Engineering, 2013, 5, 47-52
http://dx.doi.org/10.4236/eng.2013.510B010 Published Online October 2013 (http://www.scirp.org/journal/eng)
Study of Multimedia Technology in Postur e Training
for the Elderly
Chih-Chen Chen1, De-Jou Hong2, Shih-Ching Chen3, Ying-Ying Shih4, Yu-Luen Chen2,5
1Department of Management Information System, Hwa Hsia Institute of Technology, Taipei, Chinese Taipei
2Department of Computer Science, National Taipei University of Education, Taipei, Chinese Taipei
3Department of Physical Medicine & Rehabilitation, Taipei Medical University Hospital, Taipei, Chines e Tai pei
4Department Physical & Rehabilitation Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Chinese Taipei
5Department of Information Management, St. Mary’s Medicine, Nursing and Management College, Yilan, Chinese Taipei
Received October 2012
ABSTRACT
Wrist diseases, also known as “mama hand”, “mouse hand” or “keyboard hand”, are commonly seen and easily over-
looked symptoms in daily life. The diseases are mostly related to incorrect exercise or excessive force imposed on
hands, leading to tenosynovitis or carpal tunnel syndrome. To alleviate the symptoms or even to recover, besides drug
treatment, s upplementary rehabilitation training is nece ssary. The rehabilitation process for ces the affected wrist area to
continually exercise in order to stimulate the self -repair signals sent to the affected area for partial restoration, if not all,
of the supposed functions. In modern world, using information technology to improve the rehabilitation environment
with better approaches has become a trend. In this study, software programs coded in C# and Flash are developed to
work on the Bluetooth ball hardware to facilitate the rehabilitation. The basic principle is to use the reaction from the
Bluetooth ball’s swaying or swinging to drive the movement of the objects on the computer screen, making the suppo-
sedly boring rehabilitation much more fun and vivid in the interactive multimedia environment, thus gaining better
treatment effect. Also, RFID, Internet and databases c an be integrated into this f acility to provide patient iden tification
and data storage for references in making rehabilitation training programs.
Keywords: Rehabilitation; Bluetooth Ball; RFID; Databases; Interactive Multimedia
1. Preface
The interactive multimedia controller has evolved rapidly,
from the early knob and joystick to the Xbox360 con-
troller, the PS3 controller’s direction button and press
button, and then the Wii remote controller. The controller
design has changed from the two-hand gripping to the
single handheld rod, coupled with the triaxial accelera-
tion detection technology to determine the action of the
hand swaying and infrared optical positioning technology
to detect the direction of the controller’s front end, for
the interface control.
This study makes an insight into the rehabilitation
training aided with the Bluetooth ball for signals trans-
mission. The numeric values generated by the Bluetooth
ball actions drive the movement of the objects on the
computer screen, making the supposedly boring rehabili-
tation much more fun and vivid, for a better medical re-
sult. And the rehabilitation data can be integrated into the
RFID patient identification, Internet access connection,
computer server storage, and database queries, to consti-
tute a comprehensive management mechanism for medi-
cal references.
Of all the wrist diseases, the “mama hand”, whose
scientific name is stenosing tenosynovitis, occurs at age
30 to 50, and female’s incidence is about 10 times that of
male. It’s the stenotic tendon bursitis of the extended
thumb brevis tendon and longus tendon of the thumb
abduction near the side of wrist, which brings tendon
glide difficulties and causes wrist pain. However, the
“mouse hand” and “keyboard hand” are of the carpal
tunnel syndrome, which is caused by the wrist transverse
ligament pressing the wrist median nerve, occurring at
age 30 to 60 to those who repeat their wrist exercises
over and over, and statistics shows the male and female
incidence ratio is 1:4. Also, using mobile phones conti-
nuously for a long time can bring great pressure to the
palm, causing wrist pains in many cases. To alleviate the
symptom or even recover from the disease, besides drug
treatment, complimentary rehabilitation is necessary.
2. Literature Review
Bluetooth ball was created by Finland Ball-It [ 1], since it

C.-C. CHEN ET AL.
48
has been massively used in entertainment. Following are
some of the literatures on its applications.
In his article titled “Interactive multimedia applica-
tions—illustrated with the campus navigation system”,
Chau-Cheng Cheung argues that the merit of Bluetooth
ball wireless transmission is to get rid of the keyboard
and mouse for control, and instead use the handh eld Blu-
etooth ball to do pinch, press, toss, and rotation to send
instruction signals to Quest3D for corresponding actions
to control the objects in the scene, making the campus
navigation system more flexible and fun [2].
Yu-Jie Lin, in his article titled “A hand rehabilitation
system based on Bluetooth ball: case studies of stroke
disabled adults,” points out that the rehabilitation system
built on Bluetooth ball games can increase stoke patients’
interest in rehabilitation. The Bluetooth ball games pre-
sented on the computer screen can increase the visual
stimulation, which appears very helpful in the interfe-
rence phase and helps the participants understand their
own rehabilitation statues. Besides, the visual and audio
combination gets patients’ attention and makes them
more interested in rehabilitation [3].
In his paper titled “The development of traceable intel-
ligent weighing system” released for an industrial-uni-
versity cooperative research project, Bai-Sheng Chen
suggests a mechanism that can automatically integrate
consumers’ health information (e.g. height, weight, B MI ,
eating habit, exercise habit), calories of consumer food
(e.g. beverages, light food, fruit) and its traceability sys-
tem, health maintenance recommendations, and shopping
recommendations, which are processed by the triaxial
six-directional wireless Bluetooth ball to calculate the
calorie consumption in exercise, so as to fulfill the goals
of food traceability and health management [4].
Chin-Jui Chang et al. in the article “Applications for
medical recovery using wireless control of a Bluetooth
ball with a hybrid G-sensor and human-computer inter-
face technology” point out that extension of the Blue-
tooth applications helps the development of human-ma-
chine interfaced interactive games which allow players to
follow the rhythm of songs to change the hand pressing
actions or the speed of swaying the Bluetooth ball, so as
to improve the flexibility of the hand movement and en-
hance the body balancing [5].
3. The Research Methods and Purposes
3.1. Wrist Diseases
The commonly seen wrist diseases are mama hand,
mouse hand and keyboard hand. When housewives cook,
they use hands to grip the pot handle and turning shovel,
and move their wrists up and down, and such a persistent
movement can hurt the wrist and cause the mama hand
disease. When working on a computer, one will use fin-
gers to click the mouse or two hands to strike the key-
board, with the wrist posed in a fixed position for a long
duration, and such a persistent movement day after day
can finally cause serious damage to the wrist. Also, rid-
ing motorcycle with a fixed hand position to turn the
throttle can also cause keyboard hand disease after a
long-term operation.
3.2. System Planning
Figure 1 shows the schematic overview of the study.
Before using the Bluetooth system, following prepro-
cesses are required:
• The hardware:
This includes an RFID reader and tag, a PC with a
Bluetooth device, and a Bluetooth ball (make sure it is
adequately charged and can communicate with the PC
via the Bluetooth). Since Bluetooth ball stays in sleep
mode under constant state, we need to wake it up by
tossing it, shaking is or swa ying it. On the syste m startup,
the ball’s blue light will flash.
• The software:
Microsoft Visual Studio C# 2008, Microsoft SQL
Server 200 8, A dobe Flash CS4. Vis ual Studio C# consti-
tutes the main program codes, and SQL Server is respon -
sible for managing the database that stores the RFID card
numbers, user information and the Bluetooth ball-related
data. As for Flash CS4, it supports the Action Script 3.0
syntax and the Flash file is played under Visual Studio
C#.
After all the preparation is done, we can start to ex-
ecute the program. To begin with, it is the RFID authen-
tication, during which the RFID tag is detected by the
reader which then displays the tag number and sent it to
the SQL Server to search for a matched tag number and
its holder information stor ed in the database; if the RFID
holder is an administrator , the administrator’s screen w ill
Figure 1. Overall schematic diagram.

C.-C. CHEN ET AL.
49
be displayed, and if the holder is a general user, the user
training screen will be displayed. Before doing the exer-
cise, toss up the Bluetooth ball to start it, then connect
the PC to the Bluetooth and test the communication by
moving the ball left and right in the hand for the ball’s
built-in electronic gyroscope, pressure sensor and G-
Sensor to detect the X-axis acceleration values. When the
exercise is done, the wireless communication between
the PC and the Bluetooth ball will terminate, and X-axis
acceleration values resulted from the exercise will be
averaged and stored in the SQL Server database for re-
trieval later on when one wants to resume previous exer-
cise so the averaged X-axis acceleration value can be
applied directly to the gaming screen.
The gaming mechanism is schemed into two parts: the
Bluetooth ball movement and the PC end reactions. The
former part includes moving left and right, press, clock-
wise and counterclockwise rotations which are respec-
tively reacted in the latter part PC-end screen display of
moving left, right, up and down, and rotation. Before the
game is started, play the Flash file under the Visual Stu-
dio C# execution first, and then proceed to connect the
PC with the Bluetooth ball so that the ball can do its
work, which is correspondingly reacted on the PC screen.
After the game is done, the communication between the
PC and the Bluetooth ball will terminate, and the data
collected during the gaming period will be stored in the
SQL Server database and can be used for analysis on the
training effect.
3.3. Process Flow Design
• The hardware: connection between the PC and Blue-
tooth ball:
Figu re 2 demonstrates the flow of connection between
the PC and Bluetooth ball, and the connection is based on
the Bluetooth communication protocol. Bluetooth ball is
in sleep mode when it stays still. So, toss the ball up or
heavily shake it to wake it up before using it. Once the
ball is initiated, it is in on status, ready for subsequent
connection to the PC. The ball will seek available con-
nection devices, and if the connection fails, it could be
insufficient charge of the ball; if so , recharge the ball and
have it seek connection spots again.
• The software:
This is categorized into preprocessing of d atabase cre-
ation, identity authentication and training activities.
1) Identity authentication
The flow chart of identity authentication shown in
Figure 3 is to determine the identity of an administrator
or a user. The authentication is done by matching the
RFID tag number which is unique to an individual user,
and is required for entry into the program. If the identity
is determined as an administrator, the maintenance me-
chanism for managing the electronic tag numbers and
Figure 2. The flowchart of PC and Bluetooth ball.
Figure 3. The flow chart of identity authentication.
user identities in the database is enabled; if the tag num-
ber is absent in the database, an authentication failure
message will be displayed and adding a new tag number
to the database is required so that the new user can pro-
ceed with the operations.
2) Training activities
The overall flow chart of the training activities shown
in Figure 4 can be divided into the practice screen and
gaming screen. After being authenticated, the user enters
the practice screen. Since every user has his/her unique
hand acceleration force, before getting to the formal ex-
ercise, the user is required to do the acceleration force
practice and test. This is done by holding the Bluetooth
ball for a specified duration and continuously swinging it
left and right for it to capture the acceleration values in
the right and left directions (X-axis); the values are then
averaged and stored in the database. One of the games
designed in this study is Tetris, which has graphic boxes
in different shapes on the screen for the player to rear-
range them into appropriate positions, and the player
scores when a bunch of boxes are seamlessly put together
into a row, and the row is then erased. Later on, when the

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50
Figure 4. Overall flow chart.
patient in training re-enters the gaming screen, the pa-
tient’s acceleration force data is first retrieved from the
database and passed to the gaming screen. Before the
game begins, the Flash needs to be initiated and then the
PC and the Bluetooth ball be connected for communica-
tion. The Bluetooth movements are left and right moves,
press and rotation, which are correspondingly reacted on
the screen as the manipulated object’s left and right, up
and down moves and rotation. When the gaming is fi-
nished, the connection between the PC and Bluetooth
ball terminates, and the time used as well as the scores
gained during the gaming session are stored in the data-
base and can be used later on for rehabilitation analysis
and program planning.
4. Results and Discussion
The purpose of this study is to introduce the multimedia
interactive technology to the wrist rehabilitation training
programs, in the hope of presenting an interesting and
convenient wrist rehabilitation approach.
• Identity authentication
Figure 5 shows the RFID authentication screen. The
RFID reader detects the tag number and sends it to the
database for identity matching authentication.
• The practice screen
Figu re 6 shows the practice screen. The user holds the
Bluetooth ball in his hand and sways it left and right, and
the system fetches the ball’s X-axis acceleration values
in a fixed time interval. When the practice is done, the
user’s averaged acceleration values in the left and right
directions are calculated for later use in the formal gam-
ing exercise.
• The gaming screen
One of the games developed in this study is Tetris as
shown in Figure 7. Originally, Tetris was played with
the keyboard. The new Tetris developed in this study is
manipulated with the electronic gyroscope, pressure
sensor and G-Sensor inside the Bluetooth ball to make
wrist rehabilitation much more effective and fun as well
• The empirical test
In this study, a middle-aged woman suffered from
minor mama hand is taken as an empirical test subject
(see Figure 8). The training is given 3 times a week, with
each time taking 10 minutes, for a total training period of
3 weeks. In this training, the Bluetooth ball’s left and
right moves, rotation and press are given to manipulate
the Tetris game. Of the manipulative moves, the left and

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51
Figure 5. Identity authentication.
Figure 6. Practice screen.
Figure 7. Game screen.
Figure 8. Empirical test.
right moves command horizontal shifts of the square to
the left and right; the rotation flips the square over; the
press action drops the square quickly. It is a 25-point
gain when a bunch of boxes are put together into a
seamless row and the row will then be erased. The score
will be accumulated as more rows are completed. During
the gaming, if any of the squares is stacked up to touch
the top of the screen, the game is over. If the training
time is not up yet, click the game again to re-enter the
gaming screen and continue the training.
The result of the training on this subject is shown in
Figure 9. The red box indicates the game is over and the
number in the red box stands for the score. The empirical
analysis shows that the subject was not familiar with the
use of the Bluetooth ball in the 3 practices of the first
week, causing repe titive restarts of the game, and ga ining
no score in the first 2 practices, but gaining 25 points in
the 3rd practice—an indication the subject was getting
more familiar with the game. Starting from the 2nd week,
however, the game restart became less frequent, and the
scores were getting higher. In the 3rd week, there was no
restart of the game in the 3rd practice. The results reveal
how this woman played the game and how well she was
getting more familiar with the use of the Bluetooth ball.
Also, the less game restarts and the higher scores demon-
strate the rehabilitation was getting its performance into
effect.
5. Conclusion
In this study, the Bluetooth wireless communication
technology is applied to the medical rehabilitation prac-
tices. In contrast with the traditional rehabilitation ap-
proach that is compulsive exercise-centric, monotonous
and unable to automatically record and analyze the reha-
bilitation data, the interactive multimedia-aided rehabili-
tation developed in this study off ers versatility, vividness
and mobility, bringing lots of fun to the supposedly bor-
ing and long-lasting rehabilitation process. Furthermore,
Figure 9. Training results.

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52
the RFID authentication technology makes it possible to
store the rehabilitation data, such as the rehabilitation
dates and times used in the exercises, which can then be
used for analyses. This makes breakthrough for the tradi-
tional approach, thus increases th e rehabilitation effects.
6. Acknowledgements
The authors wish to thank the National Science Council
(NSC) in Taiwan (Grant Number: NSC 101-2221-E-146-
001-, NSC101-2221-E-152-001-, NSC101-2627-E-002-
006-) for support this research.
REFERENCES
[1] Ball-It. http://www.ball-it.com/index.html
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Illustrated with the Campus Navigation System,” Master
Thesis, Nan Jeon Institute of Technology, 2011.
[3] Y.-J. Lin, “A Hand Rehabilitation System Based on Blu-
etooth Ball: Case Studies of Stroke Disabled Adults,”
2012.
[4] B.-S. Chen, “The Development of Traceable Intelligent
Weighing System,” A C oncise Report on the Out comes of
the Industry, University Cooperative Research Program
Subsidied by the National Science Council of the Execu-
tive Yuan, The Technology and Knowledge Application
Type, 2010.
[5] C.-J. Chang, C.-Y. Chen and C.-W. Huang, “Applications
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