WO2008067607A1 - Method and system of deriving measurements - Google Patents

Abstract

A method and system of deriving physical measurements from a user undergoing a user exercise in order to assess the user, the method comprising obtaining the physical measurements from the user, transmitting the measurements wirelessly or by cable to a processor, processing the measurements and displaying the processed measurements in real time in order to make the assessment and monitor any changes required by the user.

Description

"Method and system of deriving measurements"

Cross-Reference to Related Applications

The present application claims priority from Australian Provisional Patent Application No 2006906820 filed on 6 December 2006, the content of which is incorporated herein by reference.

Field of the Invention

This invention relates to a method and system of deriving measurements from a user in relation to a physical condition of the user in order to assess and train the user to improve the physical condition.

Background to the Invention

Biofeedback is a process in which physiological signals that are usually imperceptible, such as heart rate, skin conductance, muscle activity are amplified and presented to a user in a perceptible format. It may also include data sensed on or in the user in relation to motion or muscle activity which is then presented to the user in a perceptible form, such as audio or video.

Existing biofeedback systems typically incorporate wired systems where a user has various sensors attached to his or her body and these are connected to processors through the wires which present obvious problems when movement of the user is required to be sensed and analysed. Furthermore, some systems incorporate force plate sensors which provide assessment and analysis through a stable surface. However such sensors are not suitable when seeking measurements from a user subjected to an unstable surface. Furthermore, biofeedback software is typically written by biofeedback hardware developers as an adjunct to their own hardware. This tends to restrict the user, such as a clinician or trainer, to a single solution for both the hardware or software of a particular developer. Consequently the software tends to be expensive and inflexible and the features of a particular item of software may only work with a particular item of hardware and is not available to other hardware users. This also presents difficulties when several hardware devices are used each from different manufacturers.

It is desirable to provide a method and system of deriving measurements that are presented to the user in real time and where the measurements are compared to a predetermined protocol. In this manner assessment and training can be implemented in real time in order for the user to improve upon their physical condition. Summary of the Invention

According to a first aspect of the invention there is provided a method of deriving physical measurements from a user undergoing a user exercise in order to assess the user, the method comprising the steps of: obtaining the physical measurements from the user; transmitting the measurements wirelessly or by cable to a processor; processing the measurements; displaying the processed measurements in real time in order to make the assessment and monitor any changes required by the user. The method may further comprise the step of providing a programmed exercise for the user to follow. The physical measurements may represent the user performing the exercise and the user's physical measurements processed such that the processed measurements and the programmed exercise are displayed. Both may be displayed concurrently to the user and/or a clinician or just to the clinician. This enables the user and/or clinician to see how closely the user's exercise follows the programmed exercise.

The method preferably uses an unstable device on which the user performs their exercise, such as a balance platform or exercise ball. Located on the device is preferably a small portable measurement device that includes an accelerometer for measuring movement of the user in three dimensions. The measurement device may also house a magnetometer and angular rate gyroscopes. The portable measurement device may alternatively be located on a part of the user or inside the user and not necessarily attached to a separate device. The transmitting of data wirelessly may use the Bluetooth protocol or other protocols. Transmission may also occur via regular cable protocols, such as USB.

Preferably there is displayed in real time a target location and a user location. The target location forms part of the programmed exercise and the user, whose movements correlate to the user location, strives to follow the target location as closely as possible by viewing the user location displayed. Thus the physical measurements obtained and processed are translated, through software, to be displayed as the coordinates of the user location. Alternatively, an assessment may be undertaken whereby no live feedback is given to the user, for example in the assessment of static balance. Static assessment entails the user trying to maintain stationary balance over an unmoving target location on an unstable platform, so that the objective is for the user to remain static with the target also being static. A dynamic assessment is where the user tries to follow a moving target location on an unstable platform. Statistics or data on the user's exercise may be recorded and stored in memory.

The exercise may be for assessment or for training. The programmed exercise may be a training exercise in which the target location is programmed as a number of holds and transitions making up the exercise. The length of each of the holds and transitions can be specified as well as the speed of the programmed exercise or protocol.

A number of exercises by the user can be recorded and stored, so that over a period of time changes can be observed that show improvement in the physical condition of the user. These are displayed in a table or chart showing any one or more of the following characteristics: date and time of exercise; exercise type - training or assessment; average distance of the user location from the target location (also in X and Y directions); percentage of time the user location is inside the target location standard deviation of the user location from the target location; maximum angle of the board or other device

The direction, tilt of the board or other device and distance from the origin of the user location and target location may be displayed in real time.

Apart from the user having visual feedback in terms of their movements being displayed in real time, the user may receive audio feedback indicative of their position, through the user location, relative to the target location. The pitch of the audio may vary depending on the distance of the user location from the target location. A chime or other sound may alert the user that they are located within the target location and a further chime or sound may be uttered when the user location is within a predetermined distance of the origin of the target location, which target location may be varied in size.

Furthermore, the audio may be heard in the user's left ear when the user location is to the left of the target location and be heard in the user's right ear when the user location is to the right of the target location.

According to a second aspect of the invention there is provided apparatus for deriving physical measurements from a user undergoing a user exercise in order to assess the user, the apparatus comprising: measurement means for obtaining the physical measurements from the user; means for transmitting the measurements wirelessly or by cable from the measurement means; processing means for processing the measurements; and display means for displaying the processed measurements in real time in order to make the assessment and monitor any changes required by the user.

According to a third aspect of the invention there is provided computer program element comprising computer program code means operable to instruct a processor, whereby physical measurements are derived from a user undergoing a user exercise in order to assess the user, the program element instructing the processor to: receive the physical measurements from the user wirelessly or by cable; process the measurements; and enable display of the processed measurements in real time in order to make the assessment and monitor any changes required by the user.

Brief Description of the Drawings

A preferred embodiment of the invention will hereinafter be described, by way of example only, with reference to the drawings in which: Figure 1 is a block diagram of apparatus used to derive physical measurements from a user and processed for display in real time to the user;

Figure 2 is a block diagram showing a number of sources of the physical measurements that are measured and processed simultaneously;

Figure 3 is a screen image of a programmed exercise that a user follows in real time to assess and/or improve the user's physical condition;

Figure 4 is a screen image of a programmed exercise in demonstration mode showing all features of the exercise;

Figure 5 is a screen image of user data including a user database, a user session statistics table and a user summary statistic chart; Figure 5 A is a block diagram of a network enabling uploading and downloading of assessment data of particular users;

Figure 6 is a screen image showing the user session statistics table for training exercises including a summary statistic chart for the selected session or exercise;

Figure 7 is a screen image showing the user session statistics table for an assessment exercise including a summary statistic chart in scatter plot form together with bar charts on particular characteristics of the assessment exercise;

Figure 7A shows a screen image of a progress chart of a characteristic of a programmed exercise of a user over a period of time; and

Figure 8 is a screen image enabling a user to receive audio feedback whilst performing an exercise. Detailed Description of the Preferred Embodiment

With reference to Figure 1 there is shown a system that is used to take measurements from a user, that has a physical condition that needs improvement, which measurements are sent wirelessly or via cable to a receiver forming part of a processor. Specifically there is a very small portable device 100 that communicates wirelessly or via cable over link 101 to a processor such as a PC, personal digital assistant or smartphone 104 or other dedicated wall mounted display. The portable device 100 may be attached to a part of a subject that requires measurement and analysis or may be located internally of the user or implanted in the user. The portable device 100 may be attached to an exercise device, such as a balance board, to assess balance of the user or to an exercise ball to assist in balance training and rehabilitation of the spinal column and/or abdominal muscles of the user.

The device 100 has a microprocessor 108 which receives and processes signals from a triple axis accelerometer 110 which measures movement in three dimensions. The device also optionally has a magnetometer to measure yaw in addition to pitch and roll and angular rate gyroscopes to measure angular rates. The device 100 has a power supply 114, typically in the form of a battery powered source, optionally a motion based tilt-switch for waking the device, a transmitter 112, which is preferably a Bluetooth transmitter, for transmitting digital signals converted by the microprocessor 108 from the accelerometer 110 over the wireless link 101 to a Bluetooth receiver 102 that is associated with the processor 104. The results of the measurements taken in real time may be displayed on an output monitor 106 to the user and to a professional, such as a clinician or physiotherapist, to assess the user and to train the user to follow a specific routine or protocol. The device 100 is ideally extremely small and lightweight to be unobtrusive when mounted. LED Indicators on the device 100 indicate when the device is active and when it is transmitting data.

With reference to Figure 2 the processor 104 can receive a number of measurement inputs from various devices placed on or in a user or on an exercise device to be used by the user. For example, simultaneously the processor 104 may receive signals from an electromyogram (EMG) sensor, a pressure sensor and also a sensor used to measure the balance of a user. All of these can be viewed simultaneously by a clinician or relevant professional.

As well as placing the portable device 100 on exercise devices, such as a platform, a more accurate accelerometer version may be placed on a user for monitoring limb and body movements. This version has greater sensitivity and optionally measures angular rates through gyroscopes, has a magnetometer for yaw measurement and digital filters for separating acceleration from the true tilt of the limb or body from which measurements are being taken. Thus a distinction is made as to what is actually being measured, that is whether it is a limb or body placement or a limb or body movement. Software is stored in memory and is used by the processor 104 to provide biofeedback functionality for research, clinical assessment or training. The software assists in making the processor 104 display in real time on the output 106, the 2D or 3D orientation and movement of the user for assessment, training and/or research in accordance with a predefined routine. The following description, with reference to Figure 3, is equally applicable to any application whereby the portable device 100 is attached to an exercise device or similar device or is carried on or in the user's body. In this example, a balance platform is shown, by clicking on Display button 324, whereby a target location 302 and a user location 304 are displayed on the monitor 106 on a background 306 which in this case is a circular background. Software stored in the processor 104 facilitates the display of these features and the target location 302 is the desired orientation/location that the user should strive to attain, which can be either a moving target or a stationary target or a combination of both. The larger circular background 306 represents the boundaries of a specified balance board, the user location 304 (white) shows the current inclination of the physical balance board as measured by the portable device 100 that is attached to the physical balance board. The target location 302 is represented in a different colour, for example a red circle, which may be of varying diameter. This target may change location according to a specified protocol, to be described hereinafter, and transitions need to be smooth and represent the real world, that is, continuous changes. The representation of the features shown in Figure 3 may be two dimensional or three dimensional. The graphical display 308 can be toggled between 2D and 3D modes by clicking on the "Display 3D" check box 305. The 3D display requires DirectX 9.0c to be installed on the system together with an appropriate video card. The display screen area 308 may be maximised or displayed in a standard manner, that is to fill the majority of the display screen 106 of a PC monitor or PDA. The display background, that is, the graphic display area 306 representing the balance board, may be varied to represent other styles of balance board and/or brand logo. For example in this particular figure a pair of feet is shown in the display area 306 to indicate that it is a balance board. The orientation of the feet also indicate the front direction of the balance board and therefore the orientation of the board and how it should be used. In order to represent the user and target locations, these can be represented by precise cross hairs or larger generic patterns. Using the cross hair check box 307, the user location 304 can be changed between a cross hair appearance and a regular circular appearance. An introductory timer of between 0 and 30 seconds may be implemented to enable a user to start a program, in accordance with a given protocol, and to get established on the balance board before actual recording of the activity begins.

A smoothing algorithm must be implemented through the software to enable the last one to nine samples read by the device 100 to be smoothed in order to reduce jitter and make the feedback easier to control. Thus there are updates of ten samples per second and therefore the display is updated every 10 hertz, that is, one sample and display update every 100 mS. Control of the amount of smoothing applied through the software is performed through the box 309 on display 308 whereby an appropriate value can be selected from the numeric box. The value display in the box indicates how many previous samples are averaged. In order to turn the smoothing function off, it is set to 1 , which refers only to the current sample rate.

The display on screen 308 has a number of alphanumerical indicators. The number 311 indicates the amount of time remaining in a fixed duration protocol (i.e. counting down), or indicates total time elapsed (i.e. counting up) when in free running mode. The text 313 indicates whether the target is stationery, that is on hold, or is moving or transiting in between target locations in which case it would indicate "moving". Finally the timer indicated by 315 is a countdown timer in seconds indicating how much time is left in the current target mode, that is, in the present moving or holding mode. Also shown in Figure 3 is the direction at 310 and tilt at 312 of the user both in degrees. A demonstration mode may be activated which illustrates the balance board motions using a mouse. The version shown in Figure 3 is actually in demonstration mode. There are a number of buttons available to the user to control the program. For example, there is a play button 314 to start the program, a stop button 316, a pause button 318 and a button 320 that allows the user to go to the end of the program. There is also display button 322 which enables the program to be restarted. A display icon 324, balance protocol icon 326 and user data icon 328 is also shown.

A key feature of the system is the unique ability to create protocols which is a training target inclination that a user strives to achieve. For example, assuming that a user is utilising the system to increase flexibility in their ankle, by creating a custom protocol the user is able to undertake a precise exercise which is tailored for their particular need. In this case, the protocol might simply be to move a balance board in a continual slow circle extending the join to a comfortable position. A protocol might be anything from holding still in a particular position for several minutes through to rapid side-to-side rocking. Live graphical feedback enables the user to focus on maintaining or following the particular balance motion exercise and provides instantaneous feedback on how well they are doing. Statistics taken from each training session are also stored and presented to the user so that continual changes or improvements can be seen as more and more sessions are undertaken. This is essential to the motivation of the user in addition to validation of the specific training method. With reference to Figure 4 there is shown a screen 400 that depicts a particular balance protocol or routine that has been created for a user to follow and this is accessed by depressing button 326. The protocols can be defined by users or their clinicians and is essentially a time based sequence of holds and transitions of the target location 302. An example of a training protocol is where there is a total time of thirty seconds to do the routine and within this time the target stays stationary in one position for ten seconds then takes ten seconds to transit smoothly to a second location and stays stationary at the second location for a final ten seconds. Protocols may be either training protocols, with one or more target locations, or assessment protocols, with only one stationary location. Clicking on the new training button 407 will initiate a dialog box to appear that requests a new name for the protocol that is mapped out by the user or a clinician. A suitable name is provided such as TestProtocoll and then an "OK" button is clicked. The user or clinician is now in a position to plot out a course for a variety of target inclinations on the display area 306 as shown. A mouse associated with the processor 104 is used to hover over the circular display in which case the distance and angle boxes update automatically to provide the current position of the mouse, that is the angle from 0 to 360° and the distance from the origin (in degrees) at which the board is positioned. The board can be tilted in any direction, as indicated by the angle box 418 and also to any distance, that is as measured as an angle of tilt. This is indicated by the distance box 410. Using the mouse to left click in a few places on the board it is possible to see a target appear under the mouse. By left clicking on the circular display the target location is automatically entered into the target data table 402. Editing or deleting a target location can be done in the table 402 directly by either manually entering values or right clicking and using the menu to delete entries. Multiple target locations can be entered as separate rows in the table 402. Thus a series of target locations are presented in order to a user, with each target location being held still for a certain time as indicated in the hold column of the table 402 and then moves to the next target location, which is a transition that takes the time shown in the transit column in the data table. The clock as shown in the box 412 displays the total time taken at a certain point, with the last entry in the table displaying the full time taken for the entire protocol. Various buttons 426, 428, 430 and 432 are used to see the protocol course that has been plotted and steps through the particular targets that have been entered in the data table.

The assessment protocol is a single stationary location target for a specified period of time and the training protocol is one or more target locations in either stationary (hold) or transition (movement).

An example of a simple protocol might be to hold a balance board tilted directly forward for ten seconds and then to hold it tilted backwards for ten seconds. An example of an assessment protocol may be to keep a balance board flat, that is, non- tilted, for a thirty second period. Alternatively the assessment may require the user to keep a balance board at 10° tilt to the left for two minutes. In both cases the user maintains a single stationary position and the target location 302 does not move. Conversely, a training protocol has one or more holds or transitions an example of which may be the target being initially set at centre, that is 0°, and held for twenty seconds, before the target moves to 15° to the right and held for a further five seconds. An assessment can be seen to be a subset of training protocols, that is a training protocol can intentionally consist of one single hold only and no transitions and therefore it appears identical to an assessment. The difference is in the analysis of the user data after the session. Assessment data is treated differently from training data as to be discussed hereinafter. AU protocols are explicitly named so that a number of differing protocols can be created and stored. To create a new assessment protocol the "new assessment" button 409 is depressed and to create a new training protocol the "new training" button 407 is depressed. In the naming box that will be shown the name for the new protocol is then entered which must differ from any existing protocol name and can only consist of alphanumeric characters. The protocol file which stores details of the protocol is saved as an XML file, so that it can be opened, edited or shared and the name of the XML file is the same as the name of the protocol. Thus there is a need for a unique name with alphanumeric characters. When defining a new protocol it is to be ensured that the board angle is suitable for the physical board being used. Once the new protocol has been created, for either assessment or training, it is useful to add a description to the protocol in box 406. This can give details on the protocol such as author, date and protocol uses or instructions for use. This field is optional and can be left empty, however if it is required to add or modify a description then this can be done by clicking in the description box 406 above the target location table 402 and the description subsequently entered. Target locations are entered in the same manner for either assessment protocols or training protocols. The target locations can be entered either manually or by moving the mouse over the target display editor area 306. Manually entering the angle, distance, hold time (in seconds) and transit time (in seconds) in the table 402 is possible. Four such entered target locations are displayed in table 402 under the protocol named Test 2 accessed through drop down box 404. The angle represents the orientation of the target location 302 from 0 to 360°. The distance represents the angle of tilt of the board. With the second method of entering target locations, the mouse can be moved over the area 306 and clicked to add a new target location at a specific point. Successive clicking on the target display will add a succession of targets, whilst in a training protocol, or will update the single target location in an assessment protocol.

A combination of both mouse plotting and manually entering in the table 402 can be used. Using the mouse will provide rapid plotting of a series of training protocol points and the table can be used to manually adjust any values thereafter. When using the target display editor area 306, default values are entered for a hold time in seconds and transit time in seconds. The hold time is the length of time a position will be held stationary and the transit time is the length of time it will take for the target to move to the next location. The shorter the time, then the faster the move will be. The default values that are entered are found in the specific boxes 414 and 416. Changing the value in either of these boxes will cause the entered time to be used as a default when entering a new target location by a mouse click on the display area 306.

Other software features displayed on screen 400 include a limit on the board angle entered in box 408 which can be variable. This is made in order to make the display represent the real world balance platform. For example, a balance board with a maximum angle, that is the point where the edge hits the ground, of ± 10° needs to be entered as 10° so that a boundary position is known. That is the edge of the display board is known to represent 10° in the real world. The actual tilt of 14.18° is shown in box 410 at the time of four seconds shown in box 412 during the running of the specific protocol. The number of seconds entered for the hold segment is done at box 414 and for the transit time in box 416. The current direction is given in box 418 and a speed factor is given in box 420 which governs the speed at which the target moves. The size of the target location 302 as mentioned before is variable and its diameter in degrees can be entered in box 422. It is made variable to make the exercise easier or more difficult for the user. In assessment protocols, the size of the target location is not important as all measurements are taken from the centre of the target location, that is the origin. It may optionally be altered for a visual and audio feedback and to provide a larger visible area for a user, however it does not contribute to the statistical analysis.

The target size however is important in training^'protocols. Statistical results are based on a user's location relative to the nearest edge of the target location boundary. That is, the distance is not measured from a user location to the origin, but rather is based on the distance of the user location to the edge of a target. In this way, the target size has an immediate impact on the level of difficulty. Thus the larger the target size, the easier it is for a user to position close to or within the boundary of the target location. Also an important statistic for training protocols is the "percentage of time on target". This refers directly to the amount of time that a user location is within the target boundary.

, Target sizes can be set from 1 to 16 in box 422 and these values map to the actual target size diameters by multiplying the maximum board angle value by a predefined coefficient. The actual diameter of the resulting target size is measured in degrees and is placed in parentheses under the "Target Size" title above numeric input box 422 as seen on screen 400. The target size in the box 422 is presently set to a value of 6, with a board angle of 15° taken from box 408. This creates a target having a diameter of 9° and this value is seen above the numeric box 422. The final target diameter is calculated as follows: Target size value* board angle/10.

Thus in the present case the values are: 6*15/10 which gives a final target diameter of 9°.

The number of grids to be shown on the balance platform is provided in box 424. In this case it is twelve grids with each grid defining an arc of 30°. When the protocol set-up has been finalised, the save button 411 is depressed.

Once a new protocol has been created, it can be run and seen as a program as can existing protocols, by initially clicking on a row in the target location data table

402 which will cause the target to be displayed in the area 306. By clicking on the buttons 426, 428, 430 and 432 it is possible to step through or animate the target locations. The control button 426 is a previous button that jumps to the previous target location. The control button 428 is a next button that jumps to the next target location. Button 430 is a reset button that jumps to the first target location and button 432 is an animation button which starts moving through the target locations in real time. All holds and transits are timed in real time. The button 432 is depressed again in order to stop the animation. At 434 there is a check box which enables the clinician or user to set a free running mode called an infinite loop whereby a training protocol is repeated infinitely, with no final statistical analysis. The start button 314 and stop button 316 are used to control the duration of the loop. A further check box 436 is provided to generate random training protocol locations with random hold and transition times. In total there are 99 separate locations that can be produced. Whilst the box 436 is checked it is not possible to edit the random target location data or edit the protocol. All of the software is written in XML and the creation and saving of protocols is provided with the names and descriptions and saved to XML files.

The visual playback of protocols in the protocol editor should have the functionality to enable the user to play back their protocol either in steps or in real time that is, animation, to verify the design. The main display data is presented in polar coordinates as this system is easier to understand for some users. However, logged data is preferably in the Cartesian coordinate format. A balance board with a circular top is easily implemented in Cartesian X and Y coordinates. For example a tilt directly forward of 10°, so that the edge touches the floor, can be expressed as X = 0, Y = 10. A 10° tilt to the right can be expressed as X = 10, Y = 0. A tilt of 10° backwards will be X = 0, Y = -10 and finally a tilt of 10° to the left will be expressed as X = -10, Y = 0.

For all positions in between, X and Y can be used to plot a particular position. For example X = 4, Y = 4 means a tilt of 4° forwards (that is upwards) and 4° to the right.

When describing the board orientation in polar coordinates, degrees is used clockwise from 0° and distance from the origin is used.

The speed factor which is identified in box 420 allows an existing protocol to be increased in speed in both the hold and transit times. This functionality allows an existing protocol to be made easier or more difficult. In general terms, the faster a protocol is, the harder it is to follow. The speed factor is simply a divisor that reduces the times specified in the transit and hold columns on the table 402. Having a speed factor of two, halves the existing hold time and transit time. Data that defines each protocol is held in user accessible XML format files. The name of the XML file is the same as the protocol name and is located in the "extensions/balancedata" subdirectory. Users can use any XML tool/viewer to edit or create the protocol files outside of the software provided by this invention. Furthermore, protocols can be shared between users by sharing the XML files and placing them in the "balancedata" directory. An import/export tool may be provided to import and export protocol data and to enable users to share or distribute protocols.

An intro numeric box 413 on screen 400 is used to enable a delay to occur before recording of live data of the user starts. The value displayed represents the number of seconds available when the play button 314 is activated and lasts until recording starts. The main function of the delay is to allow a user to settle into the balance platform and get steady before recording begins. This is particularly useful for training alone. A delay of up to thirty seconds can be set which allows the user to configure and start the software and get established on the balance platform before recording of their locations begins. Shown in Figure 5 is a screen 500 that displays user data by clicking on the button 328. The data to be stored on each user includes log files, being an optional user/time stamped file of raw data, and statistics for each user's sessions for each named user in the user database. Also stored for assessment protocols is the actual raw data as well as summary statistics. For training protocols the segmented average data is stored. This is the average distance of the user location from the target location whilst the target was within one of seventy-two segments on the displayed background 306.

All the data is stored in the XML format. User data is in the form of raw log files, and statistics session files which are both stored in XML.

Screen 500 is divided into a user database 501, a session statistics table 522, and a summary statistic chart 503 for a selected session. It shows the record of a particular user, and the database allows multiple sessions to be recorded for different users on the system. For each user there is stored the first name of the user in box 502, the surname in box 504, an identification in box 506 and comments are able to be stored in boxes 507 and 508. A search facility is provided by clicking on box 510 or the actual user name can be entered directly in box 512. The new user details can be added by depressing box 514. Existing user comments in box 508 can be edited by depressing box 516 and a selected user can be deleted from the database by depressing box 518. Refresh button 511 reloads all data for the currently selected user from their data file. Preferably, the name of each user is encrypted in order to preserve confidentiality of each user. After a successfully completed protocol by the user, statistics are stored in both table form (522) and a chart form (503). Clicking on a row in table 522 selects the session and enters the statistics into the summary chart 503. The statistics are derived from the raw data. Referring to Figure 5A, there is shown a central data repository 534 that can be used to store data results for balance assessments for pre-specified protocols. Users, such as clinicians or trainers will need to register to have access to the database 534, such access being through a user ID and password. The database 534 is linked to server 532 that hosts a website to enable access to the database 534 and for processing data. The internet 530 is the communications network used to access server 532 from a PC (or PDA or Smart Phone) such as 104 or 536.

Registered users can upload results of balance assessments for pre-specified protocols and download normalised balance data for a specific protocol based on a particular demographic. The server 532 can perform the normalisation of the received data results. Thus after recordal and processing of data relating to an assessment, according to a pre-specified protocol, using the processor 104 (or 536), the registered user uploads the assessment data to the database 534 for storage. When uploading, in addition to the protocol name, other user information is uploaded such as age, location, medical condition (from preset lists). After a collection of assessment data for various people is uploaded and stored, the database will provide a set of normalised balance data for a specific demographic. Thus registered users are able to access and download the normalised data to compare against a particular user. The comparison will enable an experienced professional to assess the individual's balance data with a normalised representative from the same demographic group. Reports on the data or comparisons can be made available through server 532.

Training statistics include the protocol name, a date and time of recordal, the average distance (in degrees) of the user location from the centre of the target location whilst in assessment mode, or the edge of the target when in training mode, the percentage on the target (that is the percentage of samples where a user location is within the bounds of the target location circumference), standard deviation of the distance of each user location from the centre/edge (dependent upon the assessment or training mode) of the target, and the board angle. An example of the training statistics are given in Figure 6 whereby the abovementioned statistics are included in a session history table 602 and the selected row is illustrated on a chart 604. The chart 604 is split into 72 segments. The average distance of user location from the edge of the target is assessed for each segment when the target is centred within that segment. Each segment represents an area of the full balance board where a target location could be. The segments are colour coded to represent areas of the board where the target was located for some period of time and a different colour for where the target was never located in a particular segment. Thus the path of the target is easily seen at a glance by a user or clinician. Furthermore, in addition to showing the path of the target, there is shown colour coded segments that illustrate how far the average distance of the user location was from the target whilst the target was in that particular segment. Thus for example a full red colour shows when the user location average distance is 0, that is under the target location, whereas a full yellow is achieved when the user average distance is the furthest from the target location on the board, this is equal to twice the board angle.

In Figure 6 the auto-adjust contrast range check box 603 can make the colour coding more visual. In auto-adjust contrast mode, the minimum and maximum differences from the range of recorded average distances are calculated with full red being allocated to the minimum and a full yellow being allocated to the maximum value. These new maximum and minimum average distance values are indicated next to the red/yellow colour key 605 next to the chart 604. The contrast from red to yellow across the board can be used to look for areas of particular strength and weakness imbalance ability. For example, areas of red indicate successful maintenance of balance with a minimum average distance of the user location from the target location whilst the yellow coloured areas show an increased average distance from the target and hence weaker control of the balance platform by the user.

For the assessment statistics a session history table and chart is also displayed, referring to Figure 7, with the table having columns for the protocol name, date and time that the routine is recorded, the average distance (in degrees) from the user location to the centre of the target location, the standard deviation of the distance of each user location from the centre of the target location, the X distance (the average distance of the user location from the centre of the target location in the X direction, that is left to right, + X values are to the right of the target) and the Y distance (the average distance of the user location from the centre of the target location in the Y direction, that is forward to back, + Y values are forward of the target) and the board angle. An example of such a table is shown on the screen 700 in Figure 7 at 702.

An assessment of statistics chart illustrates a colour varied scatter plot 703 of the data points (showing all user location samples) and bar charts showing distribution of the points on the X and Y axes. An example of the assessment under the protocol name Kathrynl is shown as a scattered plot at 703 and bar charts 706 and 708 for the X and Y directions. A colour variation corresponding to the plot 703 is shown as a distance from the target at 710. The crosshair on plot 703 is the target location.

Each sample is colour coded with its distance from the target location. As the samples move further away from the target, the colour turns from red to yellow. In normal mode, full red is achieved when a user location sample is under the target location and full yellow is achieved when the user sample is as far away as possible from the target location, this is equal to twice the board angle. To make the colour coding more useful, an auto contrast function check box 707 can be crossed. In auto adjust contrast mode, the minimum and maximum distances from the range of recorded samples are calculated with full red being allocated the minimum and full yellow being allocated a maximum value. These maximum and minimum distance values are indicated next to the colour key 710.

The two bar charts 706 and 708 are the distribution of samples in the X plane and Y plane. The maximum and minimum distances of the samples are used for the upper and lower limits. These charts are useful for looking for forward/back (Y axis) or left/right tendencies (X axis).

In each of the bar charts 706, 708 the upright white line represents the target location, that is effectively zero. The upright dotted line indicates the average distance of the user location from the target location and can be used for defining training protocols.

Progress charts are available by clicking on the icon 606 in the training session and 711 for the assessment session. The progress charts show the data time based sessions of statistics with the progress reports being based on average distance, distance of the standard deviation and percentage on target for training protocols and average distance and distance standard deviation for assessment protocols.

Shown in Figure 7A is a screen 730 depicting a progress chart on the average distance from the user location to the centre of the target over a number of sessions for a protocol called "zero". It is useful to track the progress over time of a user's progression through a particular protocol. Changes can be used to assess improvements and balance coordination, to assess the efficacy of a particular protocol or a method of training and can also be used to motivate and encourage the user. By sorting the columns in the session history table by date it is possible to see progress in any of the columns by reading down a particular column. Otherwise it is possible to export the statistics table to an Excel spreadsheet package. Sessions are sorted by protocol and these are selected from the drop down box

732. The session data in date order is presented along the X axis and the statistic value is presented on the Y axis in degrees. Specifically statistical session history data and single session raw data (that is target locations and user locations) are able to be directly exported. This is done by using the table 715 in Figure 7 and is accessed by clicking on the table or row buttons 717 and 719 respectively. Prior to clicking on one of these buttons it is necessary to choose the version of Excel loaded onto the system. This can be selected from any one of Excel 2000, 2003 or XP. Clicking on the table button 717 exports the current user's entire session history table. Clicking on the row button 719 exports the currently selected session row and all of the raw data for that session. Charts and reports are able to be printed by depressing the respective icons 608 and 712 that includes all session data. It is possible to export XML files into ready formatted Excel work books. Stored data sessions can be optionally deleted by depressing the respective buttons 610 and 714.

With regard to Figure 8 there is shown a screen 800 in the user data that enables audio to be played back to the user whilst performing a routine according to a protocol. The user clicks on the audio menu 804 for access. Variable pitch audio feedback is based on the distance of the user location relative to the edge of the user target area. That is it is not the distance from the absolute centre of the target. This is so that changing the target area diameter varies the difficulty of the exercise. The pitch of the audio increases as the distance from the target circumference decreases. Variable pan audio feedback pans from a left speaker to a right speaker according to the distance of the user location from the target edge in the X direction only, that is from left to right.

There are options available to change the sounds as different people respond to and prefer different sounds. An optional selection of MIDI sounds is presented in the Window box 802 to allow users to customise their experience. An optional additional chiming sound may be made available when a user location is within the bounds of the target circumference. Users can select a MIDI instrument for the chime. An optional additional chiming sound may be made available when a user location is within 5% from the target centre. Again users can select a MIDI instrument for the chime. The 5% is calculated as a percentage of the total maximum board angle. This audio indicator is used to provide positive feedback when the user location gets very close to the absolute centre of the target location, that is the origin.

With reference to the box 802 the user can use the drop down box selections to suit the instruments played to their taste. To turn any one of their three options off, the user selects the "off - no sound" option from the drop down list which is the last entry on the list. To turn all sounds off the mute check box 806 is checked. Finally the fast check box 808 is checked to increase the frequency of feedback for the variable pitch and pan, this option provides a faster frequency update or a slower update.

Where the balance platform may be placed at a slightly offset angle, a zeroing function comprising the entry of tilt direction and angle for offset may be implemented through the software. It is sometimes necessary to position an inclination sensor on a slight angle as the board or object on which the sensor is affixed is not totally flat or it is intentionally placed on the side of an object. The entry of the tilt direction and angle, both in degrees, will then be subtracted from the raw data to zero "the data". Without any zeroing, the user will click on the "loop infinitely" checkbox 434 on the balance protocol tab page setting to allow the software to free run for a few moments. The portable device 100 is then turned on and placed in its final position and the program is run. That is, the session is started and a note is made of the offset angle and distance on the display tab page. The driver is then opened by clicking on the "device/show properties" menu option and clicking on the "advanced" tab, which may be hidden. The angle and distance values are then entered from the display tab page and then once that has been done the "OK" button is clicked to accept the change. Values entered into the angle and distance boxes on the device properties are subtracted from the input from the inclination device.

The portable device can be recalibrated if necessary using a "balance calibrator" utility. This tool is provided in the "tools" menu and is physically located in the "utilities" directory as BalanceCalibrator.exe. The tool can be launched manually by double clicking on its entry within the utilities directory or it can be selected from the Tools menu. The utility or tool contains step by step instructions for its usage.

The software can be configured to hide certain features of the software such as balance protocol editing functionality, the user database and user data. It can be configured so that the user simply sees the display screen and the start/stop functional buttons to undertake the routine in accordance with a particular protocol. In this way a clinician or researcher can hide the complexities of the software from the user and prevent them from altering the details. The display format can be locked with a password to prevent tampering and prevent access to the user database, the user data and protocol editor area. This facility enables a simplified interface to be presented to users after a more experienced user has configured the software. The display mode can be "locked" by use of a password.

The entire suite of programs or protocols can be run from within a USB based memory device or memory stick. In this way a clinician, researcher, trainer can open the program and run it from within the memory stick without loading it onto a PC hard drive. The software can then be configured, for example a protocol established, the board angle set and the user selected and optionally the display changed to hide these settings and the display locked via a password. The USB device can then be taken away by a second user and the software run from within the USB device with the software ready configured. User data results are stored on the memory stick which can then be subsequently taken back to the clinician, researcher or trainer for analysis and review.

As mentioned previously the portable device 100 may be attached to any physical device used by a user or be worn on the body or in the body of the user. In the case where it is attached to a balance platform or an unstable platform, typically used by physical therapists, this is used to assist in balance training and rehabilitation of feet, ankle, knee, hip or the spinal column of the user. The balance platform can be made large enough to support the whole body standing, lying in a prone position or in a supine position, sitting on a chair or kneeling. The balance platform can be made to move in one plane of motion or in multiple planes of motion. Once the portable device 100 is attached, the patient is assessed for any imbalances or neuro-musculoskeletal weaknesses, and then the healthcare provider or trainer prescribes exercises based on the information from the assessment. The user or patient then performs the exercises either with or without the multimedia feedback and the data from the exercise routine is recorded so that the healthcare provider or trainer can track the progress of the user.

The portable device may be attached to another physical device such as an exercise ball which is typically used by physical therapists to again assist in balance training and rehabilitation of the spinal column and abdominal muscles in particular.

As mentioned previously the portable unit 100 may be directly attached to any part of the body to detect and transmit movement to the processor 104, in the form of a PC or PDA/Smart Mobile Phone or other wall mounted display. The patient is assessed for any imbalances or neuro-musculoskeletal weaknesses through the unit 100. The healthcare provider or trainer then prescribes exercises based on the information received from that assessment. An example of this may be attaching the portable device 100 to the wrist of the user and asking the user to move the arm through the full range of circumduction at the shoulder. Another example would be attaching the portable device 100 to the head of the user in order to assess movement of the head at the neck through all planes of motion and rotation. The health care provider then plots a path on the computer screen for the exercise routine that they wish the patient or user to follow. The exercise routine or protocol may include audible narration to encourage and instruct the patient. The patient then performs the exercises either with or without the multimedia biofeedback and the data from the exercise routine is recorded so that the healthcare provider or trainer can track the progress of the patient. Electromyograms (EMG) and/or pressure biofeedback can also be incorporated into the recording of the data, so that while a patient is moving a limb in a particular manner, EMG electrodes can detect muscle activity from particular muscles, thereby indicating to the healthcare provider if the correct muscles are being recruited to perform the function or movement required.

The portable device 100 can be attached to the head of the user and used to direct the movement of a pointer or cursor on a computer screen. This is done by the user following a predetermined protocol using the pointer or cursor. The healthcare provider or trainer can then suggest that the user gets more exercise by using their head to move the pointer rather than using a mouse. This can be beneficial to people who have no use or limited use of their hands or arms, giving them an alternative way to control the pointer. The portable device 100 can also be attached to a limb of the user in order to detect any tremors. In the early stages of some neurological and post trauma conditions, such as Parkinson's Disease, or damage to the spine or brain, tremors may not be detectable without the aid of sophisticated equipment. The portable device 100 could be placed in the patient's hand or wrist as they attempt to hold it as still as possible. The device 100 could be used to assist in an initial assessment and regular monitoring of the patient. Any movement is detected and recorded by the software and displayed in real time for the patient and/or healthcare provider to view the results.

The portable device 100 can also be used to assess a woman undertaking pelvic floor exercises correctly. The device will be mounted to a probe that is inserted into the vagina and when the pelvic floor contraction is performed the probe, having a pointer, points downwardly anteriorly if the patient is lying in a supine position. The device will give an accurate output of the angle of the probe and pointer thereby giving the healthcare provider a more accurate reading and recording than previous devices. This can be used in combination with pressure and EMG biofeedback thereby indicating to the clinician if the correct muscles are being used to perform the required movement.

If a number of portable devices 100 are placed on key parts of the body of a user that are critical to good posture, for example the neck or head, software on a PC 104 can monitor and alert the clinician when the user falls into a bad posture, for example when the head or neck is at an undesirable angle. A three dimensional figure on the computer screen or output 106 can indicate good posture so that the user can adjust the image of their posture to conform to the image on the screen. In this application the portable devices could be used to act as a sleep or drowsiness indicator when the user's head drops. When this is detected an alert may be shown on a computer screen, a PDA or mobile phone or on the dashboard of a car and alternatively or in addition an audible sound is made to alert the user. A number of the devices 100 can be placed on the feet and legs of a user in order to assist with analysing gait of the user and foot/leg angles. This can aid researchers and clinicians in gait analysis and can also help in podiatric assessment. Podiatrists typically use technology that is not adequate in order to obtain exact measurements of angles of the feet and legs. The software receiving signals from the devices 100 can record the data and display images on the output 106 for analysis by the clinicians. The audible and visual biofeedback to the user can assist the patient in improving their gait and foot angle, that is in relation to the direction that they are walking.

The system uses the Microsoft Windows 98SE or later as its operating system, .Net framework v 2.0 software and DirectX 9.0c software with suitable graphics cards and an audio card. It requires a Pentium 2 or later CPU, a processing speed of IGHz or more, at least 512Mb of RAM and a Bluetooth enabled serial port access or for cable connections, a USB port.

XML or extensible mark-up language is used for organising the data into a readily readable form. It also allows manual editing and viewing of the data within the files, either with a basic text editor or with a dedicated XML editing tool.

Log files are kept in XML format with a log file being generated for each new session that is run. Furthermore, protocol definition files are kept in XML format with each single protocol having its own XML file named the same as the protocol. Also user data files are kept in XML format with each user in the user database having a single XML file containing all of their personal data and session history data. For each training and assessment session stored for each user, the full raw data is stored. This is to allow additional analysis to be undertaken outside of the use of the current software, for example in a spreadsheet application. The contents of the XML files for each of the log files, protocol definition files and user data files are as follows:

Log Files

Whenever a session is run and completed successfully a new Log file is written to file. This Log file is replaced each time a new session is run, so it must be renamed if it is to retain specific session data. The DTD (the specification for the XML data format) for the Log files is below:

<! ELEMENT data(sessiondate, channelid, sample*)>

<! ELEMENT sessiondate >

<! ATTLIST sessiondate date CDATA #required>

<!ELEMENT channelid> <! ATTLIST channelid Channel_l CDATA #required

Channel_l_Units CDATA # required Channel_2 CDATA #required Channel_2_Units CDATA # required> <!ELEMENT sample> <! ATTLIST sample channel CDATA #required time CDATA #required value CDATA #required>

Protocol Definition Files

Each protocol is defined in its own self-named XML file.

<!ELEMENT BalanceProtocol (GENERAL, DP *)> <!ELEMENT GENERAL> <! ATTLIST GENERAL DESCRIPTION CDATA Required

ASSESSMENT CDATA #required SPEEDFACTOR CDATA Required TARGETSIZE CDATA #required> <!ELEMENT DP> <! ATTLIST DP Angle CDATA Required

Distance CDATA #required Hold CDATA #required Transit CDATA #required>

User Data Files A single User data file is created for every User in the User database. The file contains personal information as well as session history and raw data files. NB The User first name and surname are encrypted to retain anonymity; if it is necessary to identify a specific users file, use an explicit ID as the ID is used in the file name.

<! ELEMENT client (userdetail, comment, session *)>

<! ELEMENT userdetail>

<! ATTLIST userdetail firstname CDATA #required surname CDATA #required id CDATA #required> <! ELEMENT comment> <!ATTLIST comment text CDATA #required>

<!ELEMENT session (SAMPLES *)>

<!ATTLIST session date CDATA #required time CDATA #required protocol CDATA #required avdistance CDATA #required avdistancex CDATA #required // These are the session statistics - most are obvious from avdistancey CDATA #required // the name. The

'logavedistance' is not so obvious, it is the distancesd CDATA #required // pre-calculated values for the 72 segments in a Training ontarget CDATA #required // session (-1 implies no value) type CDATA #required boardangle CDATA #required logavedistance CDATA #required>

<!ELEMENT SAMPLES (S *)>

<! ELEMENT S>

<!ATTLIST S X CDATA Required // These are the actual samples,

X & Y are the User, TA and TD

Y CDATA #required // are the target angle and distance TA CDATA Required TD CDATA #required>

In order to connect the portable device 100 through the Bluetooth link to the computer processor 104, initially the remote device is turned on either by gently moving the device or using a power switch. With a USB Bluetooth module plugged into the computer processor active, the software searches for Bluetooth devices and checks that the module 100 is listed. It is then paired with the device 100 creating a serial port connection. A note of the comm port number which is used should be made. The software is then opened and the user accesses the "Device/Show Properties" window. The comm port number for the connection is then entered and optionally the "stay connected" check box is checked. When the portable device 100 is active and signals are being transmitted over the Bluetooth link this is easily recognisable as a blue LED is visible in that it flashes rapidly on the device 100.

It will be appreciated by persons skilled in the art that numerous variations and/or modifications may be made to the invention as shown in the specific embodiments without departing from the scope of the invention as broadly described. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive.

Claims

CLAIMS:

1. A method of deriving physical measurements from a user undergoing a user exercise in order to assess the user, the method comprising the steps of: obtaining the physical measurements from the user; transmitting the measurements wirelessly or by cable to a processor; processing the measurements; displaying the processed measurements in real time in order to make the assessment and monitor any changes required by the user.

2. A method according to claim 1 further comprising providing a programmed exercise for the user to follow in order to undertake the user exercise.

3. A method according to claim 2 wherein the physical measurements are derived in real time from the user exercise and the physical measurements are processed and displayed substantially simultaneously with the programmed exercise.

4. A method according to claim 3 further comprising displaying the processed physical measurements and the programmed exercise to either the user, a clinician or to both the user and the clinician, in order to compare the user's exercise and the programmed exercise as part of the assessment.

5. A method according to claim 3 or claim 4 further comprising the user using an unstable device to perform the user exercise.

6. A method according to claim 5 wherein the unstable device is a balance platform or exercise ball.

7. A method according to claim 5 or claim 6 wherein the unstable device is fitted with a portable measurement device that includes an accelerometer for measuring movement of the unstable device in up to three dimensions.

8. A method according to claim 5 or claim 6 further comprising a portable measurement device that is located on the user or implanted in the user, the portable measurement device including an accelerometer for measuring movement of the user in up to three dimensions.

9. A method according to claim 7 or claim 8 wherein the measurement device has a magnetometer for measuring any one of pitch, roll or yaw of the unstable device or a part of the user and angular rate gyroscopes to measure angular rates.

10. A method according to any ne of claims 5 to 9 further comprising the user or clinician creating the programmed exercise for the user to follow.

11. A method according to any one of claims 5 to 10 further comprising displaying in real time a target location and a user location.

12. A method according to claim 11 wherein the target location forms part of the programmed exercise and the movements of the user correlate to the user location such that the physical measurements obtained and processed are translated into displayed coordinates of the user location.

13. A method according to claim 12 further comprising the user undertaking the user exercise by attempting to keep the displayed user location, indicative of the physical measurements resulting from the exercise, as closely as possible to the displayed target location.

14. A method according to claim 13 wherein an assessment is undertaken such that no live display of the user's movement is provided to the user.

15. A method according to claim 13 or claim 14 wherein the assessment is for static balance, whereby the user attempts to maintain stationary balance over an unmoving target location on the unstable device.

16. A method according to any one of the claims 5 to 14 wherein the programmed exercise is a training exercise in which the target location is programmed as a number of holds and transitions, the holds representing a stationary target location and the transitions representing a moving target location from one position to another position.

17. A method according to claim 16 further comprising specifying the time duration of each of the holds and transitions and the speed of the programmed exercise.

18. A method according to claim 17 wherein the user or clinician creates the programmed exercise, including the hold times and/or transition times of the target location and the positions in sequence of the target location, using a graphical interface.

19. A method according to claim 18 wherein the hold times and/or transition times of the target location and the positions in sequence of the target location are manually entered into a table or positions of the target location are selected on a pictorial background using a mouse that are then entered into the table.

20. A method according to claim 19 wherein the programmed exercise is simulated such that the target locations can be viewed in sequence including any hold and transitions.

21. A method according to claim 20 further comprising providing control buttons on the graphical interface to jump to a particular target location.

22. A method according to claim 21 wherein the physical measurements, user exercises and programmed exercises followed by the user are recorded and stored, so that over a period of time observations and assessments of the user can be made.

23. A method according to claim 22 wherein a further graphical interface provides a user database, a user session statistics table and a summary statistics chart for a user session, where statistics and information on multiple users can be accessed.

24. A method according to claim 23 wherein physical measurements, user exercises and programmed exercises of multiple users are recorded and stored for later access by an authorised user and/or authorised clinician, where such access is through the internet via a username and password.

25. A method according to claim 24 further comprising displaying the physical measurements in a table or chart showing any one or more of the following characteristics: date and time of exercise; exercise type, being a training exercise or an assessment exercise; average distance of the user location from the target location; percentage of time the user location is inside the target location standard deviation of the user location from the target location; geometry of the unstable device.

26. A method according to claim 25 such that where the unstable device is a balance platform , the geometry and characteristics of the balance platform that are measured include any one of the maximum angle of the platform, the direction and tilt of the platform and the distance of the user location from the centre of the target location.

27. A method according to any one of claims 11 to 26 further comprising the user receiving audio feedback indicative of the user's position, through the user location, relative to the target location.

28. A method according to claim 27 wherein the pitch of the received audio varies depending on the distance of the user location from the target location.

29. A method according to claim 28 wherein a chime or other sound alerts the user when the user is located within the target location and a further chime or sound is audible when the user location is within a predetermined distance of the origin of the target location, which target location varies in size.

30. A method according to claim 29 wherein the audio is heard in the user's left ear when the user location is to the left of the target location and is heard in the user's right ear when the user location is to the right of the target location.

31. A method according to any one of claims 7 to 30 wherein multiple measurement devices are on or in the user's body or on an unstable device such that physical measurements from the measurement devices are simultaneously transmitted to the processor and simultaneously displayed.

32. A method according to claim 31 wherein the measurement devices are any one of pressure sensor, electromyogram sensor, motion sensor and balance sensor.

33. Apparatus for deriving physical measurements from a user undergoing a user exercise in order to assess the user, the apparatus comprising: measurement means for obtaining the physical measurements from the user; means for transmitting the measurements wirelessly or by cable from the measurement means; processing means for processing the measurements; and display means for displaying the processed measurements in real time in order to make the assessment and monitor any changes required by the user.

34. Apparatus according to claim 33 further comprising providing a programmed exercise for the user to follow in order to undertake the user exercise.

35. Apparatus according to claim 34 wherein the physical measurements are derived in real time from the user exercise and the physical measurements are processed and displayed substantially simultaneously with the programmed exercise.

36. Apparatus according to claim 35 wherein the processed physical measurements and the programmed exercise are displayed to either the user, a clinician or to both the user and the clinician, in order to compare the user's exercise and the programmed exercise as part of the assessment.

37. Apparatus according to claim 35 or claim 36 further comprising an unstable device used by the user to perform the user exercise.

38. Apparatus according to claim 37 wherein the unstable device is a balance platform or exercise ball.

39. Apparatus according to claim 37 or claim 38 wherein the measuring means is a portable measurement device fitted to the unstable device, the portable measurement device having an accelerometer for measuring movement of the unstable device in up to three dimensions.

40. Apparatus according to claim 37 or claim 38 wherein the measuring means is a portable measurement device located on the user or implanted in the user, the portable measurement device having an accelerometer for measuring movement of the unstable device in up to three dimensions.

41. Apparatus according to claim 39 or claim 40 wherein the measurement device has a magnetometer for measuring any one of pitch, roll or yaw of the unstable device or a part of the user and angular rate gyroscopes to measure angular rates.

42. Apparatus according to claim 41 wherein the physical measurements measured by the accelerometer or magnetometer are digitally converted prior to wireless or cable transmission.

43. Apparatus according to any one of claims 37 to 42 wherein the user or clinician creates the programmed exercise for the user to follow.

44. Apparatus according to any one of claims 37 to 43 wherein a target location and a user location are displayed on the display means in real time.

45. Apparatus according to claim 44 wherein the target location forms part of the programmed exercise and the movements of the user correlate to the user location such that the physical measurements obtained and processed are translated into displayed coordinates of the user location on the display means.

46. Apparatus according to claim 45 the user undertaking the user exercise by attempting to keep the displayed user location, indicative of the physical measurements resulting from the exercise, as closely as possible to the displayed target location.

47. Apparatus according to claim 46 wherein an assessment is undertaken such that no live display of the user's movement is provided to the user.

48. Apparatus according to claim 46 or claim 47 such that when the assessment is for static balance, the user attempts to maintain stationary balance over an unmoving target location on the unstable device.

49. Apparatus according to any one of claims 37 to 48 wherein the programmed exercise is a training exercise in which the target location is programmed as a number of holds and transitions, the holds representing a stationary target location and the transitions representing a moving target location from one position to another position.

50. Apparatus according to claim 49 further comprising specifying the time duration of each of the holds and transitions and the speed of the programmed exercise.

51. Apparatus according to claim 50 wherein the user or clinician creates the programmed exercise, including the hold times and/or transition times of the target location and the positions in sequence of the target location, using a graphical interface.

52. Apparatus according to claim 51 wherein the hold times and/or transition times of the target location and the positions in sequence of the target location are manually entered into a table or positions of the target location are selected on a pictorial background using a mouse that are then entered into the table.

53. Apparatus according to claim 52 wherein the programmed exercise is simulated such that the target locations can be viewed in sequence including any hold and transitions.

54. Apparatus according to claim 53 wherein control buttons are provided on the graphical interface to jump to a particular target location.

55. Apparatus according to claim 54 wherein the physical measurements, user exercises and programmed exercises followed by the user are recorded and stored in the processing means or in a database, so that over a period of time observations and assessments of the user can be made.

56. Apparatus according to claim 55 wherein the physical measurements, user exercises and programmed exercises of multiple users are recorded and stored in the processing means or in the database and accessible by an authorised user and/or authorised clinician, where such access is through the internet via a username and password.

57. Apparatus according to claim 56 further comprising a second graphical interface that provides a user database, a user session statistics table and a summary statistics chart for a user session, where statistics and information on multiple users can be accessed.

58. Apparatus according to claim 57 wherein the physical measurements are displayed in a table or chart showing any one or more of the following characteristics: date and time of exercise; exercise type, being a training exercise or an assessment exercise; average distance of the user location from the target location; percentage of time the user location is inside the target location standard deviation of the user location from the target location; geometry of the unstable device.

59. Apparatus according to claim 58 such that where the unstable device is a balance platform , the geometry and characteristics of the balance platform that are measured include any one of the maximum angle of the platform, the direction and tilt of the platform and the distance of the user location from the centre of the target location.

60. Apparatus according to any one of claims 44 to 59 wherein the user receives audio feedback indicative of the user's position, through the user location, relative to the target location.

61. Apparatus according to claim 60 wherein the pitch of the received audio varies depending on the distance of the user location from the target location.

62. Apparatus according to claim 61 wherein a chime or other sound alerts the user when the user is located within the target location and a further chime or sound is audible when the user location is within a predetermined distance of the origin of the target location, which target location varies in size.

63. Apparatus according to claim 62 wherein the audio is heard in the user's left ear when the user location is to the left of the target location and is heard in the user's right ear when the user location is to the right of the target location.

64. Apparatus according to 39 to 63 wherein multiple measurement devices are on or in the user's body or on an unstable device such that physical measurements from the measurement devices are simultaneously transmitted to the processing means and simultaneously displayed on the display means.

65. Apparatus according to claim 64 wherein the measurement devices are any one of pressure sensor, electromyogram sensor, motion sensor and balance sensor.

66. A computer program element comprising computer program code means operable to instruct a processor to undertake any of method claims 1 to 32.