EP4021592A1

EP4021592A1 - Telemedicine for orthopedic treatment

Info

Publication number: EP4021592A1
Application number: EP20866635.4A
Authority: EP
Inventors: Daniel Posnack; Peter ARN; Wendy Para; S. Adam Hacking; Micheal Mueller; Joseph GUANERI; Jonathan Greene; Steven Mason
Original assignee: Rom Technologies Inc
Current assignee: Rom Technologies Inc
Priority date: 2019-09-17
Filing date: 2020-09-16
Publication date: 2022-07-06
Also published as: GB202203313D0; EP4021592A4; CN113424268A; GB2602406B; GB2602406A

Abstract

A computer-implemented system includes an assistant interface for providing remote medical assistance to aid a patient in performing various aspects of a rehabilitation regimen for a body part comprising a joint, a bone, or a muscle group. The assistant interface is configured to communicate, via a network connection, a telemedicine signal with the patient interface. The telemedicine signal is configured to control the patient interface and/or a treatment apparatus configured to be manipulated by the patient to perform the rehabilitation regimen. The patient interface and the treatment apparatus are at a patient location geographically separate from a location of the assistant interface. The telemedicine signal includes one or more of an audio signal, an audiovisual signal, an interface control signal for controlling a function of the patient interface, and/or an apparatus control signal for changing an operating parameter of the treatment apparatus.

Description

TELEMEDICINE FOR ORTHOPEDIC TREATMENT

CROSS-REFERENCES TO RELATED APPLICATIONS [0001] This application claims priority to and the benefit of U.S. Non-provisional Application Patent Serial No. 17/021 ,895, which claims priority to and the benefit U.S. Provisional Application Patent Serial No. 62/910,232 filed October 3, 2019, titled “Telemedicine for Orthopedic Treatment.” This application claims priority to and the benefit of U.S. Non-provisional Application Patent Serial No. 17/021 ,889, which claims priority to and the benefit U.S. Provisional Application Patent Serial No. 62/901 ,666 filed September 17, 2019, titled “Reactive Protocols for Orthopedic Treatment.” This application claims priority to and the benefit of U.S. Non-provisional Application Patent Serial No. 17/021 ,899, which claims priority to and the benefit U.S. Provisional Application Patent Serial No. 62/911 ,638 filed October 7, 2019, titled “Computer-Implemented Questionnaire for Orthopedic T reatment.” The entire disclosures of these applications are hereby incorporated by reference for all purposes.

BACKGROUND

[0002] Remote medical assistance, or telemedicine, may aid a patient in performing various aspects of a rehabilitation regimen for a body part. The patient may use a patient interface in communication with an assistant interface for receiving the remote medical assistance via audio and/or audiovisual communications.

SUMMARY

[0003] A computer-implemented system is provided. The computer-implemented system comprises a patient interface comprising an output device and an input device. The output device is configured to communicate information to a patient regarding the patient’s performance of a treatment plan for the patient. The treatment plan comprises a rehabilitation regimen for a body part comprising at least one of a joint, a bone, or a muscle group. The computer-implemented system also comprises a treatment apparatus configured to be manipulated by the patient for performing the rehabilitation regimen upon the body part. The computer-implemented system also comprises an assistant interface remote from the patient interface and configured to communicate, via a network connection, a telemedicine signal with the patient interface. The telemedicine signal comprises one of an audio signal, an audiovisual signal, an interface control signal for controlling a function of the patient interface, or an apparatus control signal for changing an operating parameter of the treatment apparatus.

[0004] A system for remote treatment is also provided. The system for remote treatment comprises a patient interface having an output device and an input device for communicating information to and from a patient. The system for remote treatment also comprises a treatment apparatus configured to be manipulated by the patient for performing a rehabilitation regimen upon the body part, with the body part comprising at least one of a joint, a bone, or a muscle group. The system for remote treatment also comprises an assistant interface configured to communicate a telemedicine signal with the patient interface via a network connection, the telemedicine signal configured to control one of the patient interface or the treatment apparatus. The patient interface and the treatment apparatus are each configured to operate from a patient location geographically separated from the assistant interface.

[0005] An assistant user interface generated by a computer is also provided. The assistant user interface comprises an apparatus control having an apparatus status display and an apparatus session control configured to adjust an operating parameter of a treatment apparatus. The treatment apparatus is configured to be manipulated by a patient for performing a rehabilitation regimen upon a body part. The assistant user interface also comprises a patient communications control for controlling an audio or an audiovisual communications session with a patient interface, where the patient interface is configured for use by the patient while performing the rehabilitation regimen upon the body part. BRIEF DESCRIPTION OF THE DRAWINGS [0006] The disclosure is best understood from the following detailed description when read in conjunction with the accompanying drawings. It is emphasized that, according to common practice, the various features of the drawings are not to-scale. On the contrary, the dimensions of the various features are arbitrarily expanded or reduced for clarity. [0007] FIG. 1 shows a block diagram of an embodiment of a computer implemented system for managing a treatment plan;

[0008] FIG. 2 shows a perspective view of an embodiment of a treatment apparatus; [0009] FIG. 3 shows a perspective view of a pedal of the treatment apparatus of FIG. 2; [0010] FIG. 4 shows a perspective view of a person using the treatment apparatus of FIG. 2;

[0011] FIG. 5 shows an example embodiment of an overview display of an assistant interface;

[0012] FIG. 6 shows an example embodiment of a positioning confirmation screen of a patient interface;

[0013] FIG. 7 shows an example embodiment of a positioning help screen of a patient interface;

[0014] FIG. 8 shows an example embodiment of a session period action screen of a patient interface;

[0015] FIG. 9 illustrates example operations of a method for initiating a telemedicine session using a patient interface and an assistant interface according to certain embodiments of this disclosure;

[0016] FIG. 10 shows a block diagram of an embodiment of a computer implemented system for managing a treatment plan;

[0017] FIG. 11 shows a perspective view of an embodiment of a treatment apparatus; [0018] FIG. 12 shows a perspective view of a pedal of the treatment apparatus of FIG. 11 ;

[0019] FIG. 13 shows a perspective view of a person using the treatment apparatus of FIG. 11;

[0020] FIG. 14 shows an example embodiment of an overview display of a clinician interface; [0021] FIG. 15 shows an example embodiment of a patient profile display of a clinician interface;

[0022] FIG. 16 shows another view of the example patient profile display of FIG. 15; [0023] FIG. 17 shows an example embodiment of a treatment plan display of a clinician interface;

[0024] FIG. 18 shows an example embodiment of a treatment plan modification display of a clinician interface;

[0025] FIG. 19 shows an example embodiment of a treatment protocol management display of a clinician interface;

[0026] FIG. 20 shows an example embodiment of a login screen of a patient interface; [0027] FIG. 21 shows an example embodiment of a body part confirmation screen of a patient interface;

[0028] FIG. 22 shows an example embodiment of a treatment plan overview screen of a patient interface;

[0029] FIG. 23 shows an example embodiment of a pain level input screen of a patient interface;

[0030] FIG. 24 shows an example embodiment of a first patient questionnaire screen of a patient interface;

[0031] FIG. 25 shows an example embodiment of a second patient questionnaire screen of a patient interface;

[0032] FIG. 26 shows an example embodiment of a question confirmation screen of a patient interface;

[0033] FIG. 27 shows an example embodiment of a third patient questionnaire screen of a patient interface;

[0034] FIG. 28 shows an example embodiment of a positioning confirmation screen of a patient interface;

[0035] FIG. 29 shows an example embodiment of a positioning help screen of a patient interface;

[0036] FIG. 30 shows an example embodiment of a session period introduction screen of a patient interface; [0037] FIG. 31 shows an example embodiment of an E-stop confirmation screen of a patient interface;

[0038] FIG. 32 shows an example embodiment of an adjustment introduction screen of a patient interface;

[0039] FIG. 33 shows an example embodiment of an adjustment confirmation screen of a patient interface;

[0040] FIG. 34 shows an example embodiment of a session period action screen of a patient interface;

[0041] FIG. 35 shows an example embodiment of an exercise introduction screen of a patient interface;

[0042] FIG. 36 shows an example embodiment of an exercise action screen of a patient interface;

[0043] FIG. 37 shows an example embodiment of a first progress data screen of a patient interface;

[0044] FIG. 38 shows an example embodiment of a first progress data screen of a patient interface;

[0045] FIG. 39 shows a block diagram of an embodiment of a computer-implemented system for managing a treatment plan;

[0046] FIG. 40 shows a perspective view of an embodiment of a treatment apparatus; [0047] FIG. 41 shows a perspective view of a pedal of the treatment apparatus of FIG. 40;

[0048] FIG. 42 shows a perspective view of a person using the treatment apparatus of FIG. 40;

[0049] FIG. 43 shows an example embodiment of an overview display of a clinician interface;

[0050] FIG. 44 shows an example embodiment of a patient profile display of a clinician interface;

[0051] FIG. 45 shows another view of the example patient profile display of FIG. 44; [0052] FIG. 46 shows an example embodiment of a body part confirmation screen of a patient interface; [0053] FIG. 47 shows an example embodiment of a treatment plan overview screen of a patient interface;

[0054] FIG. 48 shows an example embodiment of a pain level input screen of a patient interface;

[0055] FIG. 49 shows an example embodiment of a first pretreatment questionnaire screen of a patient interface;

[0056] FIG. 50 shows an example embodiment of a second pretreatment questionnaire screen of a patient interface;

[0057] FIG. 51 shows an example embodiment of a question confirmation screen of a patient interface;

[0058] FIG. 52 shows an example embodiment of a third pretreatment questionnaire screen of a patient interface;

[0059] FIG. 53 shows an example embodiment of a positioning confirmation screen of a patient interface;

[0060] FIG. 54 shows an example embodiment of a positioning help screen of a patient interface;

[0061] FIG. 55 shows an example embodiment of an adjustment introduction screen of a patient interface;

[0062] FIG. 56 shows an example embodiment of an adjustment confirmation screen of a patient interface; and

[0063] FIG. 57 shows an example embodiment of a session period action screen of a patient interface.

NOTATION AND NOMENCLATURE

[0064] Various terms are used to refer to particular system components. Different companies may refer to a component by different names - this document does not intend to distinguish between components that differ in name but not function. In the following discussion and in the claims, the terms “including” and “comprising” are used in an open- ended fashion, and thus should be interpreted to mean “including, but not limited to... Also, the term “couple” or “couples” is intended to mean either an indirect or direct connection. Thus, if a first device couples to a second device, that connection may be through a direct connection or through an indirect connection via other devices and connections.

[0065] The terminology used herein is for the purpose of describing particular example embodiments only, and is not intended to be limiting. As used herein, the singular forms “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. The method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed.

[0066] The terms first, second, third, etc. may be used herein to describe various elements, components, regions, layers and/or sections; however, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms may be only used to distinguish one element, component, region, layer, or section from another region, layer, or section. Terms such as “first,” “second,” and other numerical terms, when used herein, do not imply a sequence or order unless clearly indicated by the context. Thus, a first element, component, region, layer, or section discussed below could be termed a second element, component, region, layer, or section without departing from the teachings of the example embodiments. The phrase “at least one of,” when used with a list of items, means that different combinations of one or more of the listed items may be used, and only one item in the list may be needed. For example, “at least one of: A, B, and C” includes any of the following combinations: A, B, C, A and B, A and C, B and C, and A and B and C. In another example, the phrase “one or more” when used with a list of items means there may be one item or any suitable number of items exceeding one.

[0067] Spatially relative terms, such as “inner,” “outer,” “beneath,” “below,” “lower,” “above,” “upper,” “top,” “bottom,” and the like, may be used herein. These spatially relative terms can be used for ease of description to describe one element’s or feature’s relationship to another element(s) or feature(s) as illustrated in the figures. The spatially relative terms may also be intended to encompass different orientations of the device in use, or operation, in addition to the orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be oriented “above” the other elements or features. Thus, the example term “below” can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptions used herein interpreted accordingly.

[0068] Moreover, various functions described below can be implemented or supported by one or more computer programs, each of which is formed from computer readable program code and embodied in a computer readable storage medium. The terms “application” and “program” refer to one or more computer programs, software components, sets of instructions, procedures, functions, methods, objects, classes, instances, related data, or a portion thereof adapted for implementation in a suitable computer readable program code. The phrase “computer readable program code” includes any type of computer code, including source code, object code, and executable code. The phrase “computer readable storage medium” includes any type of medium capable of being accessed by a computer, such as read only memory (ROM), random access memory (RAM), a hard disk drive, a flash drive, a compact disc (CD), a digital video disc (DVD), solid state drive (SSD), or any other type of memory. A “non-transitory” computer readable storage medium excludes wired, wireless, optical, or other communication links that transport transitory electrical or other signals. A non-transitory computer-readable storage medium includes media where data can be permanently stored and media where data can be stored and later overwritten, such as a rewritable optical disc or an erasable memory device.

[0069] The terms “transmit,” “receive,” and “communicate,” as well as derivatives thereof, encompass both direct and indirect communication. The terms “transmit,” “receive,” and “communicate,” as well as derivatives thereof, encompass both communication with remote systems and communication within a system, including reading and writing to different portions of a memory device. The term “controller” means any device, system or part thereof that controls at least one operation. Such a controller may be implemented in hardware or a combination of hardware and software and/or firmware. The functionality associated with any particular controller may be centralized or distributed, whether locally or remotely. [0070] A “treatment plan” may include one or more treatment protocols, and each treatment protocol includes one or more treatment sessions. Each treatment session comprises several session periods, with each session period including a particular exercise for treating the body part of the patient. For example, a treatment plan for post operative rehabilitation after a knee surgery may include an initial treatment protocol with twice daily stretching sessions for the first 3 days after surgery and a more intensive treatment protocol with active exercise sessions performed 4 times per day starting 4 days after surgery. A treatment plan may also include information pertaining to a medical procedure to perform on the patient, a treatment protocol for the patient using a treatment device, a diet regimen for the patient, a medication regimen for the patient, a sleep regimen for the patient, additional regimens, or some combination thereof.

[0071] The terms telemedicine, telehealth, telemed, teletherapeutic, telemedicine, etc. may be used interchangeably herein.

DETAILED DESCRIPTION

[0072] The following discussion is directed to various embodiments of the invention. Although one or more of these embodiments may be preferred, the embodiments disclosed should not be interpreted, or otherwise used, as limiting the scope of the disclosure, including the claims. In addition, one skilled in the art will understand that the following description has broad application, and the discussion of any embodiment is meant only to be exemplary of that embodiment, and not intended to intimate that the scope of the disclosure, including the claims, is limited to that embodiment.

[0073] FIG. 1 shows a block diagram of a computer-implemented system 10, hereinafter called “the system” for managing a treatment plan. The treatment plan includes one or more treatment protocols, and each treatment protocol includes one or more treatment sessions. Each treatment session comprises several session periods, with each session period including a particular activity for treating the body part of the patient. For example, a treatment plan for post-operative rehabilitation after a knee surgery may include an initial treatment protocol with twice daily stretching sessions for the first 3 days after surgery and a more intensive treatment protocol with active exercise sessions performed 4 times per day starting 4 days after surgery. [0074] The system 10 also includes a server 30 configured to store and to provide data related to managing the treatment plan. The server 30 may include one or more computers and may take the form of a distributed and/or virtualized computer or computers. The server 30 also includes a first communication interface 32 configured to communicate with the clinician interface 20 via a first network 34. In some embodiments, the first network 34 may include wired and/or wireless network connections such as Wi Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc. The server 30 includes a first processor 36 and a first machine-readable storage memory 38, which may be called a “memory” for short, holding first instructions 40 for performing the various actions of the server 30 for execution by the first processor 36. The server 30 is configured to store data regarding the treatment plan. For example, the memory 38 includes a system data store 42 configured to hold system data, such as data pertaining to treatment plans for treating one or more patients. The server 30 is also configured to store data regarding performance by a patient in following a treatment plan. For example, the memory 38 includes a patient data store 44 configured to hold patient data, such as data pertaining to the one or more patients, including data representing each patient’s performance within the treatment plan.

[0075] The system 10 also includes a patient interface 50 configured to communicate information to a patient and to receive feedback from the patient. Specifically, the patient interface includes an input device 52 and an output device 54, which may be collectively called a patient user interface 52, 54. The input device 52 may include one or more devices, such as a keyboard, a mouse, a touch screen input, a gesture sensor, and/or a microphone and processor configured for voice recognition. The output device 54 may take one or more different forms including, for example, a computer monitor or display screen on a tablet, smartphone, or a smart watch. The output device 54 may include other hardware and/or software components such as a projector, virtual reality capability, augmented reality capability, etc. The output device 54 may incorporate various different visual, audio, or other presentation technologies. For example, the output device 54 may include a non-visual display, such as an audio signal, which may include spoken language and/or other sounds such as tones, chimes, and/or melodies, which may signal different conditions and/or directions. The output device 54 may comprise one or more different display screens presenting various data and/or interfaces or controls for use by the patient. The output device 54 may include graphics, which may be presented by a web- based interface and/or by a computer program or application (App.).

[0076] As shown in FIG. 1 , the patient interface 50 includes a second communication interface 56, which may also be called a remote communication interface configured to communicate with the server 30 and/or the clinician interface 20 via a second network 58. In some embodiments, the second network 58 may include a local area network (LAN), such as an Ethernet network. In some embodiments, the second network 58 may include the Internet, and communications between the patient interface 50 and the server 30 and/or the clinician interface 20 may be secured via encryption, such as, for example, by using a virtual private network (VPN). In some embodiments, the second network 58 may include wired and/or wireless network connections such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc. In some embodiments, the second network 58 may be the same as and/or operationally coupled to the first network 34.

[0077] The patient interface 50 includes a second processor 60 and a second machine- readable storage memory 62 holding second instructions 64 for execution by the second processor 60 for performing various actions of patient interface 50. The second machine- readable storage memory 62 also includes a local data store 66 configured to hold data, such as data pertaining to a treatment plan and/or patient data, such as data representing a patient’s performance within a treatment plan. The patient interface 50 also includes a local communication interface 68 configured to communicate with various devices for use by the patient in the vicinity of the patient interface 50. The local communication interface 68 may include wired and/or wireless communications. In some embodiments, the local communication interface 68 may include a local wireless network such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc.

[0078] The system 10 also includes a treatment apparatus 70 configured to be manipulated by the patient and/or to manipulate a body part of the patient for performing activities according to the treatment plan. In some embodiments, the treatment apparatus 70 may take the form of an exercise and rehabilitation apparatus configured to perform and/or to aid in the performance of a rehabilitation regimen, which may be an orthopedic rehabilitation regimen, and the treatment includes rehabilitation of a body part of the patient, such as a joint or a bone or a muscle group. The body part may include, for example, a spine, a hand, a foot, a knee, or a shoulder. The body part may include a part of a joint, a bone, or a muscle group, such as one or more vertebrae, a tendon, or a ligament. As shown in FIG. 1 , the treatment apparatus 70 includes a controller 72, which may include one or more processors, computer memory, and/or other components. The treatment apparatus 70 also includes a fourth communication interface 74 configured to communicate with the patient interface 50 via the local communication interface 68. The treatment apparatus 70 also includes one or more internal sensors 76 and an actuator 78, such as a motor. The actuator 78 may be used, for example, for moving the patient’s body part and/or for resisting forces by the patient.

[0079] The internal sensors 76 may measure one or more operating characteristics of the treatment apparatus 70 such as, for example, a force a position, a speed, and /or a velocity. In some embodiments, the internal sensors 76 may include a position sensor configured to measure at least one of a linear motion or an angular motion of a body part of the patient. For example, an internal sensor 76 in the form of a position sensor may measure a distance that the patient is able to move a part of the treatment apparatus 70, where such distance may correspond to a range of motion that the patient’s body part is able to achieve. In some embodiments, the internal sensors 76 may include a force sensor configured to measure a force applied by the patient. For example, an internal sensor 76 in the form of a force sensor may measure a force or weight the patient is able to apply, using a particular body part, to the treatment apparatus 70.

[0080] The system 10 shown in FIG. 1 also includes an ambulation sensor 82, which communicates with the server 30 via the local communication interface 68 of the patient interface 50. The ambulation sensor 82 may track and store a number of steps taken by the patient. In some embodiments, the ambulation sensor 82 may take the form of a wristband, wristwatch, or smart watch. In some embodiments, the ambulation sensor 82 may be integrated within a phone, such as a smartphone.

[0081] The system 10 shown in FIG. 1 also includes a goniometer 84, which communicates with the server 30 via the local communication interface 68 of the patient interface 50. The goniometer 84 measures an angle of the patient’s body part. For example, the goniometer 84 may measure the angle of flex of a patient’s knee or elbow or shoulder.

[0082] The system 10 shown in FIG. 1 also includes a pressure sensor 86, which communicates with the server 30 via the local communication interface 68 of the patient interface 50. The pressure sensor 86 measures an amount of pressure or weight applied by a body part of the patient. For example, pressure sensor 86 may measure an amount of force applied by a patient’s foot when pedaling a stationary bike.

[0083] The system 10 shown in FIG. 1 also includes a supervisory interface 90 which may be similar or identical to the clinician interface 20. In some embodiments, the supervisory interface 90 may have enhanced functionality beyond what is provided on the clinician interface 20. The supervisory interface 90 may be configured for use by a person having responsibility for the treatment plan, such as an orthopedic surgeon.

[0084] The system 10 shown in FIG. 1 also includes a reporting interface 92 which may be similar or identical to the clinician interface 20. In some embodiments, the reporting interface 92 may have less functionality from what is provided on the clinician interface 20. For example, the reporting interface 92 may not have the ability to modify a treatment plan. Such a reporting interface 92 may be used, for example, by a biller to determine the use of the system 10 for billing purposes. In another example, the reporting interface 92 may not have the ability to display patient identifiable information, presenting only pseudonymized data and/or anonymized data for certain data fields concerning a data subject and/or for certain data fields concerning a quasi-identifier of the data subject. Such a reporting interface 92 may be used, for example, by a researcher to determine various effects of a treatment plan on different patients.

[0085] The system 10 includes an assistant interface 94 for an assistant, such as a doctor, a nurse, a physical therapist, or a technician, to remotely communicate with the patient interface 50 and/or the treatment apparatus 70. Such remote communications may enable the assistant to provide assistance or guidance to a patient using the system 10. More specifically, the assistant interface 94 is configured to communicate a telemedicine signal 96, 97, 98a, 98b, 99a, 99b with the patient interface 50 via a network connection such as, for example, via the first network 34 and/or the second network 58. The telemedicine signal 96, 97, 98a, 98b, 99a, 99b comprises one of an audio signal 96, an audiovisual signal 97, an interface control signal 98a for controlling a function of the patient interface 50, an interface monitor signal 98b for monitoring a status of the patient interface 50, an apparatus control signal 99a for controlling the treatment apparatus 70 (e.g., by changing an operating parameter (a speed of the motor, a resistive force of the pedals, a degree of motion provided by the pedal(s), etc.) of the treatment apparatus 70), an environmental change signal for controlling another electronic device (e.g., thermostat, speaker, light, door, appliance, etc.) that is proximate (e.g., within the same physical space) to the treatment apparatus 70 and/or the patient interface 50, and/or an apparatus monitor signal 99b for monitoring a status of the treatment apparatus 70. In some embodiments, the environmental change signal may cause the electronic device to change a temperature, change an air pressure, change an ambient setting, change an audio setting, etc. In some embodiments, each of the control signals 98a, 99a may be unidirectional, conveying commands from the assistant interface 94 to the patient interface 50. In some embodiments, in response to successfully receiving a control signal 98a, 99a and/or to communicate successful and/or unsuccessful implementation of the requested control action, an acknowledgement message may be sent from the patient interface 50 to the assistant interface 94. In some embodiments, each of the monitor signals 98b, 99b may be unidirectional, status-information commands from the patient interface 50 to the assistant interface 94. In some embodiments, an acknowledgement message may be sent from the assistant interface 94 to the patient interface 50 in response to successfully receiving one of the monitor signals 98b, 99b.

[0086] In some embodiments, the patient interface 50 may be configured as a pass through for the apparatus control signals 99a and the apparatus monitor signals 99b between the treatment apparatus 70 and one or more other devices, such as the assistant interface 94 and/or the server 30. For example, the patient interface 50 may be configured to transmit an apparatus control signal 99a in response to an apparatus control signal 99a within the telemedicine signal 96, 97, 98a, 98b, 99a, 99b from the assistant interface 94.

[0087] In some embodiments, the assistant interface 94 may be presented on a shared physical device as the clinician interface 20. For example, the clinician interface 20 may include one or more screens that implement the assistant interface 94. Alternatively or additionally, the clinician interface 20 may include additional hardware components, such as a video camera, a speaker, and/ora microphone, to implement aspects of the assistant interface 94.

[0088] In some embodiments, one or more portions of the telemedicine signal 96, 97, 98a, 98b, 99a, 99b may be generated from a prerecorded source (e.g., an audio recording, a video recording, or an animation) for presentation by the output device 54 of the patient interface 50. For example, a tutorial video may be streamed from the server 30 and presented upon the patient interface 50. Content from the prerecorded source may be requested by the patient via the patient interface 50. Alternatively, via a control on the assistant interface 94, the assistant may cause content from the prerecorded source to be played on the patient interface 50.

[0089] The assistant interface 94 includes an assistant input device 22 and an assistant display 24, which may be collectively called an assistant user interface 22, 24. The assistant input device 22 may include one or more of a telephone, a keyboard, a mouse, a trackpad, or a touch screen, for example. Alternatively or additionally, the assistant input device 22 may include one or more microphones. In some embodiments, the one or more microphones may take the form of a telephone handset, headset, or wide-area microphone or microphones configured for the assistant to speak to a patient via the patient interface 50. In some embodiments, assistant input device 22 may be configured to provide voice-based functionalities, with hardware and/or software configured to interpret spoken instructions by the assistant by using the one or more microphones. The assistant input device 22 may include functionality provided by or similar to existing voice- based assistants such as Siri by Apple, Alexa by Amazon, Google Assistant, or Bixby by Samsung. The assistant input device 22 may include other hardware and/or software components. The assistant input device 22 may include one or more general purpose devices and/or special-purpose devices.

[0090] The assistant display 24 may take one or more different forms including, for example, a computer monitor or display screen on a tablet, a smartphone, or a smart watch. The assistant display 24 may include other hardware and/or software components such as projectors, virtual reality capabilities, or augmented reality capabilities, etc. The assistant display 24 may incorporate various different visual, audio, or other presentation technologies. For example, the assistant display 24 may include a non-visual display, such as an audio signal, which may include spoken language and/or other sounds such as tones, chimes, melodies, and/or compositions, which may signal different conditions and/or directions. The assistant display 24 may comprise one or more different display screens presenting various data and/or interfaces or controls for use by the assistant. The assistant display 24 may include graphics, which may be presented by a web-based interface and/or by a computer program or application (App.).

[0091] In some embodiments, the system 10 may provide computer translation of language from the assistant interface 94 to the patient interface 50 and/or vice-versa. The computer translation of language may include computer translation of spoken language and/or computer translation of text. Additionally or alternatively, the system 10 may provide voice recognition and/or spoken pronunciation of text. For example, the system 10 may convert spoken words to printed text and/or the system 10 may audibly speak language from printed text. The system 10 may be configured to recognize spoken words by any or all of the patient, the clinician, and/or the assistant. In some embodiments, the system 10 may be configured to recognize and react to spoken requests or commands by the patient. For example, the system 10 may automatically initiate a telemedicine session in response to a verbal command by the patient (which may be given in any one of several different languages).

[0092] In some embodiments, the server 30 may generate aspects of the assistant display 24 for presentation by the assistant interface 94. For example, the server 30 may include a web server configured to generate the display screens for presentation upon the assistant display 24. In some embodiments, the assistant display 24 may be configured to present a virtualized desktop hosted by the server 30. In some embodiments, the server 30 may be configured to communicate with the assistant interface 94 via the first network 34. In some embodiments, the first network 34 may include a local area network (LAN), such as an Ethernet network. In some embodiments, the first network 34 may include the Internet, and communications between the server 30 and the assistant interface 94 may be secured via privacy enhancing technologies, such as, for example, by using encryption over a virtual private network (VPN). Alternatively or additionally, the server 30 may be configured to communicate with the assistant interface 94 via one or more networks independent of the first network 34 and/or other communication means, such as a direct wired or wireless communication channel. In some embodiments, the patient interface 50 and the treatment apparatus 70 may each operate from a patient location geographically separate from a location of the assistant interface 94. For example, the patient interface 50 and the treatment apparatus 70 may be used as part of an in-home rehabilitation system, which may be aided remotely by using the assistant interface 94 at a centralized location, such as a clinic or a call center. [0093] In some embodiments, the assistant interface 94 may be one of several different terminals that may be grouped together, for example, in one or more call centers or at one or more clinicians’ offices. In some embodiments, a plurality of assistant interfaces 94 may be distributed geographically. In some embodiments, a person may work as an assistant remotely from any conventional office infrastructure. Such remote work may be performed, for example, where the assistant interface 94 takes the form of a computer and/or telephone. This remote work functionality may allow for work-from-home arrangements that may include part time and/or flexible work hours for an assistant. [0094] FIGS. 2-3 show an embodiment of a treatment apparatus 70. More specifically, FIG. 2 shows a treatment apparatus 70 in the form of a stationary cycling machine 100, which may be called a stationary bike, for short. The stationary cycling machine 100 includes a set of pedals 102 each attached to a pedal arm 104 for rotation about an axle 106. In some embodiments, and as shown in FIG. 2, the pedals 102 are movable on the pedal arms 104 in order to adjust a range of motion used by the patient in pedaling. For example, the pedals being located inwardly toward the axle 106 corresponds to a smaller range of motion than when the pedals are located outwardly away from the axle 106. A pressure sensor 86 is attached to or embedded within one of the pedals 102 for measuring an amount of force applied by the patient on the pedal 102. The pressure sensor 86 may communicate wirelessly to the treatment apparatus 70 and/or to the patient interface 50.

[0095] FIG. 4 shows a person (a patient) using the treatment apparatus of FIG. 2, and showing sensors and various data parameters connected to a patient interface 50. The example patient interface 50 is a tablet computer or smartphone, or a phablet, such as an iPad, an iPhone, an Android device, or a Surface tablet, which is held manually by the patient. In some other embodiments, the patient interface 50 may be embedded within or attached to the treatment apparatus 70. FIG. 4 shows the patient wearing the ambulation sensor 82 on his wrist, with a note showing “STEPS TODAY 1355”, indicating that the ambulation sensor 82 has recorded and transmitted that step count to the patient interface 50. FIG. 4 also shows the patient wearing the goniometer 84 on his right knee, with a note showing “KNEE ANGLE 72°”, indicating that the goniometer 84 is measuring and transmitting that knee angle to the patient interface 50. FIG. 4 also shows a right side of one of the pedals 102 with a pressure sensor 86 showing “FORCE 12.5 lbs.,” indicating that the right pedal pressure sensor 86 is measuring and transmitting that force measurement to the patient interface 50. FIG. 4 also shows a left side of one of the pedals 102 with a pressure sensor 86 showing “FORCE 27 lbs.”, indicating that the left pedal pressure sensor 86 is measuring and transmitting that force measurement to the patient interface 50. FIG. 4 also shows other patient data, such as an indicator of “SESSION TIME 0:04:13”, indicating that the patient has been using the treatment apparatus 70 for 4 minutes and 13 seconds. This session time may be determined by the patient interface 50 based on information received from the treatment apparatus 70. FIG. 4 also shows an indicator showing “PAIN LEVEL 3”. Such a pain level may be obtained from the patient in response to a solicitation, such as a question, presented upon the patient interface 50. [0096] FIG. 5 is an example embodiment of an overview display 120 of the assistant interface 94. Specifically, the overview display 120 presents several different controls and interfaces for the assistant to remotely assist a patient with using the patient interface 50 and/or the treatment apparatus 70. This remote assistance functionality may also be called telemedicine.

[0097] Specifically, the overview display 120 includes a patient profile display 130 presenting biographical information regarding a patient using the treatment apparatus. The patient profile display 130 may take the form of a portion or region of the overview display 120, as shown in FIG. 5, although the patient profile display 130 may take other forms, such as a separate screen or a popup window. In some embodiments, the patient profile display 130 may include a limited subset of the patient’s biographical information. More specifically, the data presented upon the patient profile display 130 may depend upon the assistant’s need for that information. For example, a medical professional that is assisting the patient with a medical issue may be provided with medical history information regarding the patient, whereas a technician troubleshooting an issue with the treatment apparatus 70 may be provided with a much more limited set of information regarding the patient. The technician, for example, may be given only the patient’s name. The patient profile display 130 may include pseudonym ized data and/or anonymized data or use any privacy enhancing technology to prevent confidential patient data from being communicated in a way that could violate patient confidentiality requirements. Such privacy enhancing technologies may enable compliance with laws, regulations, or other rules of governance such as, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA), or the General Data Protection Regulation (GDPR), wherein the patient may be deemed a “data subject”. In some embodiments, the patient profile display 130 may present information regarding the treatment plan for the patient to follow in using the treatment apparatus 70. Such treatment plan information may be limited to an assistant who is a medical professional, such as a doctor or physical therapist. For example, a medical professional assisting the patient with an issue regarding the treatment regimen may be provided with treatment plan information, whereas a technician troubleshooting an issue with the treatment apparatus 70 may not be provided with any information regarding the patient’s treatment plan.

[0098] The example overview display 120 shown in FIG. 5 also includes a patient status display 134 presenting status information regarding a patient using the treatment apparatus. The patient status display 134 may take the form of a portion or region of the overview display 120, as shown in FIG. 5, although the patient status display 134 may take other forms, such as a separate screen or a popup window. The patient status display 134 includes sensor data 136 from one or more of the external sensors 82, 84, 86, and/or from one or more internal sensors 76 of the treatment apparatus 70. In some embodiments, the patient status display 134 may present other data 138 regarding the patient, such as last reported pain level, or progress within a treatment plan.

[0099] User access controls may be used to limit access, including what data is available to be viewed and/or modified, on any or all of the user interfaces 20, 50, 90, 92, 94 of the system 10. In some embodiments, user access controls may be employed to control what information is available to any given person using the system 10. For example, data presented on the assistant interface 94 may be controlled by user access controls, with permissions set depending on the assistant/user’s need for and/or qualifications to view that information.

[0100] The example overview display 120 shown in FIG. 5 also includes a help data display 140 presenting information for the assistant to use in assisting the patient. The help data display 140 may take the form of a portion or region of the overview display 120, as shown in FIG. 5. The help data display 140 may take other forms, such as a separate screen or a popup window. The help data display 140 may include, for example, presenting answers to frequently asked questions regarding use of the patient interface 50 and/or the treatment apparatus 70. The help data display 140 may also include research data or best practices. In some embodiments, the help data display 140 may present scripts for answers or explanations in response to patient questions. In some embodiments, the help data display 140 may present flow charts or walk-throughs for the assistant to use in determining a root cause and/or solution to a patient’s problem. In some embodiments, the assistant interface 94 may present two or more help data displays 140, which may be the same or different, for simultaneous presentation of help data for use by the assistant. For example, a first help data display may be used to present a troubleshooting flowchart to determine the source of a patient’s problem, and a second help data display may present script information for the assistant to read to the patient, such information to preferably include directions for the patient to perform some action, which may help to narrow down or solve the problem. In some embodiments, based upon inputs to the troubleshooting flowchart in the first help data display, the second help data display may automatically populate with script information.

[0101] The example overview display 120 shown in FIG. 5 also includes a patient interface control 150 presenting information regarding the patient interface 50, and/or to modify one or more settings of the patient interface 50. The patient interface control 150 may take the form of a portion or region of the overview display 120, as shown in FIG. 5. The patient interface control 150 may take other forms, such as a separate screen or a popup window. The patient interface control 150 may present information communicated to the assistant interface 94 via one or more of the interface monitor signals 98b. As shown in FIG. 5, the patient interface control 150 includes a display feed 152 of the display presented by the patient interface 50. In some embodiments, the display feed 152 may include a live copy of the display screen currently being presented to the patient by the patient interface 50. In other words, the display feed 152 may present an image of what is presented on a display screen of the patient interface 50. In some embodiments, the display feed 152 may include abbreviated information regarding the display screen currently being presented by the patient interface 50, such as a screen name or a screen number. The patient interface control 150 may include a patient interface setting control 154 for the assistant to adjust or to control one or more settings or aspects of the patient interface 50. In some embodiments, the patient interface setting control 154 may cause the assistant interface 94 to generate and/or to transmit an interface control signal 98 for controlling a function or a setting of the patient interface 50.

[0102] In some embodiments, the patient interface setting control 154 may include collaborative browsing or co-browsing capability for the assistant to remotely view and/or control the patient interface 50. For example, the patient interface setting control 154 may enable the assistant to remotely enter text to one or more text entry fields on the patient interface 50 and/or to remotely control a cursor on the patient interface 50 using a mouse or touchscreen of the assistant interface 94.

[0103] In some embodiments, using the patient interface 50, the patient interface setting control 154 may allow the assistant to change a setting that cannot be changed by the patient. For example, the patient interface 50 may be precluded from accessing a language setting to prevent a patient from inadvertently switching, on the patient interface 50, the language used for the displays, whereas the patient interface setting control 154 may enable the assistant to change the language setting of the patient interface 50. In another example, the patient interface 50 may not be able to change a font size setting to a smaller size in order to prevent a patient from inadvertently switching the font size used for the displays on the patient interface 50 such that the display would become illegible to the patient, whereas the patient interface setting control 154 may provide for the assistant to change the font size setting of the patient interface 50.

[0104] The example overview display 120 shown in FIG. 5 also includes an interface communications display 156 showing the status of communications between the patient interface 50 and one or more other devices 70, 82, 84, such as the treatment apparatus 70, the ambulation sensor 82, and/or the goniometer 84. The interface communications display 156 may take the form of a portion or region of the overview display 120, as shown in FIG. 5. The interface communications display 156 may take other forms, such as a separate screen or a popup window. The interface communications display 156 may include controls for the assistant to remotely modify communications with one or more of the other devices 70, 82, 84. For example, the assistant may remotely command the patient interface 50 to reset communications with one of the other devices 70, 82, 84, or to establish communications with a new one of the other devices 70, 82, 84. This functionality may be used, for example, where the patient has a problem with one of the other devices 70, 82, 84, or where the patient receives a new or a replacement one of the other devices 70, 82, 84.

[0105] The example overview display 120 shown in FIG. 5 also includes an apparatus control 160 for the assistant to view and/or to control information regarding the treatment apparatus 70. The apparatus control 160 may take the form of a portion or region of the overview display 120, as shown in FIG. 5. The apparatus control 160 may take other forms, such as a separate screen or a popup window. The apparatus control 160 may include an apparatus status display 162 with information regarding the current status of the apparatus. The apparatus status display 162 may present information communicated to the assistant interface 94 via one or more of the apparatus monitor signals 99b. The apparatus status display 162 may indicate whether the treatment apparatus 70 is currently communicating with the patient interface 50. The apparatus status display 162 may present other current and/or historical information regarding the status of the treatment apparatus 70.

[0106] The apparatus control 160 may include an apparatus setting control 164 for the assistant to adjust or control one or more aspects of the treatment apparatus 70. The apparatus setting control 164 may cause the assistant interface 94 to generate and/or to transmit an apparatus control signal 99 for changing an operating parameter of the treatment apparatus 70, (e.g., a pedal radius setting, a resistance setting, a target RPM, etc.). The apparatus setting control 164 may include a mode button 166 and a position control 168, which may be used in conjunction for the assistant to place an actuator 78 of the treatment apparatus 70 in a manual mode, after which a setting, such as a position or a speed of the actuator 78, can be changed using the position control 168. The mode button 166 may provide for a setting, such as a position, to be toggled between automatic and manual modes. In some embodiments, one or more settings may be adjustable at any time, and without having an associated auto/manual mode. In some embodiments, the assistant may change an operating parameter of the treatment apparatus 70, such as a pedal radius setting, while the patient is actively using the treatment apparatus 70. Such “on the fly” adjustment may or may not be available to the patient using the patient interface 50. In some embodiments, the apparatus setting control 164 may allow the assistant to change a setting that cannot be changed by the patient using the patient interface 50. For example, the patient interface 50 may be precluded from changing a preconfigured setting, such as a height or a tilt setting of the treatment apparatus 70, whereas the apparatus setting control 164 may provide for the assistant to change the height or tilt setting of the treatment apparatus 70.

[0107] The example overview display 120 shown in FIG. 5 also includes a patient communications control 170 for controlling an audio or an audiovisual communications session with the patient interface 50. The communications session with the patient interface 50 may comprise a feed from the assistant interface 94 for presentation by the output device of the patient interface 50. In some embodiments, the feed is live (e.g., real time or near real-time). In some embodiments, the feed is prerecorded and may be played, paused, fast-forwarded, stopped, and/or replayed. The feed may take the form of an audio feed and/or a video feed. In some embodiments, the patient interface 50 may be configured to provide two-way audio communications, two-way audiovisual communications, two-way visual communications, two-way haptic communications, two- way environmental communications, or two-way communications using on each side of the communications one of the foregoing means, where the means on one side and the means on the other side are different, with a person using the assistant interface 94. Specifically, the communications session with the patient interface 50 may include bidirectional (two-way) video or audiovisual feeds, with each of the patient interface 50 and the assistant interface 94 presenting video of the other one. In some embodiments, the patient interface 50 may present video from the assistant interface 94, while the assistant interface 94 presents only audio or the assistant interface 94 presents no live audio or visual signal from the patient interface 50. In some embodiments, the assistant interface 94 may present video from the patient interface 50, while the patient interface 50 presents only audio or the patient interface 50 presents no live audio or visual signal from the assistant interface 94.

[0108] In some embodiments, the audio or an audiovisual communications session with the patient interface 50 may take place, at least in part, while the patient is performing the rehabilitation regimen upon the body part. The patient communications control 170 may take the form of a portion or region of the overview display 120, as shown in FIG. 5. The patient communications control 170 may take other forms, such as a separate screen or a popup window. The audio and/or audiovisual communications may be processed and/or directed by the assistant interface 94 and/or by another device or devices, such as a telephone system, or a videoconferencing system used by the assistant while the assistant uses the assistant interface 94. Alternatively or additionally, the audio and/or audiovisual communications may include communications with a third party. For example, the system 10 may enable the assistant to initiate a 3-way conversation regarding use of a particular piece of hardware or software, with the patient and a subject matter expert, such as a medical professional or a specialist. The example patient communications control 170 shown in FIG. 5 includes call controls 172 for the assistant to use in managing various aspects of the audio or audiovisual communications with the patient. The call controls 172 include a disconnect button 174 for the assistant to end the audio or audiovisual communications session. The call controls 172 also include a mute button 176 to temporarily silence an audio or audiovisual signal from the assistant interface 94. In some embodiments, the call controls 172 may include other features, such as a hold button (not shown). The call controls 172 also include one or more record/playback controls 178, such as record, play, and pause buttons to control, with the patient interface 50, recording and/or playback of audio and/or video from the teleconference session. The call controls 172 also include a video feed display 180 for presenting still and/or video images from the patient interface 50, and a self-video display 182 showing the current image of the assistant using the assistant interface. The self-video display 182 may be presented as a picture-in-picture format, within a section of the video feed display 180, as shown in FIG. 5. Alternatively or additionally, the self-video display 182 may be presented separately and/or independently from the video feed display 180.

[0109] The example overview display 120 shown in FIG. 5 also includes a third party communications control 190 for use in conducting audio and/or audiovisual communications with a third party. The third party communications control 190 may take the form of a portion or region of the overview display 120, as shown in FIG. 5. The third party communications control 190 may take other forms, such as a display on a separate screen or a popup window. The third party communications control 190 may include one or more controls, such as a contact list and/or buttons or controls to contact a third party regarding use of a particular piece of hardware or software, e.g., a subject matter expert, such as a medical professional or a specialist. The third party communications control 190 may include conference calling capability for the third party to simultaneously communicate with both the assistant via the assistant interface 94, and with the patient via the patient interface 50. For example, the system 10 may provide for the assistant to initiate a 3-way conversation with the patient and the third party.

[0110] FIG. 6 shows an example embodiment of positioning confirmation screen 520 of the patient interface 50. This screen 520 is the beginning of a guided walk-through for the patient to use the treatment apparatus 70. Specifically, this screen 520 includes written instructions to guide the patient in placing their feet in the pedals 102 of a stationary cycling machine 100. In some embodiments, this screen 520 may include graphics, such as pictures or animations to help the patient perform particular actions for using the treatment apparatus 70. Screen 520 includes a position confirmation selector 522 for the patient to indicate that they are in position to use the treatment apparatus 70. Screen 520 also includes a trouble button 524 for the patient to indicate that they are having trouble getting in position to use the treatment apparatus 70.

[0111] FIG. 7 shows an example embodiment of a positioning help screen 560 of the patient interface 50. This positioning help screen 560 may be shown in response to the user selecting the trouble button 524 on the positioning confirmation screen 520. The help screen 560 may automatically be displayed if the patient fails to select the position confirmation selector 522 within a predetermined period of time. In some embodiments, an intermediate screen such as a popup asking if the patient needs more time may be displayed before the help screen 560 is shown. The help screen 560 includes a tutorial request button 562 for the patient to obtain additional prerecorded instructions for using the treatment apparatus 70. The help screen 560 may include a live assistance request button 563 for the patient to initiate a telemedicine session with a remote assistant by using the assistant interface 94.

[0112] In some embodiments, an operator or dispatcher may receive an initial request for assistance from the patient interface 50. The operator or dispatcher may forward the request for assistance to an assistant available and/or to an assistant qualified or suited to help the patient with a particular problem or inquiry. For example, medical questions regarding the patient’s body may be forwarded to an assistant having medical qualifications, such as a doctor or a nurse. Technical questions regarding operation or use of the treatment apparatus 70 may be forwarded to a technician having training and/or experience with the treatment apparatus 70. In some embodiments, the operator or dispatcher may be equipped and authorized to answer some questions that are frequently asked and/or which do not require specialized knowledge or training.

[0113] The help screen 560 may also include an exit button 564 that the patient can use to stop the treatment session in case they are unable to resolve their issue with using the treatment apparatus 70. Use of the exit button 564 may generate an alert to the clinician. The help screen 560 also includes a proceed button 566 that the patient can use to indicate that they have resolved their issue and are able to proceed with the treatment session.

[0114] FIG. 8 shows an example embodiment of a session period action screen 760 of the patient interface 50. This screen 760 is displayed while a given session period is in progress. The session period action screen 760 includes an on-screen E-stop control 642 as a stop button for stopping the treatment apparatus 70, which may be present on all screens of the patient interface 50 during the treatment session. The session period action screen 760 also includes a help button 644, which may be present on several or all of the screens of the patient interface 50, and which functions as a manual control for the patient to initiate a telemedicine session with a remote assistant by using the assistant interface 94. [0115] In some embodiments, a telemedicine session with the assistant interface may be initiated by the patient interface 50 in response to a predetermined condition of the treatment apparatus 70. For example, if a patient is unable to meet certain performance criteria, such as RPM or a force upon one of the pedals, or if the patient’s performance of an activity using the treatment apparatus 70 is outside of normal use by that patient, then the system 10 may be configured to automatically initiate the telemedicine session wherein an assistant checks to see if the patient needs help.

[0116] FIG. 9 illustrates example operations of a method 900 for initiating a telemedicine session using a patient interface 50 and an assistant interface 94 according to certain embodiments of this disclosure. The method 900 is performed by processing logic that may include hardware (circuitry, dedicated logic, etc.), software (such as is run on a general purpose computer system or a dedicated machine), or a combination of both. The method 900 and/or each of their individual functions, routines, subroutines, or operations may be performed by one or more processors of a computing device (e.g., any component of FIG. 1 , such as patient interface 50, assistant interface server 94, server 30, clinical interface 20, supervisory interface 90, reporting interface 92, treatment apparatus 70, etc.). In certain implementations, the method 900 may be performed by a single processing thread. Alternatively, the method 900 may be performed by two or more processing threads, each thread implementing one or more individual functions, routines, subroutines, or operations of the methods.

[0117] For simplicity of explanation, the method 900 is depicted and described as a series of operations. Flowever, operations in accordance with this disclosure can occur in various orders and/or concurrently, and with other operations not presented and described herein. For example, the operations depicted in the method 900 may occur in combination with any other operation of any other method disclosed herein. Furthermore, not all illustrated operations may be required to implement the method 900 in accordance with the disclosed subject matter. In addition, those skilled in the art will understand and appreciate that the method 900 could alternatively be represented as a series of interrelated states via a state diagram or events.

[0118] At 902, the processing device may receive, at the patient interface 50, data from one or more sources. In some embodiments, the one or more sources may include a sensor (e.g., pressure or force sensor, goniometer, wearable sensor, etc.), the treatment apparatus 70, an input peripheral (e.g., touchscreen, mouse, keyboard, microphone, camera, etc.) of the patient interface 50, or some combination thereof. In some embodiments, the data may include a sensor measurement (e.g., force measurement from a pressure sensor of the pedal, a range of motion measurement from the goniometer, a vital sign from a wearable, a temperature of the patient from a thermometer, etc.), an answer (e.g., a pain level, whether the exercise is too difficult, etc.) to a question presented on the patient interface 50, a vital sign (e.g., heartrate, blood pressure, etc.), a characteristic of the user, or some combination thereof.

[0119] The data may be received while a user (patient) is operating the treatment apparatus 70 to perform a treatment plan. The treatment plan may include a rehabilitation regimen for a body part. In some embodiments, the body part may include at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

[0120] At 904, the processing device may determine, based on the data, whether a trigger event has occurred. In some embodiments, the trigger event may include receiving a response to one or more questions presented on the patient interface 50, where the response is an answer to the one or more questions. In some embodiments, the trigger event may include determining a condition of the treatment apparatus 70 (e.g., the patient is not exerting a threshold level of force on the pressure sensor of the pedal, the patient is not able to pedal at a particular range of motion setting, etc.).

[0121] At 906, responsive to determining the trigger event has occurred and using the patient interface 50 and the assistant interface 94, the processing device may electronically initiate the telemedicine session. Initiating the telemedicine session may include two-way communication between the patient interface 50 and the assistant interface 94 that triggers an application installed as a stand-alone application or within another application (e.g., website in a web browser) on each of the patient interface 50 and assistant interface 94 to execute computer instructions. The execution of the computer instructions may control the application to initiate the telemedicine session, where the telemedicine session can include audio, visual, audiovisual, or the like. In some embodiments, a portion of a user interface of the application executing on the assistant interface 94 and the patient interface 50 may present a video feed of each respective participant (e.g., the patient feed is presented on the assistant interface 94 and the assistant feed is presented on the patient interface 50).

[0122] In some embodiments, the processing device may cause presentation of the data on the assistant interface 94 by transmitting the data to the assistant interface 94. In some embodiments, the processing device may receive, from the assistant interface 94, a telemedicine signal including one of an audio signal, an audiovisual signal, a visual signal, a haptic signal, an environmental change signal, an interface control signal for controlling a function of the patient interface 50, or an apparatus control signal for changing an operating parameter of the treatment apparatus 70.

[0123] In some embodiments, the processing device may cause, during the telemedicine session, a patient profile display to be presented on the assistant interface 94. The patient profile display may include information related to the treatment plan for the patient, and the treatment plan may be related to how the patient is intended to use the treatment apparatus.

REACTIVE PROTOCOLS FOR ORTHOPEDIC TREATMENT

[0124] FIG. 10 shows a block diagram of a computer-implemented system 1010, hereinafter called “the system” for managing a treatment plan. The treatment plan includes one or more treatment protocols, and each treatment protocol includes one or more sessions. Each session comprises several session periods, with each session period including a particular activity for treating the body part of the patient. For example, a treatment plan for post-operative rehabilitation after a knee surgery may include an initial treatment protocol with twice daily stretching sessions for the first 3 days after surgery and a more intensive treatment protocol with active exercise sessions performed 4 times per day starting 4 days after surgery.

[0125] The system 1010 includes a clinician interface 1020 for a clinician, such as a doctor, a nurse, a physical therapist, or a technician, to use to review and to configure various aspects of a treatment plan for use in treating a patient. The clinician interface 1020 includes a clinician input device 1022 and a clinician display 1024, which may be collectively called a clinician user interface 1022, 1024. The clinician input device 1022 may include one or more of a keyboard, a mouse, a trackpad, or a touch screen, for example. Alternatively or additionally, the clinician input device 1022 may include one or more microphones and voice-based functionalities, with hardware and/or software configured to interpret spoken instructions by the clinician by using the one or more microphones. The clinician input device 1022 may include functionality provided by or similar to existing voice-based assistants such as Siri by Apple, Alexa by Amazon, Google Assistant, or Bixby by Samsung. The clinician input device 1022 may include other hardware and/or software components. The clinician input device 1022 may include one or more general purpose devices and/or special-purpose devices.

[0126] The clinician display 1024 may take one or more different forms including, for example, a computer monitor or display screen on a tablet, smartphone, or a smart watch. The clinician display 1024 may include other hardware and/or software components such as a projector, virtual reality capability, or augmented reality capability etc. The clinician display 1024 may incorporate various different visual, audio, or other presentation technologies. For example, the clinician display 1024 may include a non-visual display, such as an audio signal, which may include spoken language and/or other sounds such as tones, chimes, and/or melodies which may signal different conditions and/or directions. The clinician display 1024 may comprise one or more different display screens presenting various data and/or interfaces or controls for use by the clinician. The clinician display 1024 may include graphics, which may be presented by a web-based interface and/or by a computer program or application (App.).

[0127] The system 1010 also includes a server 1030 configured to store and to provide data related to managing the treatment plan. The server 1030 may include one or more computers and may take the form of a distributed and/or virtualized computer or computers. In some embodiments, the server 1030 may generate aspects of the clinician display 1024 for presentation by the clinician interface 1020. For example, the server 1030 may include a web server configured to generate the display screens for presentation upon the clinician display 1024. In some embodiments, the clinician display 1024 may be configured to present a virtualized desktop that is hosted by the server 1030. The server 1030 also includes a first communication interface 1032 configured to communicate with the clinician interface 1020 via a first network 1034. In some embodiments, the first network 1034 may include a local area network (LAN), such as an Ethernet network. In some embodiments, the first network 1034 may include the Internet, and communications between the server 1030 and the clinician interface 1020 may be secured via encryption, such as, for example, by using a virtual private network (VPN). In some embodiments, the first network 1034 may include wired and/or wireless network connections such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc. The server 1030 includes a first processor 1036 and a first machine-readable storage memory 1038, which may be called a “memory” for short, holding first instructions 1040 for performing the various actions of the server 1010 for execution by the first processor 1036. The server 1010 is configured to store data regarding the treatment plan. For example, the memory 1038 includes a system data store 1042 configured to hold system data, such as data pertaining to treatment plans for treating one or more patients. The server 1010 is also configured to store data regarding performance by a patient in following a treatment plan. For example, the memory 1038 includes a patient data store 1044 configured to hold patient data, such as data pertaining to the one or more patients, including data representing each patient’s performance within the treatment plan.

[0128] The system 1010 also includes a patient interface 1050 configured to communicate information to a patient and to receive feedback from the patient. Specifically, the patient interface includes an input device 1052 and an output device 1054, which may be collectively called a patient user interface 1052, 1054. The input device 1052 may include one or more devices, such as a keyboard, a mouse, a touch screen input, a gesture sensor, and/or a microphone and processor configured for voice recognition. The output device 1054 may take one or more different forms including, for example, a computer monitor or display screen on a tablet, smartphone, or a smart watch. The output device 1054 may include other hardware and/or software components such as a projector, virtual reality capability, augmented reality capability, etc. The output device 1054 may incorporate various different visual, audio, or other presentation technologies. For example, the output device 1054 may include a non-visual display, such as an audio signal, which may include spoken language and/or other sounds such as tones, chimes, and/or melodies, which may signal different conditions and/or directions. The output device 1054 may comprise one or more different display screens presenting various data and/or interfaces or controls for use by the patient. The output device 1054 may include graphics, which may be presented by a web-based interface and/or by a computer program or application (App.).

[0129] As shown in FIG. 10, the patient interface 1050 includes a second communication interface 1056, which may also be called a remote communication interface configured to communicate with the server 1030 and/or the clinician interface 1020 via a second network 1058. In some embodiments, the second network 1058 may include a local area network (LAN), such as an Ethernet network. In some embodiments, the second network 1058 may include the Internet, and communications between the patient interface 1050 and the server 1030 and/or the clinician interface 1020 may be secured via encryption, such as, for example, by using a virtual private network (VPN). In some embodiments, the second network 1058 may include wired and/or wireless network connections such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc. In some embodiments, the second network 1058 may be the same as and/or operationally coupled to the first network 1034.

[0130] The patient interface 1050 includes a second processor 1060 and a second machine-readable storage memory 1062 holding second instructions 1064 for execution by the second processor 1060 for performing various actions of patient interface 1050. The second machine-readable storage memory 1062 also includes a local data store 1066 configured to hold data, such as data pertaining to a treatment plan and/or patient data, such as data representing a patient’s performance within a treatment plan. The patient interface 1050 also includes a local communication interface 1068 configured to communicate with various devices for use by the patient in the vicinity of the patient interface 1050. The local communication interface 1068 may include wired and/or wireless communications. In some embodiments, the local communication interface 1068 may include a local wireless network such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc.

[0131] The system 1010 also includes a treatment apparatus 1070 configured to be manipulated by the patient and/or to manipulate a body part of the patient for performing activities according to the treatment plan. In some embodiments, the treatment apparatus 1070 may take the form of an exercise and rehabilitation apparatus configured to perform and/or to aid in the performance of a rehabilitation regimen, which may be an orthopedic rehabilitation regimen, and the treatment includes rehabilitation of a body part of the patient, such as a joint or a bone or a muscle group. The body part may include, for example, a spine, a hand, a foot, a knee, or a shoulder. The body part may include a part of a joint, a bone, or a muscle group, such as one or more vertebrae or a ligament. As shown in FIG. 10, the treatment apparatus 1070 includes a controller 1072, which may include one or more processors, computer memory, and/or other components. The treatment apparatus 1070 also includes a fourth communication interface 1074 configured to communicate with the patient interface 1050 via the local communication interface 1068. The treatment apparatus 1070 also includes one or more internal sensors 1076 and an actuator 1078, such as a motor. The actuator 1078 may be used, for example, for moving the patient’s body part and/or for resisting forces by the patient. [0132] The internal sensors 1076 may measure one or more operating characteristics of the treatment apparatus 1070 such as, for example, a force a position, a speed, and /or a velocity. In some embodiments, the internal sensors 1076 may include a position sensor configured to measure at least one of a linear motion or an angular motion of a body part of the patient. For example, an internal sensor 1076 in the form of a position sensor may measure a distance that the patient is able to move a part of the treatment apparatus 1070, where such distance may correspond to a range of motion that the patient’s body part is able to achieve. In some embodiments, the internal sensors 1076 may include a force sensor configured to measure a force applied by the patient. For example, an internal sensor 1076 in the form of a force sensor may measure a force or weight the patient is able to apply, using a particular body part, to the treatment apparatus 70.

[0133] The system 1010 shown in FIG. 10 also includes an ambulation sensor 1082, which communicates with the server 1030 via the local communication interface 1068 of the patient interface 1050. The ambulation sensor 82 may track and store a number of steps taken by the patient. In some embodiments, the ambulation sensor 1082 may take the form of a wristband, wristwatch, or smart watch. In some embodiments, the ambulation sensor 1082 may be integrated within a phone, such as a smartphone.

[0134] The system 1010 shown in FIG. 10 also includes a goniometer 1084, which communicates with the server 1030 via the local communication interface 1068 of the patient interface 1050. The goniometer 1084 measures an angle of the patient’s body part. For example, the goniometer 1084 may measure the angle of flex of a patient’s knee or elbow or shoulder.

[0135] The system 1010 shown in FIG. 10 also includes a pressure sensor 1086, which communicates with the server 30 via the local communication interface 1068 of the patient interface 1050. The pressure sensor 1086 measures an amount of pressure or weight applied by a body part of the patient. For example, pressure sensor 1086 may measure an amount of force applied by a patient’s foot when pedaling a stationary bike.

[0136] The system 1010 shown in FIG. 10 also includes a supervisory interface 1090 which may be similar or identical to the clinician interface 1020. In some embodiments, the supervisory interface 1090 may have enhanced functionality beyond what is provided on the clinician interface 1020. The supervisory interface 1090 may be configured for use by a person having responsibility for the treatment plan, such as an orthopedic surgeon. [0137] The system 1010 shown in FIG. 10 also includes a reporting interface 1092 which may be similar or identical to the clinician interface 1020. In some embodiments, the reporting interface 1090 may have less functionality from what is provided on the clinician interface 1020. For example, the reporting interface 1092 may not have the ability to modify a treatment plan. Such a reporting interface 1092 may be used, for example, by a biller to determine the use of the system 1010 for billing purposes. In another example, the reporting interface 1092 may not have the ability to display patient identifiable information, presenting only pseudonymized data and/or anonymized data for certain data fields concerning a data subject and/or for certain data fields concerning a quasi identifier of the data subject. Such a reporting interface 1092 may be used, for example, by a researcher to determine various effects of a treatment plan on different patients. [0138] In some embodiments, the patient interface 1050 and the treatment apparatus 1070 are each configured to operate from a patient location geographically separate from a location of the clinician interface 1020. For example, the patient interface 1050 and the treatment apparatus 1070 may be used as part of an in-home rehabilitation system, which may be monitored remotely by using the clinician interface 1020 at a centralized location, such as a clinic or hospital. In some embodiments, either or both of the patient interface 1050 and/or the treatment apparatus 1070 are configured to communicate with a remote computer, such as the server 1030, to receive the treatment plan and to report back to the remote computer with data regarding performance by the patient in following the treatment plan.

[0139] FIGS. 11-12 show an embodiment of a treatment apparatus 1070. More specifically, FIG. 11 shows a treatment apparatus 1070 in the form of a stationary cycling machine 1100, which may be called a stationary bike, for short. The stationary cycling machine 1100 includes a set of pedals 1102 each attached to a pedal arm 1104 for rotation about an axle 1106. In some embodiments, and as shown in FIG. 11, the pedals 1102 are movable on the pedal arms 1104 in order to adjust a range of motion used by the patient in pedaling. For example, the pedals being located inwardly toward the axle 1106 corresponds to a smaller range of motion than when the pedals are located outwardly away from the axle 1106. A pressure sensor 1086 is attached to or embedded within one of the pedals 1106 for measuring an amount of force applied by the patient on the pedal 1106. The pressure sensor 1086 may communicate wirelessly to the treatment apparatus 1070 and/or to the patient interface 1050.

[0140] FIG. 13 shows a person (a patient) using the treatment apparatus of FIG. 11 , and showing sensors and various data parameters connected to a patient interface 1050. The example patient interface 1050 is a tablet computer or smartphone, or a phablet, such as an iPad, an iPhone, an Android device, or a Surface tablet, which is held manually by the patient. In some other embodiments, the patient interface 1050 may be embedded within or attached to the treatment apparatus 1070. FIG. 13 shows the patient wearing the ambulation sensor 1082 on his wrist, with a note showing “STEPS TODAY 1355”, indicating that the ambulation sensor 1082 has recorded and transmitted that step count to the patient interface 1050. FIG. 13 also shows the patient wearing the goniometer 1084 on his right knee, with a note showing “KNEE ANGLE 72°”, indicating that the goniometer 1084 is measuring and transmitting that knee angle to the patient interface 1050. FIG. 13 also shows a right side of one of the pedals 1106 with a pressure sensor 1086 showing “FORCE 12.5 lbs.,” indicating that the right pedal pressure sensor 1086 is measuring and transmitting that force measurement to the patient interface 1050. FIG. 13 also shows a left side of one of the pedals 1106 with a pressure sensor 1086 showing “FORCE 27 lbs.”, indicating that the left pedal pressure sensor 1086 is measuring and transmitting that force measurement to the patient interface 1050. FIG. 13 also shows other patient data, such as an indicator of “SESSION TIME 0:04:13”, indicating that the patient has been using the treatment apparatus 1070 for 4 minutes and 13 seconds. This session time may be determined by the patient interface 1050 based on information received from the treatment apparatus 1070. FIG. 13 also shows an indicator showing “PAIN LEVEL 3”. Such a pain level may be obtained from the patent in response to a solicitation, such as a question, presented upon the patient interface 1050.

[0141] FIG. 14 is an example embodiment of an overview display 1120 of the clinician interface 1020. Specifically, the overview display 1120 presents summary information regarding each of a plurality of different patients. In some embodiments, and as shown on FIG. 14, the summary information includes an indicator showing a procedure performed upon each of the patients, temporal progress of the patient within the treatment plan (post-op day), an indicator of a last-reported pain level, range-of-motion (ROM) numbers, and an indicator showing if there are any alerts requiring special attention. [0142] FIGS. 15-16 show an example embodiment of a patient profile display 1130 of the clinician interface 1020. The example patient profile display 1130 includes a patient summary 1132 with the patient’s name, date of birth (DOB), age, a description of a procedure performed or to be performed on the patient, e.g., “Knee surgery”, and a picture of the patient, if available. The example patient profile display 1130 also includes a treatment progress summary 1134, showing one or more indicators of progress within a treatment regimen or plan. The example treatment progress summary 1134 shown on FIG. 6 includes textual progress summaries, “DAY 18”, “3 days remaining”, “12/63 DAILY SESSIONS COMPLETED”, as well as graphical progress summaries in the form of horizontal bar graphs, which may also be called progress bars.

[0143] The example patient profile display 1130 presents information regarding a treatment history of the patient. For example, the example patient profile display 1130 includes a plurality of different treatment graphs 1136 showing the effect of various treatment parameters overtime. The treatment graphs 1136 shown in the example patient profile display 1130 of FIGS. 15-16 include extension (angle), flexion (angle), pain (0-10 scale), ambulation (steps/day), and total revolutions (i.e. , revolutions performed on the stationary cycling machine 1100). The patient profile display 1130 shown on FIG. 16 also includes a pictorial history 1138, showing one or more images of the surgical site for reference by a clinician or other healthcare professional in reviewing post-operative progress. The images in the pictorial history 1138 may be taken by the patient and/or by a clinician or other healthcare professional. For example, the first picture may be taken by a member of the surgical staff, and subsequent pictures may be taken by the patient and/or the rehabilitation clinician. The example patient profile display 1130 shown on FIG. 16 also includes a protocol summary display 1140 showing a summary overview of a treatment protocol to be performed by the patient. The example protocol summary display 1140 includes a protocol heading 1142 with a protocol name, e.g. “Acute Protocol.” The protocol heading 1142 also includes overview information regarding how and when the protocol is to be performed, e.g. “Days 1-14, 3 sessions daily.” The protocol summary display 1140 also includes several protocol session icons 1144, each indicating details of an activity to be performed within a protocol session, e.g., “Passive”, “Active”, or “Resistance”, together with other information regarding the protocol session, such as a direction (forward/reverse), and an amount of time that each protocol session is prescribed to be performed.

[0144] FIG. 17 shows an example embodiment of a treatment plan management display 1150 of a clinician interface 1020 presenting a treatment protocol 1156 for the patient. More specifically, FIG. 17 shows a treatment plan display 1150, which includes a treatment plan overview 1152 for displaying and modifying a treatment plan 1154, which itself comprises one or more different treatment protocols 1156. In some embodiments, the treatment plan 1154 may be a rehabilitation regimen for rehabilitation treatment of a particular body part, such as a joint or a bone or a muscle group. In some embodiments, the treatment plan 1154 may be a weight loss or muscle-gaining regimen for working various different body parts to improve overall health and/or fitness.

[0145] The treatment plan overview 1152 includes a plan selection control 1158 in the form of a drop-down control for a clinician to select a given treatment plan 1154. Flowever, other different controls and/or presentations may be provided for viewing and/or modifying a treatment plan 1154. The example treatment plan 1154 shown on FIG. 17 includes a plan name (TKA #1), and a listing of the treatment protocols 1156 that comprise the treatment plan 1154. The treatment plan overview 1152 shown on FIG. 17 also includes an edit plan control 1159 in the form of a button for invoking a plan modification control 160 for allowing the clinician to modify the treatment plan 1154.

[0146] FIG. 18 shows an example embodiment of the plan modification control 1160 of the clinician interface 1020. The example plan modification control 1160 shown on FIG. 18 is a full-screen display, but it could take other forms such as, for example, a popup window or a region or section of another display screen. The plan modification control 1160 includes a control 1162 for renaming the treatment plan 1154. The plan modification control 1160 also includes an active plan control 1164 for setting the treatment plan 1154 as an active treatment plan for active use and for setting the treatment plan 1154 as not an active treatment plan. The plan modification control 1160 also includes a treatment mode selector 1166 for changing a treatment mode of the treatment plan 1154. The treatment modes may include different settings for the frequency of sessions to be performed. For example, the treatment modes may include “Daily Session” or “3x per day sessions.” The plan modification control 1160 is also configured to modify the treatment protocols 1156 within the treatment plan 1154. Specifically, the plan modification control 1160 includes a plan configuration control 1168 for changing the treatment protocols 1156 within the treatment plan 1154. Thus, the plan modification control 1160 is configured to modify the plurality of treatment protocols 1156 that comprise the treatment plan 1154. [0147] FIG. 19 shows an example embodiment of a protocol management display 1170 of a clinician interface 1020 for editing a treatment protocol 1156. Specifically, the protocol management display 1170 includes a protocol name control 1172 for renaming the treatment protocol 1156. The protocol management display 1170 also includes a protocol timing control 1174 for adjusting various timing settings of the treatment protocol 1156, such as a duration for the treatment protocol 1156 within the treatment plan 1152, and a number of sessions to be performed per day. The example protocol timing control 1174 shown on FIG. 19 includes drop-down menus for changing the various timing settings, but other controls could be used such as, for example, numeric entry fields or increase/decrease buttons. The protocol management display 1170 also includes a protocol session control 1176 for customizing the session periods. Specifically, the protocol session control 1176 includes a graphical representation of a session, with protocol session icons 1144, which may be similar or identical to the protocol session icons 1144 of the protocol summary display 1140. Each session period may have an associated type, such as passive, resistance, assisted, or active. Each session period may also have several parameters associated therewith.

[0148] The protocol session control 1176 allows the clinician to adjust the number, the order, and the types of the session periods within a given session of the treatment protocol 1156. Each session period has a type that corresponds to a category of activity to be performed upon a body part during that session period. For example, the session periods may be one of a passive period, an assisted period, an active period, or a resistance period. Each passive period is associated with a particular activity that includes moving a body part by an external force; each assisted period is associated with a particular activity that includes moving the body part by the patient with assistance of the external force; each active period is associated with a particular activity that includes the patient moving the body part without assistance of the external force; and each resistance period is associated with a particular activity that includes the patient actively moving the body part against a resistance force. For example, where the treatment apparatus 1070 includes a stationary cycling machine 1100, a passive period may include an actuator 1078, such as a motor, that rotates the pedals 1108 with the patient’s feet and legs attached thereto and without any action or force being applied by the patient. An assisted period may include the patient applying force to rotate the pedals 1108 with some additional help or assistance from the actuator 1078. An active period may include the patient applying force to rotate the pedals 1108 without any assistance from any outside force. A resistance period may include the patient exerting some force to rotate the pedals 1108 in opposition to a resistance force applied by the actuator 1078. In some embodiments, the actuator 1078 may produce the external forces for each of the different categories of the session periods. The external forces may have different attributes, such as directions, intensities, or rates of changes, for each of the different categories of the session periods. Each session may include any number of session periods in any combination. [0149] In some embodiments, the protocol session icons 1144 may be modified using a drag-and-drop interface. Additional protocol sessions may be added to the protocol session using a session period control 1177. Additionally, parameters for any or all of the session periods may be adjusted using various session parameter controls 1178. For example, a duration and direction of each session period may be adjusted using the session parameter controls 1178 located below an associated one of the protocol session icons 1144. Various other parameters, such as resistance, target speed range (RPM), pedal radius limits, etc. may be adjusted using other session parameter controls 1178. In some embodiments, the number and the type of session parameter controls 1178 may change depending on the type of session period selected. For example, selecting a protocol session icon 1144 for an active type of session period may cause the target speed range (RPM) session parameter control 1178 to be visible and adjustable, but the target speed range (RPM) session parameter control 1178 may not be visible and/or adjustable in response to selecting a protocol session icon 1144 for a passive type session.

[0150] In some embodiments, the system 1010 may impose limits on values that can be set using the session parameter controls 1178. For example, the treatment plan 1154 may include a maximum session time. In some embodiments, to satisfy a rule of the system 1010 or a rule within the treatment plan 1154, one or more of the values of the parameters may be automatically changed by the system 10. For example, the treatment plan 1154 may require a resistance type of session period after an active type of session period, wherein the former is at least 25% as long as the active type of session to allow the patient to cool down after active exercise. The system 1010 may automatically create the resistance type session period in response to the clinician creating an active type session period. The system 1010 may also automatically adjust the time of the resistance type session period to satisfy the requirement of it lasting at least 25% as long as the active type of session.

[0151] In some embodiments, the treatment plan 1154 may include maximum values for certain parameters until an associated condition is satisfied. For example, the pedal radius limit may be limited to 40 mm until an associated condition is satisfied. Associated conditions may include, for example, approval by an authorized person, such as an orthopedic surgeon; the elapsing of a particular time, such as 5 days after a surgical procedure; or successful completion of a post-operation checkup. Similarly, the treatment plan 1154 may place limits on the types of session periods that may be performed until an associated condition is satisfied. The treatment plan 1154 may be limited to only passive or assisted session periods (and not active periods or resistance periods until an associated condition is satisfied. Different associated conditions may be associated with each of the different parameters and/or with limits on the types of session periods available.

[0152] FIG. 20 shows an example embodiment of a login screen 1200 of the patient interface 1050. The login screen 1200 may allow the patient to identify himself or herself to the system 1010 and to verify their identity prior to using the system for treatment. In some embodiments, the patient interface 1050 may not have a login screen 200. For example, the patient interface 1050 may be preconfigured for a given patient. This may be used, for example, where the patient interface 1050 is provided for in-home care by a single patient. Additionally or alternatively, another means may be used for the patient to identify himself or herself to the system 1010. For example, a radio-frequency identification (RFID) device, such as a keycard or a wristband, may be placed upon or near a reader coupled to the patient interface 1050. In another example, the patient interface 1050 may use a biometric identification, such as a fingerprint, a palm print, or a retinal scan, to verify the identity of a patient.

[0153] FIG. 21 shows an example of a body part confirmation screen 1240 of the patient interface 1050. The patient may be asked to confirm the particular body part to be treated in order to ensure that the treatment plan is correct for that particular patient. The body part confirmation screen 1240 is also used to ensure that the patient is aware of the body part to be treated (i.e. , to set the patient’s expectations) to minimize risk of an unexpected event that could result in an adverse outcome. If the patient selects a body part that does not comport with the treatment plan, the treatment session may be cancelled, and a notice to the clinician may be generated. The patient may be asked to confirm their selection and, then, given the opportunity to change their selection to ensure that treatment is not cancelled and/or that the clinician is not notified in case of a mis-selection. [0154] FIG. 22 shows an example of a treatment plan overview screen 1280 of the patient interface 1050. Specifically, the treatment plan overview screen 1280 includes a session summary 1282 with a listing of the session periods and their respective durations (in minutes), with the total session duration, and with a display of the sessions per day. The treatment plan overview screen 1280 includes a practitioner contact data 1284 with a picture and phone numbers for a practitioner that the patient may contact for help. The practitioner may be, for example, an orthopedic surgeon and/or a physical therapist. [0155] FIG. 23 shows an example embodiment of a pain level input screen 1320 of the patient interface 1050. The pain level input screen 1320 includes a pain level selector 1322 for the patient to indicate his or her pain level. The example pain level selector 1322 is a slider that the patient can use to select a pain level of 0 (no pain) to 10 (maximum pain). The pain level input screen 1320 may include other inputs, such as a numeric input or check boxes. Graphics, such as happy-to-sad face icons may help to clarify that 10 is the highest level of pain. A similar pain level input screen 1320 may be presented before, during, and/or after a treatment session for tracking the effect of the session on the patient’s pain level.

[0156] FIGS. 24-25 show an example embodiment of a first patient questionnaire screen 360 and a second patient questionnaire screen 1400 of the patient interface 1050, respectively. The patient questionnaire screens 1360, 1400 may help to determine if the patient has any conditions that may adversely impact their ability to perform the training session. In some embodiments, particular answers to one or more of the questions may trigger associated actions, such as alerting the clinician and/or locking the treatment apparatus to prevent it from being used until the clinician or another authorized person is able to verify that it is safe for the patient to proceed with the training session. For example, affirmative answers to either of the “[Flave you noticed] wound/incision splitting” and/or the “[Flave you noticed] shortness of breath” inquiries may prevent the patient from proceeding with the treatment until the clinician first verifies that it is safe for the patient to proceed. A question confirmation screen 1440, such as the one shown in FIG. 26, may be used before the system locks the treatment apparatus and/or generates an alert to prevent those actions in case the patient indicates an associated condition, such as “shortness of breath,” in error. [0157] FIG. 27 shows an example embodiment of a third patient questionnaire screen 1480 of the patient interface 1050. Specifically, the third patient questionnaire screen 1480 requests the patient to indicate when they last took pain medication. This question may be used to compensate for the effects of pain medication on reported pain level and/or other performance parameters.

[0158] FIG. 28 shows an example embodiment of positioning confirmation screen 1520 of the patient interface 1050. This screen 1520 is the beginning of a guided walk-through for the patient to use the treatment apparatus 1070. Specifically, this screen 1520 includes written instructions to guide the patient in placing their feet in the pedals 1102 of a stationary cycling machine 1100. In some embodiments, this screen 1520 may include graphics, such as pictures or animations to help the patient perform particular actions for using the treatment apparatus 1070. Screen 1520 includes a position confirmation selector 1522 for the patient to indicate that they are in position to use the treatment apparatus 1070. Screen 1520 also includes a trouble button 1524 for the patient to indicate that they are having trouble getting in position to use the treatment apparatus 1070

[0159] FIG. 29 shows an example embodiment of a positioning help screen 1560 of the patient interface 1050. This help screen 1560 may be shown in response to the user selecting the trouble button 1524 on the positioning confirmation screen 1520. The help screen 1560 may automatically be displayed if the patient fails to select the position confirmation selector 1522 within a predetermined period of time. In some embodiments, an intermediate screen such as a popup asking if the patient needs more time may be displayed before the help screen 1560 is shown. The help screen 1560 includes assistance instructions 1562 for the patient to obtain assistance for using the treatment apparatus 1070. In some embodiments, the assistance instructions 1562 may include a phone number. The assistance instructions 1562 may also include other items, such as a link to a video conference with someone able to help the patient, and/or a link to a video or animated walk-through with detailed instructions for performing a particular action to use the treatment apparatus 1070. The particular action may include, for example, placing the feet in the pedals. The help screen 1560 may also include an exit button 1564 that the patient can use to stop the treatment session in case they are unable to resolve their issue with using the treatment apparatus 1070. Use of the exit button 1564 may generate an alert to the clinician. The help screen 1560 also includes a proceed button 1566 that the patient can use to indicate that they have resolved their issue and are able to proceed with the treatment session.

[0160] FIG. 30 shows an example embodiment of a session period introduction screen 600 of the patient interface 1050. The session period introduction screen 1600 includes various description text and/or graphics to inform the patient of the type of the session period about to begin. The session period introduction screen 1600 may also include a countdown timer 1602 to aid the patient in preparing to begin the forthcoming session period.

[0161] FIG. 31 shows an example embodiment of an emergency stop (E-stop) confirmation screen 1640 of the patient interface 1050. The E-stop confirmation screen 1640 introduces an on-screen E-stop control 1642 as a stop button present on all screens of the patient interface 1050 during the treatment session for stopping the treatment apparatus 1070. The E-stop confirmation screen 1640 explains the use of the E-stop control 1642 and the use of a physical E-Stop button (not shown) located on or near the patient interface 1050. The E-stop confirmation screen 1640 also includes a confirmation button 1644 that, before the treatment session may begin, the patient must select to confirm that they understand how to use the E-stop control 1642 and the physical E-Stop button. The E-stop confirmation screen 1640 and other screens of the patient interface 1050 also include a session overview display 1646 with progress information regarding the current session, such as a session number for the day, the remaining time, and/or the elapsed time of the session.

[0162] FIG. 32 shows an example embodiment of an adjustment introduction screen 1680 of the patient interface 1050. The adjustment introduction screen 1680 includes text and/or graphics indicating various adjustments to be performed by the treatment apparatus 1070. In the example shown, the adjustments include the treatment apparatus 1070 that is a stationary cycling machine 1100 that automatically moves the pedals 1102 outwardly to a predetermined position for the session period. FIG. 33 shows an example embodiment of an adjustment confirmation screen 1720 of the patient interface 1050. The adjustment confirmation screen 1720 includes text and/or graphics requesting the patient to confirm their satisfaction with the position of the treatment apparatus 1070 during and/or after the automatic adjustments are made. The adjustment confirmation screen 1720 includes an increase button 1722 that the patient may select to indicate a desire to change the position of the treatment apparatus 1070 such as, for example, to increase the radius of the pedal 1102 on the pedal arm 1104. The adjustment confirmation screen 1720 also includes a stay button 1724 that the patient may select to indicate acceptance of the position of the treatment apparatus 1070. The adjustment confirmation screen 1720 also includes a decrease button 1726 that the patient may select to indicate a desire to change the position of the treatment apparatus 1070. For example, if the patient experiences pain or discomfort with the initial position, he or she may change the position using the decrease button 1726 until the pain or discomfort is alleviated.

[0163] FIG. 34 shows an example embodiment of a session period action screen 1760 of the patient interface 150. This screen 1760 is displayed while a given session period is in progress. It includes pressure indicators 1762 showing an amount of pressure or force applied by each foot. The pressure indicators 1762 show the pressures of the patient’s feet upon the pedals 1106 as measured by the pressure sensors 1086. The pressure indicators 1762 are shown as bar graphs, but other types of displays may be used, such as rotary gauges and/or numeric indicators. The pressure indicators 1762 may also include a target pressure indicator 1764 representing a target pressure value which may be determined by the clinician using an associated session parameter control 1178 on the protocol management display 1170, as shown, for example, on FIG. 19.

[0164] The session period action screen 1760 also includes a speed indicator 1766 showing a speed that the pedals 1106 are turning, as measured by an internal sensor 76 of the stationary cycling machine 1100. The speed indicator 1766 is shown as a rotary gauge, but other types of displays may be used, such as a bar graph and/or a numeric indicator. The speed indicator 1766 includes an optimal or desired speed range, which may be determined by the clinician using an associated session parameter control 1178 on the protocol management display 1170, as shown, for example, on FIG. 19. The session period action screen 1760 may present prompts or messages 1768 to enable the user to change the pressure and/or speed if either of those parameters is outside of a predetermined range. [0165] FIG. 35 shows an example embodiment of an exercise introduction screen 1800 of the patient interface 1050. The exercise introduction screen 1800 includes instructions and/or prompts for the patient to perform an exercise that is not performed using the treatment apparatus 1070. In the example shown on FIG. 35, the exercise involves straightening the patient’s leg. FIG. 36 shows an example embodiment of an exercise action screen 1840 of the patient interface 1050. The exercise action screen 1840 includes a countdown timer 1842 showing an amount of time that the patient should continue with a given exercise. The exercise action screen 1840 also includes an angle display 1844 showing an angle of a body part being exercised. The angle display 1844 may show, for example, a knee flex angle measured by the goniometer 184 that is attached to the patient’s knee.

[0166] FIGS. 37-38 show two example progress data screens 1880 of the patient interface 1050. The first progress data screen 1880 presents a progress graph 1882 for each of several different parameters related to the treatment plan 1154. For example, the progress graphs 1882 may include historical data for straightening and bending of the knee pain, strength (lbs. pressure), and walking (steps per day). The progress graphs 1882 may show identical data or data similar to what is presented on the treatment parameter graphs 1136 of the clinician interface 1020.

[0167] In some embodiments, a computer, such as the server 1030, is configured to automatically modify the treatment plan 1154 in response to satisfaction by the patient of a predetermined condition. For example, the treatment plan 1154 may be limited in speed, velocity, or pressure settings or number of sessions per day until a predetermined condition is satisfied. In another example, the treatment plan 1154 may include only certain types of session periods, such as passive type exercises, until the predetermined condition is satisfied. The predetermined condition may include, for example, a successful post-operative checkup; or completion of a predetermined number of sessions or satisfying a performance benchmark within the treatment plan. Such a benchmark may include, for example, walking X number of steps in a day, or some given RPM speed or a given number of pounds of force using the treatment apparatus 1070. In some embodiments, the computer is configured to increase at least one of a frequency, a duration, or an intensity of an aspect of the treatment plan 1154 in response to performance or occurrence of the predetermined condition. In some embodiments, the computer is configured to decrease at least one of a frequency, a duration, or an intensity of an aspect of the treatment plan 1154 in response to a performance or occurrence of the condition. The predetermined condition may include, for example, the patient reporting pain in excess of a given value, or an inability to complete one or more activities within the treatment plan 1154, or a sudden decrease in walking performed by the patient. [0168] In some embodiments, the patient interface 1050 may provide a prompt to the patient in response to occurrence of the predetermined condition. For example, in a session period where the patient is expected to maintain the stationary cycling machine at a speed of between 40 and 50 RPM, the predetermined condition may include the cycling machine operating below 30 RPM for a period of 5 seconds. In that case, the patient interface 1050 may provide a prompt asking the patient if they are having trouble or pain in performing the activity. The prompts may narrow down a problem. For example, if the patient is unable to perform a given activity, then a computer, such as the server 1030, may automatically modify the treatment plan 1514 to include activities that are easier for the patient to complete, such as only passive or only assisted session periods. Alternatively, the treatment plan 1154 may be suspended until the clinician or another qualified person, such as an orthopedic surgeon, directs the system 1010 to re-enable the treatment plan 1154. Additionally or alternatively, the patient’s responses to the prompts may generate an alert to the clinician.

[0169] In some embodiments, the system may communicate an alert message to the clinician using a communication message, such as a pager message or a text message or an email. The alert message may include pseudonymized data and/or anonymized data or use any privacy enhancing technology to prevent confidential patient data from being communicated in a way that could violate patient confidentiality requirements. Such privacy enhancing technologies may enable compliance with laws, regulations, or other rules of governance such as, but not limited to, the Health Insurance Portability and Accountability Act (FIIPAA), or the General Data Protection Regulation (GDPR), wherein the patient may be deemed a “data subject”. For example, an alert message may direct the clinician that a particular type of alert exists, such as a patient reporting wound splitting, without identifying which patient made the report. The alert message may direct the clinician to check the clinician interface 1020 for more specific details regarding the alert.

COMPUTER-IMPLEMENTED QUESTIONNAIRE FOR ORTHOPEDIC TREATMENT

[0170] FIG. 39 shows a block diagram of a computer-implemented system 10010, hereinafter called “the system”, for physical rehabilitation of a body part of a patient. In some embodiments, the system 10010 includes functionality for managing a treatment plan. The treatment plan includes one or more treatment protocols, and each treatment protocol includes one or more sessions. Each session comprises several session periods, with each session period including a particular activity for treating the patient’s body part. For example, a treatment plan for post-operative rehabilitation after a knee surgery may include an initial treatment protocol with twice daily stretching sessions for the first 3 days after surgery and a more intensive treatment protocol with active exercise sessions performed four times per day starting four days after surgery.

[0171] The system 10010 includes a clinician interface 10020 for a clinician, such as a doctor, a nurse, a physical therapist, or a technician, to use to review and to configure various aspects of a treatment plan for use in treating a patient. The clinician interface 10020 includes a clinician input device 10022 and a clinician display 10024, which may be collectively called a clinician user interface 10022, 10024. The clinician input device 10022 may include one or more of a keyboard, a mouse, a trackpad, or a touch screen, for example. Alternatively or additionally, the clinician input device 10022 may include one or more microphones and voice-based functionalities, with hardware and/or software configured to interpret spoken instructions by the clinician by using the one or more microphones. The clinician input device 10022 may include functionality provided by or similar to existing voice-based assistants such as Siri by Apple, Alexa by Amazon, Google Assistant, or Bixby by Samsung. The clinician input device 10022 may include other hardware and/or software components. The clinician input device 10022 may include one or more general purpose devices and/or special-purpose devices.

[0172] The clinician display 10024 may take one or more different forms including, for example, a computer monitor or display screen on a tablet, smartphone, or a smart watch. The clinician display 10024 may include other hardware and/or software components such as a projector, virtual reality capability, or augmented reality capability etc. The clinician display 10024 may incorporate various different visual, audio, or other presentation technologies. For example, the clinician display 10024 may include a non visual display, such as an audio signal, which may include spoken language and/or other sounds such as tones, chimes, and/or melodies which may signal different conditions and/or directions. The clinician display 10024 may comprise one or more different display screens presenting various data and/or interfaces or controls for use by the clinician. The clinician display 10024 may include graphics, which may be presented by a web-based interface and/or by a computer program or application (App.).

[0173] The system 10010 also includes a server 10030 configured to store and to provide data related to managing the treatment plan. The server 10030 may include one or more computers and may take the form of a distributed and/or virtualized computer or computers. In some embodiments, the server 10030 may generate aspects of the clinician display 10024 for presentation by the clinician interface 10020. For example, the server 10030 may include a web server configured to generate the display screens for presentation upon the clinician display 10024. In some embodiments, the clinician display 10024 may be configured to present a virtualized desktop that is hosted by the server 10030. The server 10030 also includes a first communication interface 10032 configured to communicate with the clinician interface 10020 via a first network 10034. In some embodiments, the first network 10034 may include a local area network (LAN), such as an Ethernet network. In some embodiments, the first network 10034 may include the Internet, and communications between the server 10030 and the clinician interface 10020 may be secured via encryption, such as, for example, by using a virtual private network (VPN). In some embodiments, the first network 10034 may include wired and/or wireless network connections such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc. The server 10030 includes a first processor 10036 and a first machine-readable storage memory 10038, which may be called a “memory” for short, holding first instructions 10040 for performing the various actions of the server 10030 for execution by the first processor 10036. The server 10030 is configured to store data regarding the treatment plan. For example, the memory 10038 includes a system data store 10042 configured to hold system data, such as data pertaining to treatment plans for treating one or more patients. The server 10030 is also configured to store data regarding performance by a patient in following a treatment plan. For example, the memory 10038 includes a patient data store 10044 configured to hold patient data, such as data pertaining to the one or more patients, including data representing each patient’s performance within the treatment plan. The patient data stored by the server 30 may also include responses provided by the patient to one or more questions, such as questions answered by the patient at various times before, during, and/or after the treatment plan. [0174] The system 10010 also includes a patient interface 10050 configured to communicate information to a patient and to receive feedback from the patient. Specifically, the patient interface includes an input device 10052 and an output device 10054, which may be collectively called a patient user interface 10052, 10054. The input device 10052 may include one or more devices, such as a keyboard, a mouse, a touch screen input, a gesture sensor, and/or a microphone and processor configured for voice recognition. The output device 10054 may take one or more different forms including, for example, a computer monitor or display screen on a tablet, smartphone, or a smart watch. The output device 10054 may include other hardware and/or software components such as a projector, virtual reality capability, augmented reality capability, etc. The output device 10054 may incorporate various different visual, audio, or other presentation technologies. For example, the output device 10054 may include a non-visual display, such as an audio signal, which may include spoken language and/or other sounds such as tones, chimes, and/or melodies, which may signal different conditions and/or directions. The output device 10054 may comprise one or more different display screens presenting various data and/or interfaces or controls for use by the patient. The output device 10054 may include graphics, which may be presented by a web-based interface and/or by a computer program or application (App.).

[0175] As shown in FIG. 39, the patient interface 10050 includes a second communication interface 10056, which may also be called a remote communication interface configured to communicate with the server 10030 and/or the clinician interface 10020 via a second network 10058. In some embodiments, the second network 10058 may include a local area network (LAN), such as an Ethernet network. In some embodiments, the second network 10058 may include the Internet, and communications between the patient interface 10050 and the server 10030 and/or the clinician interface 10020 may be secured via encryption, such as, for example, by using a virtual private network (VPN). In some embodiments, the second network 10058 may include wired and/or wireless network connections such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc. In some embodiments, the second network 10058 may be the same as and/or operationally coupled to the first network 10034

[0176] The patient interface 10050 includes a second processor 10060 and a second machine-readable storage memory 10062 holding second instructions 10064 for execution by the second processor 10060 for performing various actions of patient interface 10050. The second machine-readable storage memory 10062 also includes a local data store 10066 configured to hold data, such as data pertaining to a treatment plan and/or patient data, such as data representing a patient’s performance within a treatment plan. The patient interface 10050 also includes a local communication interface 10068 configured to communicate with various devices for use by the patient in the vicinity of the patient interface 10050. The local communication interface 10068 may include wired and/or wireless communications. In some embodiments, the local communication interface 10068 may include a local wireless network such as Wi-Fi, Bluetooth, ZigBee, Near-Field Communications (NFC), cellular data network, etc.

[0177] The system 10010 also includes a treatment apparatus 10070 configured to be manipulated by the patient and/or to manipulate a body part of the patient for performing activities according to the treatment plan. In some embodiments, the treatment apparatus 10070 may take the form of an exercise and rehabilitation apparatus configured to perform and/or to aid in the performance of a regimen, such as a physical rehabilitation regimen for improving strength or range of motion of a body part. More specifically, the regimen may be an orthopedic rehabilitation regimen, and the treatment may include rehabilitation of the body part of the patient, such as a joint, a bone, or a muscle group. The body part may include, for example, a spine, a hand, a foot, a knee, or a shoulder. The body part may include a part of a joint, a bone, or a muscle group, such as one or more vertebrae or a ligament. As shown in FIG. 39, the treatment apparatus 10070 includes a controller 10072, which may include one or more processors, computer memory, and/or other components. The treatment apparatus 10070 also includes a fourth communication interface 10074 configured to communicate with the patient interface 10050 via the local communication interface 10068. The treatment apparatus 10070 also includes one or more internal sensors 10076 and an actuator 10078, such as a motor. The actuator 10078 may be used, for example, for moving the patient’s body part and/or for resisting forces by the patient.

[0178] The internal sensors 10076 may measure one or more operating characteristics of the treatment apparatus 10070 such as, for example, a force a position, a speed, and /or a velocity. In some embodiments, the internal sensors 10076 may include a position sensor configured to measure at least one of a linear motion or an angular motion of a body part of the patient. For example, an internal sensor 10076 in the form of a position sensor may measure a distance that the patient is able to move a part of the treatment apparatus 10070, where such distance may correspond to a range of motion that the patient’s body part is able to achieve. In some embodiments, the internal sensors 10076 may include a force sensor configured to measure a force applied by the patient. For example, an internal sensor 10076 in the form of a force sensor may measure a force or weight the patient is able to apply, using a particular body part, to the treatment apparatus 10070

[0179] The system 10010 shown in FIG. 39 also includes an ambulation sensor 10082, which communicates with the server 10030 via the local communication interface 10068 of the patient interface 10050. The ambulation sensor 82 may track and store a number of steps taken by the patient. In some embodiments, the ambulation sensor 10082 may take the form of a wristband, wristwatch, or smart watch. In some embodiments, the ambulation sensor 10082 may be integrated within a phone, such as a smartphone. [0180] The system 10010 shown in FIG. 39 also includes a goniometer 10084, which communicates with the server 10030 via the local communication interface 10068 of the patient interface 10050. The goniometer 10084 measures an angle of the patient’s body part. For example, the goniometer 10084 may measure the angle of flex of a patient’s knee or elbow or shoulder. [0181] The system 10010 shown in FIG. 39 also includes a pressure sensor 10086, which communicates with the server 10030 via the local communication interface 10068 of the patient interface 10050. The pressure sensor 10086 measures an amount of pressure or weight applied by a body part of the patient. For example, pressure sensor 10086 may measure an amount of force applied by a patient’s foot when pedaling a stationary bike.

[0182] The system 10010 shown in FIG. 39 also includes a supervisory interface 10090 which may be similar or identical to the clinician interface 10020. In some embodiments, the supervisory interface 10090 may have enhanced functionality beyond what is provided on the clinician interface 10020. The supervisory interface 10090 may be configured for use by a person having responsibility for the treatment plan, such as an orthopedic surgeon.

[0183] The system 10010 shown in FIG. 39 also includes a reporting interface 10092 which may be similar or identical to the clinician interface 10020. In some embodiments, the reporting interface 10092 may have less functionality from what is provided on the clinician interface 10020. For example, the reporting interface 10092 may not have the ability to modify a treatment plan. Such a reporting interface 10092 may be used, for example, by a biller to determine the use of the system 10010 for billing purposes. In another example, the reporting interface 10092 may not have the ability to display patient identifiable information, presenting only pseudonymized data and/or anonymized data for certain data fields concerning a data subject and/or for certain data fields concerning a quasi-identifier of the data subject. Such a reporting interface 10092 may be used, for example, by a researcher to determine various effects of a treatment plan on different patients.

[0184] In some embodiments, the patient interface 10050 and the treatment apparatus 10070 are each configured to operate from a patient location geographically separate from a location of the clinician interface 10020. For example, the patient interface 10050 and the treatment apparatus 10070 may be used as part of an in-home rehabilitation system, which may be monitored remotely by using the clinician interface 10020 at a centralized location, such as a clinic or hospital. In some embodiments, either or both of the patient interface 10050 and/or the treatment apparatus 10070 are configured to communicate with a remote computer, such as the server 10030, to receive the treatment plan and to report back to the remote computer with data regarding performance by the patient in following the treatment plan.

[0185] FIGS. 40-41 show an embodiment of a treatment apparatus 10070. More specifically, FIG. 40 shows a treatment apparatus 10070 in the form of a stationary cycling machine 10100, which may be called a stationary bike, for short. The stationary cycling machine 10100 includes a set of pedals 10102 each attached to a pedal arm 10104 for rotation about an axle 10106. In some embodiments, and as shown in FIG. 40, the pedals 10102 are movable on the pedal arms 10104 in order to adjust a range of motion used by the patient in pedaling. For example, the pedals being located inwardly toward the axle 10106 corresponds to a smaller range of motion than when the pedals are located outwardly away from the axle 10106. A pressure sensor 10086 is attached to or embedded within one of the pedals 10102 for measuring an amount of force applied by the patient on the pedal 10102. The pressure sensor 10086 may communicate wirelessly to the treatment apparatus 10070 and/or to the patient interface 10050.

[0186] FIG. 42 shows a person (a patient) using the treatment apparatus of FIG. 40, and showing sensors and various data parameters connected to a patient interface 10050. The example patient interface 10050 is a tablet computer or smartphone, or a phablet, such as an iPad, an iPhone, an Android device, or a Surface tablet, which is held manually by the patient. In some other embodiments, the patient interface 10050 may be embedded within or attached to the treatment apparatus 10070. FIG. 42 shows the patient wearing the ambulation sensor 10082 on his wrist, with a note showing “STEPS TODAY 1355”, indicating that the ambulation sensor 10082 has recorded and transmitted that step count to the patient interface 10050. FIG. 42 also shows the patient wearing the goniometer 10084 on his right knee, with a note showing “KNEE ANGLE 72°”, indicating that the goniometer 10084 is measuring and transmitting that knee angle to the patient interface 10050. FIG. 42 also shows a right side of one of the pedals 10102 with a pressure sensor 10086 showing “FORCE 12.5 lbs.,” indicating that the right pedal pressure sensor 10086 is measuring and transmitting that force measurement to the patient interface 10050. FIG. 42 also shows a left side of one of the pedals 10102 with a pressure sensor 10086 showing “FORCE 27 lbs.”, indicating that the left pedal pressure sensor 10086 is measuring and transmitting that force measurement to the patient interface 10050. FIG. 42 also shows other patient data, such as an indicator of “SESSION TIME 0:04:13”, indicating that the patient has been using the treatment apparatus 10070 for 4 minutes and 13 seconds. This session time may be determined by the patient interface 10050 based on information received from the treatment apparatus 10070. FIG. 42 also shows an indicator showing “PAIN LEVEL 3”. Such a pain level may be obtained from the patent in response to a solicitation, such as a question, presented upon the patient interface 10050.

[0187] FIG. 43 is an example embodiment of an overview display 10120 of the clinician interface 10020. Specifically, the overview display 10120 presents summary information regarding each of a plurality of different patients. In some embodiments, and as shown on FIG. 43, the summary information includes an indicator showing a procedure performed upon each of the patients, temporal progress of the patient within the treatment plan (post-op day), an indicator of a last-reported pain level, range-of-motion (ROM) numbers, and an indicator showing if there are any alerts requiring special attention. [0188] FIGS. 44-45 show an example embodiment of a patient profile display 10130 of the clinician interface 10020. The example patient profile display 10130 includes a patient summary 10132 with the patient’s name, date of birth (DOB), age, a description of a procedure performed or to be performed on the patient, e.g., “Knee surgery”, and a picture of the patient, if available. The example patient profile display 10130 also includes a treatment progress summary 10134, showing one or more indicators of progress within a treatment regimen or plan. The example treatment progress summary 10134 shown on FIG. 44 includes textual progress summaries, “DAY 18”, “3 days remaining”, “12/63 DAILY SESSIONS COMPLETED”, as well as graphical progress summaries in the form of horizontal bar graphs, which may also be called progress bars.

[0189] The example patient profile display 10130 presents information regarding a treatment history of the patient. For example, the example patient profile display 10130 includes a plurality of different treatment graphs 10136 showing the effect of various treatment parameters over time. The treatment graphs 10136 shown in the example patient profile display 10130 of FIGS. 44-45 include extension (angle), flexion (angle), pain (0-10 scale), ambulation (steps/day), and total revolutions (i.e. , revolutions performed on the stationary cycling machine 10100). The patient profile display 10130 shown on FIG. 45 also includes a pictorial history 10138, showing one or more images of the surgical site for reference by a clinician or other healthcare professional in reviewing post-operative progress. The images in the pictorial history 10138 may be taken by the patient and/or by a clinician or other healthcare professional. For example, the first picture may be taken by a member of the surgical staff, and subsequent pictures may be taken by the patient and/or the rehabilitation clinician. The example patient profile display 10130 shown on FIG. 45 also includes a protocol summary display 10140 showing a summary overview of a treatment protocol to be performed by the patient. The example protocol summary display 10140 includes a protocol heading 10142 with a protocol name, e.g. “Acute Protocol.” The protocol heading 10142 also includes overview information regarding how and when the protocol is to be performed, e.g. “Days 1-14, 3 sessions daily.” The protocol summary display 10140 also includes several protocol session icons 10144, each indicating details of an activity to be performed within a protocol session, e.g., “Passive”, “Active”, or “Resistance”, together with other information regarding the protocol session, such as a direction (forward/reverse), and an amount of time that each protocol session is prescribed to be performed.

[0190] FIG. 46 shows an example of a body part confirmation screen 10240 of the patient interface 10050. The patient may be asked to confirm the particular body part to be treated in order to ensure that the treatment plan is correct for that particular patient. The body part confirmation screen 10240 is also used to ensure that the patient is aware of the body part to be treated (i.e. , to set the patient’s expectations) to minimize risk of an unexpected event that could result in an adverse outcome. If the patient selects a body part that does not comport with the treatment plan, the treatment session may be cancelled, and a notice to the clinician may be generated. The patient may be asked to confirm their selection and, then, given the opportunity to change their selection to ensure that treatment is not cancelled and/or that the clinician is not notified in case of a mis- selection.

[0191] FIG. 47 shows an example of a treatment plan overview screen 10280 of the patient interface 10050. Specifically, the treatment plan overview screen 10280 includes a session summary 10282 with a listing of the session periods and their respective durations (in minutes), with the total session duration, and with a display of the sessions per day. The treatment plan overview screen 10280 includes a practitioner contact data 10284 with a picture and phone numbers for a practitioner that the patient may contact for help. The practitioner may be, for example, an orthopedic surgeon and/or a physical therapist.

[0192] The patient interface 10050 presents a questionnaire 10320, 10360, 10400, 10480, 10720 soliciting the patient to answer a plurality of questions. In some embodiments, the questionnaire 10320, 10360, 10400, 10480, 10720, or a portion thereof, is presented to the patient before the treatment session. Alternatively or additionally, the questionnaire 10320, 10360, 10400, 10480, 10720, or a portion thereof, may be presented to the patient after or during the treatment session. For example, one or more questions may be presented for the patient to answer using the patient interface 10050 while a training session is in progress or during a break between session periods. In some embodiments, one or more of the questions of the questionnaire 10320, 10360, 10400, 10480, 10720 pertains to a current physical condition of the patient. For example, as shown in FIG. 48, one of the questions may ask the patient to rate their current pain level. In some embodiments, one or more of the questions of the questionnaire 10320, 10360, 10400, 10480, 10720 pertains to a past physical condition of the patient. For example, as shown in FIGS. 49-50, the questionnaire 10320, 10360, 10400, 10480, 10720 may ask about various physical conditions that the patient has noticed or experienced in the past twenty-four hours that could affect the patient’s ability to perform the rehabilitation regimen.

[0193] FIG. 48 shows an example embodiment of a pain level input screen 10320 of the patient interface 10050. The pain level input screen 10320 includes a pain level selector 10322 for the patient to indicate his or her pain level. The example pain level selector 10322 is a slider that the patient can use to select a pain level of 0 (no pain) to 10 (maximum pain). The pain level input screen 10320 may include other inputs, such as a numeric input or check boxes. Graphics, such as happy-to-sad face icons may help to clarify that 10 is the highest level of pain. A similar pain level input screen 10320 may be presented before, during, and/or after a treatment session for tracking the effect of the session on the patient’s pain level. [0194] FIGS. 49-50 show an example embodiment of a first pretreatment questionnaire screen 10360 and a second pretreatment questionnaire screen 10400 of the patient interface 10050, respectively. The pretreatment questionnaire screens 10360, 10400 may help to determine if the patient has any conditions that may adversely impact their ability to perform the training session. For example, the pretreatment questionnaire screens 10360, 10400 may include one or more questions that relate to the patient’s ability to use the treatment apparatus 10070. Specifically, the example pretreatment questionnaire screens 10360, 10400 of FIGS. 49-50 ask the patient whether he/she has noticed any of several different conditions in the last 24 hours. FIGS. 49-50 provide Yes/No inputs for the patient to indicate a presence of each of the different conditions. The conditions asked about include: “New trouble or decreased ability to walk,” “Fever and/or chills,” “Drainage from surgical site,” “New redness, swelling, and/or heat,” “Nausea,” “Increased pain,” “Pain in back of calf,” “Reduced range of motion,” “Wound/incision splitting apart or opening,” and “Shortness of breath.” These are merely examples of different conditions that may be asked of the patient before beginning the rehabilitation regimen. In some embodiments, before the patient is authorized to use the treatment apparatus 10070, predetermined responses must be provided on the pretreatment questionnaire screens 10360, 10400

[0195] In some embodiments, the system 10010 is configured to take an action in response to a selected answer or response to one or more of the questions. The action, taken in response to a selected answer or response may include inhibiting or mitigating operation of the treatment apparatus 10070. The action may include transmitting an alert to the clinician, stopping the treatment apparatus 10070, and/or locking the treatment apparatus 10070 to prevent it from being used until the clinician or another authorized person is able to verify that it is safe for the patient to proceed with the training session. For example, affirmative responses to either of the “[Flave you noticed] wound/incision splitting” and/or the “[Flave you noticed] shortness of breath” inquiries may prevent the patient from proceeding with the treatment until the clinician first verifies that it is safe for the patient to proceed.

[0196] The patient interface 10050 may present a confirmation prompt for the patient to confirm the selected response before the action is taken. The confirmation prompt may take the form of a question confirmation screen 10440, such as the one shown in FIG. 51. For example, a selected response that indicates a potential serious medical issue, such as “shortness of breath,” may require confirmation before the system locks 10010 the treatment apparatus 10070 and/or generates an alert if the patient selects or otherwise indicates, in error, that particular response. The confirmation prompt may take other forms, such as visual or audible warnings, which may include a description of one or more consequences of the particular response provided. Additionally or alternatively, the patient interface 10050 may present additional instructions to the patient in response to particular answers or responses to given ones of the questions. For example, if the patient indicates that they have experienced wound/incision splitting apart or opening, the patient may be prompted to take one or more pictures of the wound for evaluation by a clinician. In some embodiments, the patient interface 10050 may provide instructions for using a camera, which may be integral with the patient interface 10050, to capture one or more images and/or video of the wound.

[0197] Alerts transmitted to the clinician, such as alerts generated and/or transmitted in response to a particular answer or response to one or more of the questions, may include an alert message upon the clinician interface 10020. Such an alert message may include a description of the question and/or the response to the question. In some cases, the alert message may also include an identification of the patient. In other cases, the identification of the patient may be omitted, for example, where the patient’s identification would violate privacy requirements. Such an alert message may be presented within an overview display 10120, as shown, for example, on FIG. 43. Additionally or alternatively, alert messages generated in response to the patient’s answer or response to one or more questions may include an instant notification to the clinician on the user interface. Such an instant notification may include a visual notification, such as a popup message or an animation, within a predetermined region of the clinician display 10024. Such alert messages may also be accompanied by an audio notification, such as a sound or a voice prompt, played by a speaker of the clinician interface 10020.

[0198] In some embodiments, the alert generated and/or transmitted in response to a particular answer or response may comprise a real-time communication to the clinician outside of the clinician interface 10020. For example, the system 10010 may communicate an alert message to the clinician using a communication message, such as a pager message or a text message or an email. The alert message may include pseudonym ized data and/or anonymized data or use any privacy enhancing technology to prevent confidential patient data from being communicated in a way that could violate patient confidentiality requirements. Such privacy enhancing technologies may enable compliance with laws, regulations, or other rules of governance such as, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA), or the General Data Protection Regulation (GDPR), wherein the patient may be deemed a “data subject”. For example, an alert message may direct the clinician that a particular type of alert exists, such as a patient reporting wound splitting, without identifying which patient made the report. The alert message may direct the clinician to check the clinician interface 10020 for more specific details regarding the alert.

[0199] FIG. 52 shows an example embodiment of a third pretreatment questionnaire screen 10480 of the patient interface 10050. Specifically, the third pretreatment questionnaire screen 10480 requests the patient to indicate when they last took pain medication. This question may be used to compensate for the effects of pain medication on reported pain level and/or other performance parameters.

[0200] FIG. 53 shows an example embodiment of positioning confirmation screen 10520 of the patient interface 10050. This screen 10520 is the beginning of a guided walk through for the patient to use the treatment apparatus 10070. Specifically, this screen 10520 includes written instructions to guide the patient in placing their feet in the pedals 10102 of a stationary cycling machine 10100. In some embodiments, this screen 10520 may include graphics, such as pictures or animations to help the patient perform particular actions for using the treatment apparatus 10070. Screen 10520 includes a position confirmation selector 10522 for the patient to indicate that they are in position to use the treatment apparatus 10070. Screen 10520 also includes a trouble button 10524 for the patient to indicate that they are having trouble getting in position to use the treatment apparatus 10070.

[0201] In some embodiments, the patient interface 10050 may present a help display 10560 in response to occurrence of a triggering event pertaining to the patient’s use of the treatment apparatus 10070. The help display 10560 may include a first control 10564, 10642, such as a “STOP” button, for the patient to stop using the treatment apparatus 10070 and/or to request additional help in using the treatment apparatus 10070. The help display 10560 may also include a second control 10566 for the patient to continue using the treatment apparatus.

[0202] FIG. 54 shows an example embodiment of a help screen 10560 in the form of a positioning help screen 10560. This help screen 10560 may be shown in response to the user selecting the trouble button 10524 on the positioning confirmation screen 10520. The help screen 10560 may automatically be displayed if the patient fails to select the position confirmation selector 10522 within a predetermined period of time. In some embodiments, an intermediate screen such as a popup asking if the patient needs more time may be displayed before the help screen 10560 is shown. The help screen 10560 includes assistance instructions 10562 for the patient to obtain assistance for using the treatment apparatus 10070. In some embodiments, the assistance instructions 10562 may include a phone number. The assistance instructions 10562 may also include other items, such as a link to a video conference with someone able to help the patient, and/or a link to a video or animated walk-through with detailed instructions for performing a particular action to use the treatment apparatus 10070. The particular action may include, for example, placing the feet in the pedals. The help screen 10560 may also include a first control 10564, which may take the form of an exit button, which the patient can use to stop the treatment session in case they are unable to resolve their issue with using the treatment apparatus 10070. Use of the first control 10564 may generate an alert to the clinician. The help screen 10560 also includes a second control 10566, which may take the form of a proceed button, that the patient can use to indicate that they have resolved their issue and are able to proceed with the treatment session.

[0203] FIG. 55 shows an example embodiment of an adjustment introduction screen 680 of the patient interface 10050. The adjustment introduction screen 10680 includes text and/or graphics indicating various adjustments to be performed by the treatment apparatus 10070. In the example shown, the adjustments include the treatment apparatus 10070 that is a stationary cycling machine 10100 that automatically moves the pedals 102 outwardly to a predetermined position for the session period. FIG. 56 shows an example embodiment of an adjustment confirmation screen 10720 of the patient interface 10050. The adjustment confirmation screen 10720 includes text and/or graphics requesting the patient to confirm their satisfaction with the position of the treatment apparatus 10070 during and/or after the automatic adjustments are made. The adjustment confirmation screen 10720 includes an increase button 10722 that the patient may select to indicate a desire to change the position of the treatment apparatus 10070 such as, for example, to increase the radius of the pedal 10102 on the pedal arm 10104. The adjustment confirmation screen 10720 also includes a stay button 10724 that the patient may select to indicate acceptance of the position of the treatment apparatus 10070. The adjustment confirmation screen 10720 also includes a decrease button 10726 that the patient may select to indicate a desire to change the position of the treatment apparatus 10070. For example, if the patient experiences pain or discomfort with the initial position, he or she may change the position using the decrease button 10726 until the pain or discomfort is alleviated.

[0204] FIG. 57 shows an example embodiment of a session period action screen 10760 of the patient interface 10050. This screen 10760 is displayed while a given session period is in progress. It includes pressure indicators 10762 showing an amount of pressure or force applied by each foot. The pressure indicators 762 show the pressures of the patient’s feet upon the pedals 10102 as measured by the pressure sensors 10086. The pressure indicators 10762 are shown as bar graphs, but other types of displays may be used, such as rotary gauges and/or numeric indicators. The pressure indicators 10762 may also include a target pressure indicator 10764 representing a target pressure value which may be determined by the clinician using an associated session parameter control 10178 on the clinician interface 10020.

[0205] The session period action screen 10760 also includes a speed indicator 10766 showing a speed that the pedals 10102 are turning, as measured by an internal sensor 10076 of the stationary cycling machine 10100. The speed indicator 10766 is shown as a rotary gauge, but other types of displays may be used, such as a bar graph and/or a numeric indicator. The speed indicator 10766 includes an optimal or desired speed range, which may be determined by the clinician using an associated session parameter control 10178 on the clinician interface 10020. The session period action screen 10760 may present prompts or messages 10768 to enable the user to change the pressure and/or speed if either of those parameters is outside of a predetermined range.

[0206] In some embodiments, the patient interface 10050 may present a mid-treatment questionnaire during a treatment session, the questionnaire configured to solicit responses to one or more questions. The mid-treatment questionnaire may include one or more questions that relate to the patient’s ability to use the treatment apparatus 10070. In some embodiments, the mid-treatment questionnaire may be presented in response to occurrence of a triggering event, the triggering event pertaining to the patient’s use of the treatment apparatus 10070.

[0207] In some embodiments, a computer, such as the server 10030, is configured to automatically modify the treatment plan 10154 in response to satisfaction by the patient of a predetermined condition. For example, the treatment plan 10154 may be limited in speed, velocity, or pressure settings or number of sessions per day until a predetermined condition is satisfied. In another example, the treatment plan 10154 may include only certain types of session periods, such as passive type exercises, until the predetermined condition is satisfied. The predetermined condition may include, for example, a successful post-operative checkup; or completion of a predetermined number of sessions or satisfying a performance benchmark within the treatment plan. Such a benchmark may include, for example, walking X number of steps in a day, or some given RPM speed or a given number of pounds of force using the treatment apparatus 10070. In some embodiments, the computer is configured to increase at least one of a frequency, a duration, or an intensity of an aspect of the treatment plan 10154 in response to performance or occurrence of the triggering event. In some embodiments, the computer is configured to decrease at least one of a frequency, a duration, or an intensity of an aspect of the treatment plan 10154 in response to a performance or occurrence of the triggering event. The triggering event may include, for example, the patient reporting pain in excess of a given value, or an inability to complete one or more activities within the treatment plan 10154, or a sudden decrease in walking performed by the patient.

[0208] In some embodiments, the patient interface 10050 may provide a prompt to the patient in response to occurrence of the predetermined condition. The prompt may take the form of a help display 10560, and/or a questionnaire, such as the mid-treatment questionnaire, soliciting responses to one or more questions. In some embodiments, the help display 10560 may be configured to include a questionnaire for soliciting responses to one or more questions. In some embodiments, a timer or counter may generate the triggering event. For example, the prompt may be presented to the patient at periodic time intervals, or after each of a predetermined number of repetitions of a given exercise. The triggering event may include the occurrence or non-occurrence of a measurement by an internal sensor 10076 of the treatment apparatus 10070. For example, in a session period where the patient is expected to maintain the stationary cycling machine at a speed of between 40 and 50 RPM, the predetermined condition may include the cycling machine operating below 30 RPM for a period of 5 seconds. In that case, the patient interface 10050 may provide a prompt, such as a help display 10560, asking the patient if they are having trouble or pain in performing the activity. The prompts may narrow down a problem. For example, if the patient is unable to perform a given activity, then a computer, such as the server 10030, may automatically modify the treatment plan 10154 to include activities that are easier for the patient to complete, such as only passive or only assisted session periods. Alternatively, the treatment plan 10154 may be suspended until the clinician or another qualified person, such as an orthopedic surgeon, directs the system 10010 to re-enable the treatment plan 10154. Additionally or alternatively, the patient’s responses to the prompts may generate an alert to the clinician.

[0209] The foregoing description, for purposes of explanation, use specific nomenclature to provide a thorough understanding of the described embodiments. Flowever, it should be apparent to one skilled in the art that the specific details are not required to practice the described embodiments. Thus, the foregoing descriptions of specific embodiments are presented for purposes of illustration and description. They are not intended to be exhaustive or to limit the described embodiments to the precise forms disclosed. It should be apparent to one of ordinary skill in the art that many modifications and variations are possible in view of the above teachings.

[0210] The above discussion is meant to be illustrative of the principles and various embodiments. Numerous variations and modifications will become apparent to those skilled in the art once the above disclosure is fully appreciated. It is intended that the following claims be interpreted to embrace all such variations and modifications. [0211] The various aspects, embodiments, implementations, or features of the described embodiments can be used separately or in any combination. The embodiments disclosed herein are modular in nature and can be used in conjunction with or coupled to other embodiments.

[0212] Any of the systems and methods described in this disclosure may be used in connection with rehabilitation. Rehabilitation may be directed at cardiac rehabilitation, rehabilitation from stroke, multiple sclerosis, Parkinson’s disease, a brain injury, a spinal cord injury, a spinal cord disease, a joint injury, a joint disease, or the like. Rehabilitation can further involve muscular contraction improving blood flow and lymphatic flow, engaging the brain and nervous system to control and affect a traumatized area to increase the speed of healing, reversing or reducing pain, reversing or reducing stiffness, recovering range of motion, cardiovascular engagement to stimulate the release of pain blocking hormones and encourage freshly oxygenated blood flow to aid in an overall feeling of well-being. Rehabilitation may be provided for individuals of average height in reasonably good physical condition having no substantial deformities, as well as individuals more typically in need of rehabilitation, such as those that are elderly, obese, injured and/or have a severely limited range of motion. Unless expressly stated otherwise, is to be understood that rehabilitation includes prehabilitation (also referred to as "pre- habilitation" or "prehab"). Prehabilitation may be used as a preventative procedure or as a pre-surgical or pre-treatment procedure. Prehabilitation may include any action performed by or on a patient (or directed to be performed by or on a patient, including, without limitation, remotely or distally through telemedicine) to, without limitation, prevent or reduce a likelihood of injury (e.g., prior to the occurrence of the injury); improve recovery time subsequent to surgery; improve strength subsequent to surgery; or any of the foregoing with respect to any non-surgical clinical treatment plan to be undertaken for the purpose of ameliorating or mitigating injury, dysfunction, or other negative consequence of surgical or non-surgical treatment on any external or internal part of a patient's body. For example, a mastectomy may require prehabilitation to strengthen muscles or muscle groups affected directly or indirectly by the mastectomy. As a further non-limiting example, the removal of an intestinal tumor, the repair of a hernia, open-heart surgery or other procedures performed on internal organs or structures, whether to repair those organs or structures, to excise them or parts of them, to treat them, etc., can require cutting through and harming numerous muscles and muscle groups in or about, without limitation, the abdomen, the ribs and/or the thoracic cavity. Prehabilitation can improve a patient's speed of recovery, measure of quality of life, level of pain, etc. in all the foregoing procedures. In one embodiment of prehabilitation, a pre-surgical procedure or a pre-non- surgical-treatment may include one or more sets of exercises for a patient to perform prior to such procedure or treatment. Performance of the one or more sets of exercises may be required in order to qualify for an elective surgery, such as a knee replacement. The patient may prepare an area of his or her body for the surgical procedure by performing the one or more sets of exercises, thereby strengthening muscle groups, improving existing muscle memory, reduce pain, reduce stiffness, establishing new muscle memory, enhancing mobility (i.e. , improve range of motion), improving blood flow, and/or the like. [0213] In some embodiments, the systems and methods described herein may use artificial intelligence and/or machine learning to generate the treatment plan for a user. Additionally, or alternatively, the systems and methods described herein may use artificial intelligence and/or machine learning to recommend an optimal exercise machine configuration for a user. Additionally, or alternatively, the systems and methods described herein may use artificial intelligence and/or machine learning to control the treatment apparatus during a telemedicine session or not during the telemedicine session an optimal exercise machine configuration for a user.

[0214] Consistent with the above disclosure, the examples of assemblies enumerated in the following clauses are specifically contemplated and are intended as a non-limiting set of examples.

[0215] 1. A computer-implemented system, comprising: a patient interface comprising an output device and an input device, the output device configured to communicate information to a patient regarding the patient’s performance of a treatment plan for the patient, the treatment plan comprising a rehabilitation regimen for a body part; a treatment apparatus configured to be manipulated by the patient for performing the rehabilitation regimen upon the body part; an assistant interface remote from the patient interface and configured to communicate, via a network connection, a telemedicine signal to the patient interface; wherein the telemedicine signal comprises one of an audio signal, an audiovisual signal, a visual signal, a haptic signal, an environmental change signal, an interface control signal for controlling a function of the patient interface, or an apparatus control signal for changing an operating parameter of the treatment apparatus.

[0216] 2. The computer-implemented system of any preceding clause, wherein the one of the audio signal, the audiovisual signal, the visual signal, the haptic signal, or the environmental change signal includes a feed from the assistant interface, and the feed is configured to be presented by the output device of the patient interface.

[0217] 3. The computer-implemented system of any preceding clause, wherein the telemedicine signal is generated from a prerecorded source, and the telemedicine signal is configured to be presented by the output device of the patient interface.

[0218] 4. The computer-implemented system of any preceding clause, wherein the patient interface is configured to transmit an apparatus monitor signal to the assistant interface, and the apparatus monitor signal includes status information related to the treatment apparatus.

[0219] 5. The computer-implemented system of any preceding clause, wherein, to effect a change to an operating parameter of the treatment apparatus, the telemedicine signal is configured to comprise the apparatus control signal from the assistant interface.

[0220] 6. The computer-implemented system of any preceding clause, wherein the patient interface is configured to provide two-way audio communications, two-way audiovisual communications, two-way visual communications, two-way haptic communications, two-way environmental communications with a person using the assistant interface, or two-way communications using on each side of the communications one of the foregoing means, where the means on one side and the means on the other side are different.

[0221] 7. The computer-implemented system of any preceding clause, wherein the patient interface includes a manual control such that the patient uses the assistant interface to initiate a telemedicine session.

[0222] 8. The computer-implemented system of any preceding clause, wherein the patient interface is configured to solicit answers to one or more questions from the patient; and wherein predetermined answers to the one or more questions are configured to enable a telemedicine session to be initiated, wherein the telemedicine session uses the assistant interface.

[0223] 9. The computer-implemented system of any preceding clause, wherein a predetermined condition of the treatment apparatus causes the patient interface to initiate a telemedicine session, wherein the telemedicine session uses the assistant interface. [0224] 10. The computer-implemented system of any preceding clause, further comprising a clinician interface, wherein such interface includes a protocol management display presenting controls for modifying a treatment protocol within the treatment plan; and wherein the assistant interface is presented on a physical device shared with the clinician interface.

[0225] 11. The computer-implemented system of any preceding clause, further comprising a server computer configured to store data related to one of the treatment plan or the patient; and wherein the assistant interface is configured to be in communication with a server for receiving the data related to the one of the treatment plan or the patient.

[0226] 12. The computer-implemented system of any preceding clause, wherein the body part comprises at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

[0227] 13. A system for remote treatment, comprising: a patient interface comprising an output device and an input device for communicating information to and from a patient; a treatment apparatus configured to be manipulated by the patient for performing a rehabilitation regimen upon a body part; an assistant interface configured to communicate a telemedicine signal with the patient interface via a network connection, the telemedicine signal configured to control one of the patient interface or the treatment apparatus; and wherein the patient interface and the treatment apparatus are each configured to operate from a patient location geographically separated from the assistant interface.

[0228] 14. The system of any preceding clause, wherein the assistant interface includes a control for changing a setting of one of the patient interface or the treatment apparatus; and wherein the assistant interface is configured to change the setting of the one of the patient interface or the treatment apparatus when the setting cannot be changed by the patient using the patient interface. [0229] 15. The system of any preceding clause, wherein the patient interface is configured to transmit a control signal to the treatment apparatus in response to receiving the telemedicine signal from the assistant interface.

[0230] 16. The system of any preceding clause, wherein the body part comprises at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

[0231] 17. An assistant user interface generated by a computer and comprising: an apparatus control comprising an apparatus status display and an apparatus session control, the apparatus session control configured to adjust an operating parameter of a treatment apparatus, the treatment apparatus configured to be manipulated by a patient for performing a rehabilitation regimen upon a body part; a patient communications control for controlling an audio or an audiovisual communications session with a patient interface, the patient interface configured for use by the patient such that the patient is able to perform the rehabilitation regimen upon the body part.

[0232] 18. The assistant user interface of any preceding clause, further comprising a patient interface control presenting information related to the patient interface.

[0233] 19. The assistant user interface of any preceding clause, wherein the information related to the patient interface comprises an image presented on a display screen of the patient interface.

[0234] 20. The assistant user interface of any preceding clause, wherein the patient interface control further includes a setting control for adjusting a setting of the patient interface.

[0235] 21. The assistant user interface of any preceding clause, further comprising a patient profile display presenting biographical information related to the patient using the treatment apparatus.

[0236] 22. The assistant user interface of any preceding clause, further comprising a patient profile display presenting information related to a treatment plan for the patient, wherein the treatment plan is related to how the patient is intended to use the treatment apparatus.

[0237] 23. A method for initiating a telemedicine session using an assistant interface and a patient interface, the method comprising: receiving, at the patient interface, data from one or more sources, wherein the data is received while a user is operating a treatment apparatus to perform a treatment plan, the treatment plan comprising a rehabilitation regimen for a body part; determining, based on the data, whether a trigger event has occurred; and responsive to determining the trigger event has occurred, using the patient interface and the assistant interface to electronically initiate the telemedicine session.

[0238] 24. The method of any preceding clause, further comprising: causing presentation of the data on the assistant interface; and receiving, from the assistant interface, a telemedicine signal comprising one of an audio signal, an audiovisual signal, a visual signal, a haptic signal, an environmental change signal, an interface control signal for controlling a function of the patient interface, or an apparatus control signal for changing an operating parameter of the treatment apparatus.

[0239] 25. The method of any preceding clause, wherein the one or more sources comprise a sensor, the treatment apparatus, an input peripheral of the patient interface, or some combination thereof.

[0240] 26. The method of any preceding clause, wherein the data comprises a sensor measurement, an answer to a question presented on the patient interface, a vital sign, a characteristic of the user, or some combination thereof.

[0241] 27. The method of any preceding clause, wherein the trigger event comprises receiving a response to one or more questions presented on the patient interface.

[0242] 28. The method of any preceding clause, wherein the trigger event comprises determining a condition of the treatment apparatus.

[0243] 29. The method of any preceding clause, wherein the body part comprises at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

[0244] 30. The method of any preceding clause, further causing, during the telemedicine session, a patient profile display to be presented on the assistant interface, wherein the patient profile display comprises information related to the treatment plan for the patient, and the treatment plan is related to how the patient is intended to use the treatment apparatus.

[0245] 31. A computer implemented system for managing a treatment plan, comprising: a clinician interface comprising a patient profile display and a protocol management display, the patient profile display presenting historical data regarding performance of the treatment plan by a patient, and the protocol management display presenting controls for modifying a treatment protocol within the treatment plan; wherein the treatment protocol comprises a plurality of sessions for treatment of a body part of the patient; wherein each session within the plurality of sessions comprises an ordered combination of session periods, with each of the session periods including a particular activity for treating the body part of the patient; wherein each of the session periods is selected from a group comprising a passive period, an assisted period, an active period, and a resistance period; wherein the particular activity of each passive period includes moving the body part by an external force; wherein the particular activity of each assisted period includes moving the body part by the patient with assistance of the external force; wherein the particular activity of each active period includes the patient moving the body part without assistance of the external force; and wherein the particular activity of each resistance period includes the patient actively moving the body part against a resistance force.

[0246] 32. The computer implemented system of any preceding clause, wherein the treatment plan comprises a rehabilitation regimen, and the body part comprises at least one of a joint, a bone, or a muscle group.

[0247] 33. The computer implemented system of any preceding clause, further comprising a computer configured to automatically modify the treatment plan in response to satisfaction by the patient of a predetermined condition.

[0248] 34. The computer implemented system of any preceding clause, wherein the predetermined condition comprises the patient satisfying a performance benchmark within the treatment plan; and wherein the computer is configured to increase at least one of a frequency, a duration, or an intensity of an aspect of the treatment plan in response to performance of the predetermined condition.

[0249] 35. The computer implemented system of any preceding clause, wherein the predetermined condition comprises the patient failing to satisfy a performance benchmark within the treatment protocol; and wherein the computer is configured to decrease at least one of a frequency, a duration, or an intensity of an aspect of the treatment protocol in response to performance of the predetermined condition. [0250] 36. The computer implemented system of any preceding clause, wherein the treatment protocol is one of a plurality of treatment protocols within the treatment plan; and further comprising the clinician interface including a plan modification control configured to modify the plurality of treatment protocols within the treatment plan.

[0251] 37. A system for remote treatment, comprising: a clinician interface presenting a protocol management display presenting controls for modifying a treatment plan for treatment of a body part of a patient; a patient interface including an output device and an input device for communicating information to and from the patient; and a treatment apparatus configured to be manipulated by the patient for performing a rehabilitation regimen upon the body part, with the body part comprising at least one of a joint, a bone, or a muscle group; and wherein the patient interface and the treatment apparatus are each configured to operate from a patient location geographically separate from a location of the clinician interface.

[0252] 38. The system of any preceding clause, wherein at least one of the patient interface or the treatment apparatus is configured to communicate with a remote computer to receive the treatment plan and to report data regarding performance by the patient in following the treatment plan.

[0253] 39. The system of any preceding clause, wherein the treatment apparatus comprises an actuator configured to provide at least one of an external force or a resistance to the body part of the patient.

[0254] 40. The system of any preceding clause, further comprising a force sensor configured to measure a force applied by the patient.

[0255] 41. The system of any preceding clause, wherein the treatment apparatus comprises a position sensor configured to measure at least one of a linear motion or an angular motion of the body part of the patient.

[0256] 42. The system of any preceding clause, wherein the clinician interface comprises an overview display including summary information regarding each of a plurality of different patients.

[0257] 43. The system of any preceding clause, further comprising a server computer configured to store data regarding the treatment plan. [0258] 44. The system of any preceding clause, further comprising a server computer configured to store data regarding performance by the patient in following the treatment plan.

[0259] 45. A clinician user interface generated by a computer and comprising: a profile display presenting information regarding a treatment history of a patient; a protocol management display presenting a treatment plan, with the treatment plan comprising a plurality of treatment protocols; a plan modification control configured to modify the plurality of treatment protocols of the treatment plan; wherein each treatment protocol of the plurality of treatment protocols comprises a plurality of sessions for treatment of a body part of the patient; wherein each session of the plurality of sessions comprises an ordered combination of session periods, with each of the session periods including a particular activity for treating the body part of the patient.

[0260] 46. The clinician user interface of any preceding clause, wherein each of the session periods is selected from a group comprising a passive period, an assisted period, an active period, and a resistance period; wherein the particular activity of each passive period includes moving the body part by an external force; wherein the particular activity of each assisted period includes moving the body part by the patient with assistance of the external force; wherein the particular activity of each active period includes the patient moving the body part without assistance of the external force; and wherein the particular activity of each resistance period includes the patient actively moving the body part against a resistance force.

[0261] 47. The clinician user interface of any preceding clause, further comprising a drag-and-drop interface for configuring the ordered combination of the session periods. [0262] 48. The clinician user interface of any preceding clause, wherein the information regarding the treatment history of the patient comprises a graphical representation of each of a plurality of different parameters over time.

[0263] 49. The clinician user interface of any preceding clause, wherein the protocol management display includes a control for modifying a parameter of the treatment plan. [0264] 50. The clinician user interface of any preceding clause, wherein the control for modifying the parameter of the treatment plan is configured to modify at least one of a speed, a force, or a duration of the particular activity within a selected one of the session periods.

[0265] 51. A computer-implemented system for physical rehabilitation, comprising: a clinician interface comprising a patient profile display, the patient profile display configured to present data regarding performance, by a patient, of a regimen for a body part, the body part comprising at least one of a joint, a bone, or a muscle group; a patient interface including an output device and an input device for communicating to and from the patient, information regarding the performance of the regimen; the patient interface presenting instructions and status information to the patient regarding the performance of the regimen; and the patient interface presenting a questionnaire soliciting the patient to answer a plurality of questions, wherein one of the plurality of questions pertains to a current physical condition of the patient or a past physical condition of the patient.

[0266] 52. The computer-implemented system of any preceding clause, wherein the regimen is a physical rehabilitation regimen for improving strength or range of motion of the body part.

[0267] 53. The computer-implemented system of any preceding clause, wherein the one of the plurality of questions pertains to the current physical condition of the patient. [0268] 54. The computer-implemented system of any preceding clause, wherein the one of the plurality of questions pertains to the past physical condition of the patient.

[0269] 55. The computer-implemented system of any preceding clause, wherein the computer-implemented system is configured to take an action in response to a selected response to one of the plurality of questions.

[0270] 56. The computer-implemented system of any preceding clause, wherein the action comprises stopping or preventing operation of a treatment apparatus by the patient.

[0271] 57. The computer-implemented system of any preceding clause, wherein the action comprises transmitting an alert to a clinician.

[0272] 58. The computer-implemented system of any preceding clause, wherein the alert to the clinician comprises an alert message on the clinician interface, the alert message including information relating to the response to the one of the plurality of questions. [0273] 59. The computer-implemented system of any preceding clause, wherein the alert to the clinician comprises a real-time communication to the clinician, and the alert is outside of the clinician interface.

[0274] 60. The computer-implemented system of any preceding clause, wherein, before the action is taken, the patient interface presents a prompt for the patient to confirm the particular response to one of the plurality of questions.

[0275] 61. The computer-implemented system of any preceding clause, further comprising a server configured to store patient data, the patient data including responses to the plurality of questions.

[0276] 62. A system for remote treatment, comprising: a clinician interface comprising a patient profile display configured to present status information regarding a patient; a patient interface including an output device and an input device for communicating information, respectively, to and from a patient; and a treatment apparatus configured to be manipulated by the patient, such that the patient can perform a regimen for a body part, the body part comprising at least one of a joint, a bone, or a muscle group; wherein the patient interface and the treatment apparatus are each configured to enable operation from a patient location geographically separate from a location of the clinician interface; and wherein the patient interface presents a questionnaire soliciting a response to a question pertaining to one of a current physical condition of the patient or a past physical condition of the patient.

[0277] 63. The computer-implemented system of any preceding clause, wherein the regimen is a physical rehabilitation regimen for improving strength or range of motion of the body part.

[0278] 64. The computer-implemented system of any preceding clause, wherein the one of the plurality of questions pertains to the current physical condition of the patient. [0279] 65. The computer-implemented system of any preceding clause, wherein the one of the plurality of questions pertains to the past physical condition of the patient.

[0280] 66. The system of any preceding clause, wherein the question is one of a plurality of questions on the questionnaire.

[0281] 67. The system of any preceding clause, wherein the question relates to an ability of the patient to use the treatment apparatus. [0282] 68. The system of any preceding clause, wherein the patient interface presents the question in response to occurrence of a triggering event, the triggering event pertaining to the patient’s use of the treatment apparatus.

[0283] 69. The system of any preceding clause, wherein the treatment apparatus comprises an internal sensor configured to measure at least one of a linear motion or an angular motion of the body part of the patient; and wherein the patient interface presents the question in response to a measurement by the internal sensor.

[0284] 70. A patient user interface generated by a computer and comprising: a session period action screen presenting real-time status of measurements regarding a patient’s use of a treatment apparatus for performing a regimen for a body part, the body part comprising at least one of a joint, a bone, or a muscle group; and a questionnaire soliciting the patient to answer a plurality of questions pertaining to physical conditions of a patient. [0285] 71. The computer-implemented system of any preceding clause, wherein the regimen is a physical rehabilitation regimen for improving strength or range of motion of the body part.

[0286] 72. The patient user interface of any preceding clause, wherein the questionnaire comprises a pretreatment questionnaire presenting a plurality of questions; and wherein predetermined responses must be provided before the patient is authorized to use the treatment apparatus.

[0287] 73. The patient user interface of any preceding clause, wherein one of the plurality of questions pertains to a current physical condition of the patient.

[0288] 74. The patient user interface of any preceding clause, wherein one of the plurality of questions pertains to a past physical condition of the patient.

[0289] 75. The patient user interface of any preceding clause, wherein the patient interface presents a help display in response to occurrence of a triggering event, the triggering event pertaining to the patient’s use of the treatment apparatus; the help display including a first control for the patient to stop using the treatment apparatus or to request additional help in using the treatment apparatus; and the help display including a second control for the patient to continue using the treatment apparatus.

[0290] The above discussion is meant to be illustrative of the principles and various embodiments of the present invention. Numerous variations and modifications will become apparent to those skilled in the art once the above disclosure is fully appreciated. It is intended that the following claims be interpreted to embrace all such variations and modifications.

[0291] The various aspects, embodiments, implementations, or features of the described embodiments can be used separately or in any combination. The embodiments disclosed herein are modular in nature and can be used in conjunction with or coupled to other embodiments.

[0292] Consistent with the above disclosure, the examples of assemblies enumerated in the following clauses are specifically contemplated and are intended as a non-limiting set of examples.

Claims

CLAIMS What is claimed is:

1. A computer-implemented system, comprising: a patient interface comprising an output device and an input device, the output device configured to communicate information to a patient regarding the patient’s performance of a treatment plan for the patient, the treatment plan comprising a rehabilitation regimen for a body part; a treatment apparatus configured to be manipulated by the patient for performing the rehabilitation regimen upon the body part; an assistant interface remote from the patient interface and configured to communicate, via a network connection, a telemedicine signal to the patient interface; wherein the telemedicine signal comprises one of an audio signal, an audiovisual signal, a visual signal, a haptic signal, an environmental change signal, an interface control signal for controlling a function of the patient interface, or an apparatus control signal for changing an operating parameter of the treatment apparatus.

2. The computer-implemented system of claim 1 , wherein the one of the audio signal, the audiovisual signal, the visual signal, the haptic signal, or the environmental change signal includes a feed from the assistant interface, and the feed is configured to be presented by the output device of the patient interface.

3. The computer-implemented system of claim 1, wherein the telemedicine signal is generated from a prerecorded source, and the telemedicine signal is configured to be presented by the output device of the patient interface.

4. The computer-implemented system of claim 1, wherein the patient interface is configured to transmit an apparatus monitor signal to the assistant interface, and the apparatus monitor signal includes status information related to the treatment apparatus.

5. The computer-implemented system of claim 1, wherein, to effect a change to an operating parameter of the treatment apparatus, the telemedicine signal is configured to comprise the apparatus control signal from the assistant interface.

6. The computer-implemented system of claim 1, wherein the patient interface is configured to provide two-way audio communications, two-way audiovisual communications, two-way visual communications, two-way haptic communications, two- way environmental communications with a person using the assistant interface, or two- way communications using on each side of the communications one of the foregoing means, where the means on one side and the means on the other side are different.

7. The computer-implemented system of claim 1, wherein the patient interface includes a manual control such that the patient uses the assistant interface to initiate a telemedicine session.

8. The computer-implemented system of claim 1, wherein the patient interface is configured to solicit answers to one or more questions from the patient; and wherein predetermined answers to the one or more questions are configured to enable a telemedicine session to be initiated, wherein the telemedicine session uses the assistant interface.

9. The computer-implemented system of claim 1 , wherein a predetermined condition of the treatment apparatus causes the patient interface to initiate a telemedicine session, wherein the telemedicine session uses the assistant interface.

10. The computer-implemented system of claim 1, further comprising a clinician interface, wherein such interface includes a protocol management display presenting controls for modifying a treatment protocol within the treatment plan; and wherein the assistant interface is presented on a physical device shared with the clinician interface.

11. The computer-implemented system of claim 1, further comprising a server computer configured to store data related to one of the treatment plan or the patient; and wherein the assistant interface is configured to be in communication with a server for receiving the data related to the one of the treatment plan or the patient.

12. The computer-implemented system of claim 1 , wherein the body part comprises at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

13. A system for remote treatment, comprising: a patient interface comprising an output device and an input device for communicating information to and from a patient; a treatment apparatus configured to be manipulated by the patient for performing a rehabilitation regimen upon a body part; an assistant interface configured to communicate a telemedicine signal with the patient interface via a network connection, the telemedicine signal configured to control one of the patient interface or the treatment apparatus; and wherein the patient interface and the treatment apparatus are each configured to operate from a patient location geographically separated from the assistant interface.

14. The system of claim 13, wherein the assistant interface includes a control for changing a setting of one of the patient interface or the treatment apparatus; and wherein the assistant interface is configured to change the setting of the one of the patient interface or the treatment apparatus when the setting cannot be changed by the patient using the patient interface.

15. The system of claim 13, wherein the patient interface is configured to transmit a control signal to the treatment apparatus in response to receiving the telemedicine signal from the assistant interface.

16. The system of claim 13, wherein the body part comprises at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

17. An assistant user interface generated by a computer and comprising: an apparatus control comprising an apparatus status display and an apparatus session control, the apparatus session control configured to adjust an operating parameter of a treatment apparatus, the treatment apparatus configured to be manipulated by a patient for performing a rehabilitation regimen upon a body part; a patient communications control for controlling an audio or an audiovisual communications session with a patient interface, the patient interface configured for use by the patient such that the patient is able to perform the rehabilitation regimen upon the body part.

18. The assistant user interface of claim 17, further comprising a patient interface control presenting information related to the patient interface.

19. The assistant user interface of claim 18, wherein the information related to the patient interface comprises an image presented on a display screen of the patient interface.

20. The assistant user interface of claim 18, wherein the patient interface control further includes a setting control for adjusting a setting of the patient interface.

21 . The assistant user interface of claim 17, further comprising a patient profile display presenting biographical information related to the patient using the treatment apparatus.

22. The assistant user interface of claim 17, further comprising a patient profile display presenting information related to a treatment plan for the patient, wherein the treatment plan is related to how the patient is intended to use the treatment apparatus.

23. A method for initiating a telemedicine session using an assistant interface and a patient interface, the method comprising: receiving, at the patient interface, data from one or more sources, wherein the data is received while a user is operating a treatment apparatus to perform a treatment plan, the treatment plan comprising a rehabilitation regimen for a body part; determining, based on the data, whether a trigger event has occurred; and responsive to determining the trigger event has occurred, using the patient interface and the assistant interface to electronically initiate the telemedicine session.

24. The method of claim 23, further comprising: causing presentation of the data on the assistant interface; and receiving, from the assistant interface, a telemedicine signal comprising one of an audio signal, an audiovisual signal, a visual signal, a haptic signal, an environmental change signal, an interface control signal for controlling a function of the patient interface, or an apparatus control signal for changing an operating parameter of the treatment apparatus.

25. The method of claim 23, wherein the one or more sources comprise a sensor, the treatment apparatus, an input peripheral of the patient interface, or some combination thereof.

26. The method of claim 23, wherein the data comprises a sensor measurement, an answer to a question presented on the patient interface, a vital sign, a characteristic of the user, or some combination thereof.

27. The method of claim 23, wherein the trigger event comprises receiving a response to one or more questions presented on the patient interface.

28. The method of claim 23, wherein the trigger event comprises determining a condition of the treatment apparatus.

29. The method of claim 23, wherein the body part comprises at least one of a joint, a bone, a ligament, a tendon, or a muscle group.

30. The method of claim 23, further causing, during the telemedicine session, a patient profile display to be presented on the assistant interface, wherein the patient profile display comprises information related to the treatment plan for the patient, and the treatment plan is related to how the patient is intended to use the treatment apparatus.