The ETIOBE Project: A Supporting System for Children Obesity CYBETHERAPY 2008 SAN DIEGO Rosa Baños, Cristina Botella Alvaro Frías, Mariano Alcañiz Ausias Cebolla, Ernestina Etchemendy Soledad Quero, Sabrina Andreu

Research teamCLINICAL TECHNICAL FROM 1996

Universidad Politécnica de Valencia Prof. Mariano Alcañiz Dr. José Antonio Lozano Irene Zaragoza Jaime Guixeres Dr Beatrriz Rey Universidad de Valencia Prof. Rosa Baños Prof. Conxa Perpiñá Álvaro Frías Universidad Jaume I Prof. Cristina Botella Prof. Azucena García-Palacios Prof. Soledad Quero Sabrina Andreu Berenice Serrano Diana Castilla Ernestina Etchemendy Dr Ausias Cebolla TEAM COMPOSITION

VIRTUAL REALITY, AUGMENTED REALITY Treatment of anxiety disorders Treatment of eating disorders

Animal phobiaFear of public speaking TELEPSYCHOLOGY Self-administered programs

TREATMENT OF OBESITY ETIOBE PROJECT: TREATMENT OF OBESITY IN CHILDREN SUPPORTED BY NEW TECHNOLOGIES (VIRTUAL REALITY, TELEPSYCHOLOGY). Instituto de Salud Carlos III: CIBER Obesidad y Nutrición

Treatment of Obesity CBT: change in behavior, cognitive, and emotional patterns that maintain obesity. CBT + medical treatment: efficacy in reducing body weight. Unfortunately, results are not so good with respect to maintaining treatment outcomes.

The problem of maintenance After a CBT program patients gain around 30-35% during the first year. 100% after 5 years. Main problem in outcome maintenance is motivational component. Motivation and self-control good predictors of treatment efficacy. Obesity is a chronic medical condition requiring a continuous and suitable supervision.

The treatment of Obesity To increase the efficacy of obesity treatment: To design techniques and strategies that help patients to monitor eating habits and energy consumption. Personalize the intervention adding supporting strategies to help the patient persevere and defend him/herself from negative stimuli (advertisement, fast food, etc.). New technologies could help in this task: tele-health and e- health. The use of new technologies means a change in the ways we can provide health care.

What is E-TIOBE? e-therapy system that uses innovative strategies to enhance motivation and treatment adherence, personalizing the treatment considering the patient’s physical, mental, and contextual state. Offer personalized supervision, support and help to the patient 24 hours a day, 7 days a week and in real time. Which is E-TIOBE’s aim? E-TIOBE

Goals of E-TIOBE –Increase motivation –Enhance treatment adherence –Enhance self-control –Weight loss maintenance –Relapse prevention promoting healthy habits –Including everybody involved in the problem

e-health systems Process that allows communication of users who are in different locations (patients and clinicians) Three types of services: prevention, personalized treatment (including assessment and follow-up), and providing information about the problem (feedback). Four technology concepts: Ambient intelligence, pervasive computing, ubiquitous computing, and virtual therapy. Prevention Personalized treatment Feedback

Ambient Intelligence Electronic environments sensitive and responsive to people’s needs. Network and intelligent sensors: physiological, psychological, and contextual information from the user. Several sensorization technologies to monitor physical activity: i.e. GPS

Using computers to change attitudes and behaviors. Generate contents with the aim of change and/or reinforce the user’s behaviors. Pervasive Computing

Ubiquitous Computing The user/patient can have access to the system from everywhere and whenever he needs to. Mobile services and ubiquitous platforms that give the patient support and orientation regarding the treatment. The system can integrate inmediately the data generated by the different devices.

Virtual Therapy Virtual reality, augmented reality, virtual agents, and natural interfaces.

Applications of E-TIOBE 1.Clinician supporting application. The therapist can design a personalized assessment, treatment and follow- up, according to the specific characteristics of each patient. 2.Home supporting application. The system presents the patient contents and strategies that help him/her in the therapy process. It also allows the communication between the patient, the family, and the therapist and make possible the recording and processing of data throughout the whole process. 3.Mobile supporting application. It makes possible communication in real time and in different contexts. Help of the virtual agent.

e-TI – scenarios

e-TI – Clinician supporting application 4 modules: Data input Treatment Personalized treatment Treatment Protocol Patient Manual Family Manual Alarms Editor

e-TI – Home supporting application Treatment View Virtual agent (personalized) 2D/3D games Augmented reality games Biometric monitoring

e-TI – Mobile supporting application Self-monitoring Virtual agent Alarm view Motivation/reinforcement messages

e-TI – Monitorization Physical health Physiological variables Monitoring What is he doing?, who is s/he with? Where is s/he? Geolocalization in and out Actions at home Physical activity How motivated is he? Treatment adherence Motivational level Positive psychology

First element developed by TIN (Therapy Intelligent Network), an open sensorization platform to develop intelligent environments oriented to the patient. TIPS conects the patient with the e-therapy environments to get feedback of the patient’s states. TIPS can get: Context information: Geolocalization, physical activity. Physiological information: heart rate, skin conductance, breathing rate. TIPS can communicate with: Mobile devices: PDA, cell phone. Computer TIS: (Therapy Intelligent Sensor) in the environment TIPS Module

TIPS Tamaño 7 x 5cm

Intelligent module: Digitalizes and processes the sensor signals. Implement the communication protocol and manages the communications. Intelligent module: Digitalizes and processes the sensor signals. Implement the communication protocol and manages the communications. Tamaño 7 x 5cm Módulo TIPS

Communications module : transmits the signals via Bluetooth or Zigbee Tamaño 7 x 5cm Módulo TIPS

Physiological module: processes and treats analogic signals from the sensors. Tamaño 7 x 5cm Módulo TIPS

Physical activity module: Detection of postures, physical activity and calories consumption. Physical activity module: Detection of postures, physical activity and calories consumption. Tamaño 7 x 5cm Módulo TIPS

Geolocalization module : outdoor localization with GPS Tamaño 7 x 5cm Módulo TIPS

Geolocalization Module xml messages are sent to the server Data can be viewed in real time via Internet. Therapists can set action points. PDA receives the signal and interacts with the patient. xml messages are sent to the server Data can be viewed in real time via Internet. Therapists can set action points. PDA receives the signal and interacts with the patient.

Physical Activity Module It’s able to detect: - Position - Level of physical activity - Frequency of steps -- Calories used It’s able to detect: - Position - Level of physical activity - Frequency of steps -- Calories used

Physiological Module It captures physiological signals from the patient to detect physical and emotional states. Heart rate Skin conductance. Breathing rate Integration with intelligent tee-shirt It captures physiological signals from the patient to detect physical and emotional states. Heart rate Skin conductance. Breathing rate Integration with intelligent tee-shirt

E-TIOBE: Hypothesis CBT + medical treatment + new technologies systems (E- TIOBE): –Higher treatment motivation. –Higher treatment adherencia. –Maintenance of weight loss at mid- and long-term.

To conduct a clinical trial to test the efficacy of ETIOBE To improve the efficacy and efficiency of current treatments for obesity. Thanks very much for your attention THE FUTURE