will occur automatically.
Physiotherapy needs after the bone have healed; it may be
necessary to restore muscle strength as well as mobility to the
affected area.
By using the Tele-monitoring concept for this kind of
patient, it will more efficient and effective way to heal that
bone without going for hospitalized sessions and reducing
overall cost for the society. Rehabilitation is typically carried
out under the supervision of a therapist or physician who
exercises if needed. There are two types of rehabilitation
processes. They are motor rehabilitation devices that are used
to move a limb automatically to follow predetermined
trajectories [5] up to a more advanced robotic exoskeleton
which leaves more freedom to the patient and prevents wrong
motions through forces and impedance control. And the other
one is based on wearable devices that support the
Tele-rehabilitation sessions under remote supervision.
This work is based on wearable devices and both
physiotherapists and the patient are using a system for the
interaction of the physiotherapy. More precisely, the system
supports the therapist in the definition of the exercises
specified in terms of postures and trajectories of a specified
patient. During rehabilitation, the patient is guided by the
system to correctly execute the exercises and at the same time,
it is provided with multi-modal feedback to enhance the
performance of the exercise. All the data produced during the
session are collected and uploaded to cloud-based
infrastructure for further analysis.
This system was done by using motion tracking based on an
inertial measurement unit. The motion of the lower limb part
of the body, which was concerned an ankle in this project,
was tracked by using MPU6050 sensor [7] and displayed the
acceleration values changing according to x, y, and z-axis
was displayed as an ECG Plot for the physiotherapist. It was

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more accurate with the visual feedback of the movement.
Motion tracking ways are shown in Fig. 1.
Fig. 1: Ways of motion tracking
Other studies found that the possibility for the users
themselves to define when to receive the feedback enhances
the quality of motion. Inspired by those works based on our
previous experiences, we present a web-based system to
implement this Tele-monitoring concept.
II. METHODOLOGY
This research is used the Tele-physiotherapy concept for
ankle fracture patients. By using the mpu6050 sensor we do
the comparison with affected leg exercise movement of the
ankle [12]. But this is not enough for the physiotherapist to
get the decision about his patient without viewing this
movement. So, by displaying his or her real movement by
using a web camera with a 2D plot can do this examination by
logging remotely.
A. Web Based Software Support Both Parties
This is the main heart of the project. Without using the
system, both parties would be impossible to connect with
each other. This patient support module is connected with the
system. This is a web-based system that was developed by
using HTML, CSS, PHP, and JAVASCRIPT [11]. This
system could be accessed by physiotherapists and patients
only. It had a logging system and patients, and
physiotherapists could log by using their own passwords.
Though it looks like a Tele-Physiotherapy system [2], it is
guided to do the exercises correctly to the ankle fracture
patient. The system is connected with the cloud for further
analysis as shown in Fig. 2.
Fig. 2: The block diagram of the system
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B. Patient Support Module
According to this section, we implemented our system
handling with the wearable device. By wearing this module,
we can track the motion of the affected leg according to the
movement. For that, we developed the programme which is
connected with a MPU6050 [8] wearable IMU sensor
[6],[10]. The programme was developed in MATLAB
software [9] and it looked like an ECG plot. An ECG plot was
used for nerve and muscle cells to communicate with each
other using electrical and chemical signals. According to the
system, it used this concept for an affected ankle fracture
patient for the patient’s healing process. Because the fracture
was healed by circulating the blood around the muscles of the
joint. The healing process wasn’t done quickly, and it would
take at least 12 weeks. The system plots this ECG plot the
acceleration (Y-Axis) value was measured by the sensor with
time (X-Axis). And this plot variation could be understood
with the visual movement of that exercise. This wearable
device is shown in Fig. 3.
Fig. 3: The wearable device
C. Cloud Based Infrastructure
In a web-based system, we store all the patients’ records
day by day for the easiness of the physiotherapist [3] for
giving feedback each week. If he connects with an online
system, he could inspect the movement of the patient. What
we hope by using cloud infrastructure is, for further analysis
of the physiotherapist. It will be helpful for clearly
understanding each and every patient through this system.
D. Physiotherapist Support Module
According to this system physiotherapist (first user),
responsible is for giving feedback to the patient (second
user). Therefore, he should analyse the movement with ECG
Plots through this system. When the first user is online, he
can directly examine the live session with the patient or
second user and give his feedback at that moment using
webcam technology [4]. Otherwise, the patient should upload
their ECG Plots with the moving day by day. By viewing
these records, he can give feedback once a week. Also, it will
be helpful for getting better at each and every patient by
analysing them. All the improvements, the performance of
each patient at each exercise are described by him for
encouraging the patient. Also, there is a guide for
rehabilitation for an ankle fracture patient and it has a general
guide for every patient. Every patient should follow this to
obtain better results to overcome these fractures. This
procedure is depicted in the following Fig. 4.
circulation around the muscles of the joint of the fracture. By
viewing these graphs, we can decide there is good blood
circulation in the non-affected leg rather than the affected leg
because of doing the speed of this exercise. But this is not
enough to understand the patient without viewing the
movement. Therefore, he must view the variation with the
actual movement of the ankle, and it is shown in Fig. 7.

Fig. 4: Rehabilitation guide

III. RESULTS AND DISCUSSION

The results are displayed on our web-based system, and

these are done by using the localhost server. as mentioned
earlier, this system is designed for an ankle fracture patient.
these are the plotting graphs according to the movements of
the exercises. we do the comparisons of these plots between
affected and non-affected legs. Fig. 5 and Fig. 6 depict the
comparison for the toe movement between the affected leg
and the non-affected leg.
Fig.7: Affected toe movement of the ankle with the ECG
plot
A. Ankle Strengthening Stretches Exercise
Fig. 8 and Fig. 9 shows the ECG Plots of the ankle fracture
patient when he is doing the ankle strengthening stretches
exercise.

Fig. 5: ECG plot for the Toe movement of the non- affected
ankle Fig:8: ECG plot of non-affected leg when doing an ankle
strengthening stretch exercises

Fig. 6: Affected Toe movement of an ankle while on a

normal speed Fig. 9: ECG plot of non-affected leg when doing ankle
strengthening stretch exercises
We can observe the variations are changed rapidly when
Fig. 9 depicts the ECG Plot of affected leg when doing ankle
increasing the speed of doing the exercises in the
strengthening stretches exercise [12]. By observing these
non-affected leg as in Fig. 5 and Fig. 6 shows the acceleration
plots, we can examine the muscle variations around the x and
values are changed when doing these exercises at normal
y-axis and how they are changing their plots according to the
speed. As stated above there should have a good blood

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positions. In both situations, Z-axis was plotted
independently. When the patient was increasing the
flexibility of the leg as much as he could, we could find the
high pulses as in the above Fig. 8. But for this time the
muscle variation was increased quickly, and it will be helpful
for the good blood circulation around that joint. Finally, we
can decide by comparing these plots the muscle variations
around the affected leg were reduced due to the speed and the
pain which was arising when doing this exercise. Therefore,
it will be helpful for the patient to be motivated to do this
exercise every day to get better healing than previously by the
encouragement of the physiotherapist by viewing these plots.
This plot is not enough to understand the patient. Therefore,
we upload to the system with the visual movement which is
recorded by the web camera as in Fig. 10 below.
Fig. 10: ECG plot of the affected leg when doing
ankle strengthening stretches
Similarly, the ECG Plots are taken for the calf stretching
exercise. According to the results, it can be decided that the
muscle variation around the joint is doing so fast in the
non-affected legs. The patient can understand these plots
clearly without less attention from the physiotherapy.
Therefore, the therapist can give feedbacks clearly by
viewing the movement. Fig. 11 and Fig.12 shows the
movement with the ECG plot when doing calf stretching
exercises for an affected and non-affected leg, respectively.
Fig. 11: ECG plot of the affected leg when doing Calf
stretching exercises
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Fig. 12: ECG plot of the non-affected leg when doing Calf
stretching exercises
All the results are obtained on one person. All the variations
that we stated above were by observing her movements.
These plots are changed person to person the way of doing
that each exercise. Generally, we are observing the blood
circulation around that joint by viewing these plots.
IV. LIMITATIONS
There are a lot of limitations found when doing this
project. This system is an online system. Therefore, the
patient and the physiotherapist need an internet connection to
log in to this system. This could be the most prior limitation
found in this research. Also, this ECG plot is plotting
continuously. So, the patient should stop it for the specific
repetitions after it was done. This is a major limitation
throughout this system.
Also, this wearable device has not any recordable media to
record the movement of the patient. Therefore, the patient
should start and stop the recordings of their movements and
they have to upload them to the web to the supervision of the
physiotherapist when he is not online at that movement. And
that should be updated about it daily and the feedback about
his or her pain or any difficulties found when it was done.
The patient should do the exercises to the non-affected leg
first before the affected leg for the comparative study of the
physiotherapist.
CONCLUSION
People suffer aches and pains for all sorts of reasons. It may
be due to an accident or illness that can occur after an
operation or simply be the result of a poor posture or general
bad habits. Physiotherapy is often the best answer because it
provides a drug-free solution to many of the physical and
subsequent problems that people face. By considering the
matter of facts this system is implemented that patients can
do exercise and rehabilitation part without going for
hospitalized sessions.
This system is for the lower limb part of the body as it
focused on ankle fracture patients. In Sri Lanka,
physiotherapy is a less considering stream that people don’t
think about their body due to the busy lifestyle. As a one-side
client, a physiotherapist gets involved with this research by
advising and paying more attention to patients’ body.
 The main target of the research was to represent the data in
a readable format. Because as mentioned earlier, the
physiotherapist has access to view the patient records and
give feedbacks to them for further analysis. Then as a final
output, it’s important to convert this raw data into an ECG
Plot using Arduino with MATLAB. By only viewing this plot
the physiotherapist, cannot decide satisfied feedback of the
patient without watching his movement. Therefore, system
used a web camera image with an ECG plot to get an idea of
the movement of the patient. This work benefits our country
as some developed countries use this system to do
physiotherapy and it will be more helpful for elderly people.

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