REPORT: PRACTICE SCHOOL 1

AMBULATORY BIOFEEDBACK
DEVICE TO IMPROVE WEIGHT-BEARING COMPLIANCE IN
PATIENTS WITH LOWER EXTREMITY ORTHOPEDIC
SURGERIES

BY
Name ID No.
Siddharth Mandar Gandhi 2019A8PS0448G

AT
YASHODA HOSPITAL
A Practice School-I Station of

BIRLA INSTITUTE OF TECHNOLOGY AND SCIENCE PILANI

1
CONTENTS PAGE NO

1. Student Details 3
2. Practice School Details 4
3. Preface 5
4. About Yashoda hospitals 6
5. Abstract 7
6. Acknowledgements 8
7. Introduction 9
8. Project Description 10
9. Project Solution 14
10. Learning outcomes 27
11. Summary and Conclusion 28
12. Reference 29

2
 STUDENT DETAILS

Name of student ID No. Discipline

Siddharth Mandar 2019A8PS0448G ENI

Gandhi

Prepared in partial fulfilment of

Practice School-I Course

AT

YASHODA HOSPITAL
A Practice School-I Station of

BIRLA INSTITUTE OF TECHNOLOGY AND SCIENCE PILANI

3
 Practice School Details
STATION: Yashoda Hospital CENTRE: Somajiguda, Hyderabad

Date of start: 31 May 2022 Date of submission: 25 June 2021

TITLE OF PROJECT: Foot-Pressure Device Development

ID NO. NAME DISCIPLINE

Siddharth Mandar 2019A8PS0448G ENI
Gandhi

NAME OF PS FACULTY- Dr. Kirtimaan Syal Sir

PROJECT AREAS- Development of microprocessor circuit for mobile app-

aided monitoring of foot-pressure to help better rehabilitation through
partial weight bearing.

Signature of Student Signature of Faculty

Date: 07/07/2022 Date:

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 PREFACE

Yashoda Hospitals is a chain of hospitals based

in Hyderabad, Telangana, India.
All of its branches are NABH  and NABL accredited. (NABH –
National Accreditation Board for Hospitals and Healthcare Provider,
NABL – National Accreditation Board for Testing and Calibration
Laboratories).

Yashoda Group of Hospitals launched Yashoda Foundation as

a Corporate Social Responsibility (CSR) initiative. Over the years, it
has been actively involved in helping orphans, raising awareness
regarding diseases, and in providing experiential learning for
students aspiring to be doctors among others

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 ACKNOWLEDGEMENTS

I would like to thank BITS Pilani for giving me this once in a

lifetime opportunity of working with such a prestigious institute
Yashoda Hospital. I would like to thank the PS division for
giving me this chance.
Special thanks to Yashoda Hospitals for giving me the
opportunity to work with them.
Special thanks to my PS instructor Prof. Dr. Kritimaan Syal Sir for
his guidance and support throughout.

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 ABOUT YASHODA HOSPITALS

- Yashoda Hospitals is a chain of hospitals based

in Hyderabad, Telangana, India.
- The best team of doctors with excellent experience and
expertise in all the specialties. Their team doctors are board
certified, experienced in wide range of subspecialties and
passionate about improving patient care. Large team available
round the clock (night and day even on weekends). Their
integrated care team ensures that the patient’s physical, mental
and support systems are working together to produce a holistic
outcome.
- They consist of a team -
G. Ravender Rao (Chairman)
Dr. G. Surender Rao (Managing Director)
G. Devender Rao (Director)
- The hospital began as a small clinic in 1989 set up by Dr G
Surendar Rao. He later teamed up with his brothers G Devender
Rao and G Ravender Rao to expand operations and start
Yashoda Hospitals. The clinic was originally started
in Madipally village, Warangal Dist., Telangana .
- Rs – 1,000 core annual turnover, and employs a workforce of
close to 10,000 people.
-

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 Abstract
We all are familiar with lower limb extremity injuries that could be
occurred well playing some sport such as football or any
orthopedics surgery or an accident.
The major problem in recovering from lower limb extremity injuries
is the patient's weight management. If the patient keeps more or
less weight, the condition can get worst or cure in a slow phase.

So, our team members are trying to create a micro process circuit
operated through a mobile app with Maximum weight bearing limit
set beforehand by the doctor. The sensors will be attached to the
area of the lower leg responsible for bearing weight while walking.
The role of the sensor is to detect the amount of extra weight put
through the injured part and display a warning on the connected
mobile.

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 INTRODUCTION

-In post-surgery physiotherapies to accelerate the healing process

of the injury the partial weight bearing (PWB) is the most common
method practiced and the treatment period is minimum of 6-8
weeks.

-There are stages in PWB process for instance no weight

application for the first 2 weeks then 25 percentage of weight
bearing in 2-4 weeks and following increase of weight gradually.

-For accurate partial weight bearing, our project helps the patient
and the doctor to set perfect weight bearing for accurate and fast
results.

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 PROJECT DESCRIPTION

Problem faced: -
-In the PWB process, generally it is associated with two problems
1- Application of more weight than the threshold. (May cause
severe extra damage to the fractured bone and leads to
unbearable pain to the patient)
2- Application of less weight/No weight than the threshold. (May
cause the fractured bone and supporting muscles to regrow brittle
and weak respectively.)
*Threshold weight: Desired amount of weight the patient has to
apply to the fractured leg prescribed by the physiotherapist.

Anatomy and physiological aspects of the leg: -

Bones

-The two main bones of the leg are the tibia (‘shin bone’) located
medially and the fibula, which is located more laterally.

-The tibia is the largest of the two, hence it is responsible for weight-
bearing.

-Two joints hold the tibia and fibula together (the superior and
inferior tibiofibular joints), as well as an anatomical structure called
the interosseous membrane.

-First is the femur, the bone in your upper leg, which is the longest
bone. People who fracture this bone usually need surgery. The
other two bones are in your lower leg- the shin bone or tibia and
the smaller bone, the fibula.
(Fractures of the tibia or fibula require a period of
immobilization to allow the bone.)

Muscles

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The leg is divided into three compartments: anterior, posterior, and
lateral. The anterior muscle group includes the tibialis
anterior, extensor hallucis longus, extensor digitorum longus, and
fibularis/peroneus tertius. 

Nerves and vessels

-The main arteries supplying the leg with oxygenated blood are the

anterior and posterior tibial arteries together with their branches.

-The posterior tibial artery gives off a crucial branch called the

fibular/peroneal artery which mainly supplies the muscles of the
leg.

-The tibial arteries originate from the popliteal artery. When it

comes to important veins of the leg; the small/short, and the
great/long, saphenous veins provide superficial drainage.

-The former opens into the femoral vein, while the latter into the
popliteal vein. The deep veins of the leg are named fibular and
tibial, with the tibial also finishing in the popliteal vein.

-In terms of innervation, the leg receives it via the common

fibular/peroneal, tibial, and saphenous nerves.

-The first two are branches of the sciatic nerve while the latter
stems from the femoral nerve. These three nerves divide further to
supply the various structures of the leg.

Sensations

-Lower limb sensory system

-The sensory modalities

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1 Light touch

2 Sharp touch (pinprick)

3 Temperature

4 Joint position sense (proprioception)

5 Vibration sense

6 2-point discrimination

(We have to see if the patient reports hypoesthesia (feels blunter)

or hyperesthesia (feels sharper) during these sensory modalities)

Patterns of weight distribution under the metatarsal heads: -

-After going through some research papers, we got through a

research paper which tells the relationship between the foot
pressure – and weight distribution.

-This was useful for our team members for making sensors for our
project model.

 There is no significant difference between men and women or

between right and left feet.
 In general, the second to fourth MTHs (Metatarsal heads)
carry higher forces (p < 0.01) than the first head and higher
pressures than the fifth (p < 0.001).
 Of the 720 feet tested, we found a transverse arch in 22 (3%)
with pressures at the first and fifth MTHs higher than under
the second to fourth MTHs

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 Force at the MTH of asymptomatic
volunteers during the stance phase.

t-pressure map and

ht ‘masks’ or zones
the analysis .

13
 PROJECT SOLUTION

We are interfacing a 40 Kg load cell to the NodeMCU ESP8266

using the HX711 Load cell amplifier module. HX711 is a precision
24-bit analog to digital converter (ADC) designed for weighing
scales and industrial control applications to interface directly with
a bridge sensor. The HX711 load cell amplifier is used to get
measurable data out from a load cell and strain gauge.

The electronic weighing machine uses a load cell to measure

the weight produced by the load, here most load cells are
following the method of a strain gauge, which converts the
pressure (force) into an electrical signal, these load cells have
four strain gauges that are hooked up in a Wheatstone bridge
formation.

We will make a Weighing Scale Machine which can measure

weights up to higher-value like 40KG. We need to calibrate the
load cell and find the calibration factor. Once the calibration is
done, we can include that factor in our code. Thus, this will make
the scale precise and accurate. The greater the mass the greater
the error. So, we will try to remove the error from the

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weighing scale. We will finally display the measured weight in the
16x2 I2C LCD Display. We will send the obtained weight value on
the IoT Cloud platform called Blynk Application. Thus, weight can
be monitored from any part of the world simply by observation on
the Blynk app dashboard.

Load cell and HX711 Module.

-load cell

A load cell is a type of transducer, specifically a force transducer.

It converts a force such as tension, compression, pressure, or
torque into an electrical signal that can be measured and
standardized. As the force applied to the load cell increases, the
electrical signal changes proportionally. Load cells are used to
measure weight.

-HX711 Module

The HX711 Dual-Channel 24 Bit Precision A/D weight Pressure

Sensor Load Cell Amplifier and ADC Module is a small
breakout board for the HX711 IC that allows you to easily read
load cells to measure weight. By connecting the module to your
microcontroller, you will be able to read the changes in the
resistance of the load cell and with some calibration.
You’ll be able to get very accurate weight measurements.

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 The HX711 Weighing
Sensor uses a two-wire interface (Clock and Data) for communication.
Any microcontroller’s GPIO pins should work making it easy to read data
from the HX711

-Circuit: IOT Weighing Scale with HX711 Load Cell & ESP8266

Here is a circuit diagram for interfacing 40KG Load Cell and HX711
Module with NodeMCU ESP8266 12E Board

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17
The connection between Load Cell & HX711 has been explained
above. Connect the DT & SCK Pins of Load Cell to ESP8266 D5
& D6 Pins respectively. I have used a push-button tact switch to
reset the weight to zero. Push-button Switch is a connected
digital pin D4 of ESP8266. I used a 16X2 I2C LCD Display to
minimize the connection. So, connect the SDA & SCL pin of I2C
LCD Display to D2 & D1 of Nodemcu respectively.

-PCB Gerber File

The PCB Board for the IoT Based Weighing Scale is designed using
EasyEDA online Circuit Schematics & PCB designing tool.

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-Program to Calibrate the Load Cell

After connecting the load cell as above, we need to calibrate it

first before going for the final design. So first calibrate the whole
assembly unit. We need to add the HX711 library to make the
code compile.

Here is a copy of the code -

#include "HX711.h" //You must have this library in your arduino library folder

#define DOUT 2
#define CLK 3

HX711 scale(DOUT, CLK);

//Change this calibration factor as per your load cell once it is found you may need to vary it in thousands
float calibration_factor = -109525;
//-109525 worked for my 40Kg max scale setup

//=============================================================================================
// SETUP
//=============================================================================================
void setup() {
Serial.begin(9600);
Serial.println("HX711 Calibration");
Serial.println("Remove all weight from scale");
Serial.println("After readings begin, place known weight on scale");
Serial.println("Press a,s,d,f to increase calibration factor by 10,100,1000,10000 respectively");

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 Serial.println("Press z,x,c,v to decrease calibration factor by 10,100,1000,10000 respectively");
Serial.println("Press t for tare");
scale.set_scale();
scale.tare(); //Reset the scale to 0

long zero_factor = scale.read_average(); //Get a baseline reading

Serial.print("Zero factor: "); //This can be used to remove the need to tear the scale. Useful in permanent scale projects.
Serial.println(zero_factor);
}

//=============================================================================================
// LOOP
//=============================================================================================
void loop() {

scale.set_scale(calibration_factor); //Adjust to this calibration factor

Serial.print("Reading: ");
Serial.print(scale.get_units(), 3);
Serial.print(" kg"); //Change this to kg and re-adjust the calibration factor if you follow SI units like a sane person
Serial.print(" calibration_factor: ");
Serial.print(calibration_factor);
Serial.println();

if(Serial.available())
{
char temp = Serial.read();
if(temp == '+' || temp == 'a')
calibration_factor += 10;
else if(temp == '-' || temp ==
'z') calibration_factor -= 10;
else if(temp == 's')
calibration_factor += 100;
else if(temp == 'x')
calibration_factor -= 100;
else if(temp == 'd')
calibration_factor += 1000;
else if(temp == 'c')
calibration_factor -= 1000;
else if(temp == 'f')
calibration_factor += 10000;
else if(temp == 'v')
calibration_factor -= 10000;
else if(temp == 't')
scale.tare(); //Reset the scale to zero
}
}

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Once we upload the calibration code, open the serial monitor and adjust your scale
factor with known weight until you see the correct readings. We can press a,s,d,f to
increase the calibration factor by 10,100,1000,10000 respectively and we can press
z,x,c,v to decrease the calibration factor by 10,100,1000,10000 respectively.

Once we see the placed weight is the same as shown weight, note down the
calibration factor and use it in the final code for Weighing Scale.

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-Setting Up Blynk IoT Application for Remote Weight Monitoring

Blynk is an application that runs over Android and IOS devices to

control any IoT based application using Smartphones. It allows you
to create your Graphical user interface for IoT applications. Here we
will set up the Blynk application to monitor Measured Weight over
Wi-Fi using NodeMCU ESP8266.

So we create a gauge and value display. We will get an Authenticate ID

on registered mail. Save the Authenticate ID. We will need to enter this
on code.

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-Source Code: Weighing Scale with HX711 Load Cell & ESP8266
on Blynk

#include <ESP8266WiFi.h>
#include "HX711.h"
#define BLYNK_PRINT Serial
#include <Blynk.h>
#include <BlynkSimpleEsp8266.h>
#include <Wire.h>
#include <LiquidCrystal_I2C.h>
LiquidCrystal_I2C lcd(0x27, 16, 2);
#define BLYNK_PRINT Serial

const char *ssid = "Alexahome"; // replace with your wifi ssid and wpa2 key
const char *pass = "12345678";
char auth[] = "hePTG-hzhuAzU2h59R90SjQUc98u2Kpb"; // Auth Token in the Blynk

App. WiFiClient client;

HX711 scale(D5, D6);

int rbutton = D4; // this button will be used to reset the scale to 0.
float weight;
float calibration_factor = -101525; // for me this value works just perfect 419640

void setup()
{
Serial.begin(115200);
pinMode(rbutton, INPUT_PULLUP);
scale.set_scale();
scale.tare(); //Reset the scale to 0
long zero_factor = scale.read_average(); //Get a baseline reading
Blynk.begin(auth, ssid, pass);
Wire.begin(D2, D1);
lcd.begin();
lcd.setCursor(6,0);
lcd.print("IOT");
lcd.setCursor(1,1);
lcd.print("Weighing Scale");
delay(3000);
lcd.clear();

lcd.print("Connecting Wifi");

WiFi.begin(ssid, pass);
{
delay(1000);
Serial.print(".");
lcd.clear();
}

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 Serial.println("");
Serial.println("WiFi connected");
lcd.clear();
lcd.print("WiFi connected");

delay(2000);
}

void loop()

Blynk.run();
scale.set_scale(calibration_factor); //Adjust to this calibration factor

weight = scale.get_units(5);

lcd.setCursor(0, 0);
lcd.print("Measured Weight");
lcd.setCursor(0, 1);
lcd.print(weight);
lcd.print(" KG ");
Blynk.virtualWrite(V3, weight);
delay(2000);
lcd.clear();

Serial.print("Weight: ");
Serial.print(weight);
Serial.println(" KG");
Serial.println();

if ( digitalRead(rbutton) == LOW)
{
scale.set_scale();
scale.tare(); //Reset the scale to 0
}

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Results & Observations

➢ When no weights are placed the Display will show the weight
almost equal to zero.
➢ When some weights are placed the Display will show the weight
almost equal to
the weight of the object.
➢ Now we can power on your Blynk Application and you will see
the changes in weight parameters both in label display as well
as gauge.

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-About Flutter
It’s a cross-platform tool intended for creating Android and iOS
apps from a single code
base by using a modern, reactive framework. Flutter apps are built
using Dart, a simple
object-oriented programming language. The central idea of Flutter
revolves around
widgets. The entire UI is made of combining different widgets, like
a button or menu, a
font or color scheme, a layout like padding, and so on. Flutter
provides its ready-made
widgets that look native either to Android or iOS apps. Some
features and qualities of the flutter are high productivity, fast and
simple development, and compatibility with open-source platforms.
-Progress
Since we have less knowledge about app development and UI
designing, we are in the learning process of the required skills and
are at a good pace of developing those skills and putting them into
practice. I am also following some tutorial videos and employing my
ideas and imagination to make them better and more elegant.
There are some of the app references I came across while I’m
surfing the web which is very similar to our project. So we also
need to come up with our ideas and creatively put them. We have
researched enough about our project and its background to
understand better and proceed further. After enough meetings and
discussions, we started with the app part of the project and wrote
basic code for the app
Basic dart code
Now, we need to develop a homepage for our app and add
necessary things to it, and also make it look good for the users. I
removed the redundancies I found in our code to make it more
efficient with less code. We haven’t added the firebase verification
and login page to the app, as our thought is to differentiate the app
between physiotherapists and patients, so we need to come up
26
with an idea for the login page for different users which again will
differentiate the main app as a physiotherapist will have more
features than the patient such as setting the threshold weight,
which the patient might not know at some times in particular. Here
is the dart code of the home page app.
Home Screen Dart code
And some snapshots of the app taken while testing the code.
Screenshots of the App
The interface of the app has almost completed, there are some
parts left with the frontend part such as the login page and adding
some extra options, and the backend part of the app has not yet
started such as management and storage of the data, analyzing
the data, connecting the app with the electronic device for data
input and output feedback

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 Learning Outcomes

● Researched upon the Load cell transducer and HX711

Module.
● Learned about transducers and their types.
● Learned about Analog to Digital converter (ADC).
● Learned to develop PCB Gerber file and build the PCB
Board for the IoT Based Weighing Scale using EasyEDA online
Circuit Schematics & PCB designing tool.
● Learned to create interfaces using the Blynk application.
● Learned the code in the HX711 library.
Build the calibration code to set the calibration
factor.

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 SUMMARY & CONCLUSION

Keeping in mind our aim of the project and the problems

associated with it, we have to process further with our plans, and
also, we must seek help from our PS faculty mentor and
industry/hospital mentor for our process to be efficient. We are
ready with the basic part of the app, the homepage and interface of
the app, for which we need to add some extra features and have to
start with the backend of the app which is an important task to do
and there will be many more challenges while implementing it as
there will be debugged in the code and should remove the
redundancies. The research part of this project has been done by
all our group members and we are into implementing them in real
life.
Thus, we made some progress in this project and learned many
new things through the course of the Practice School program
which helped us in developing skills required by the MNCs and
organizations in the real world.

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 References
1. https://www.yashodahospitals.com/

2. https://www.yashodahospitals.com/specialities/orthopaedic-hospital-in-hyderabad/

3. https://www.healthgrades.com/right-care/bones-joints-and-muscles/orthopedic-
conditions, Orthopedic Conditions by Sarah Lewis, PharmD
4. Lower Limb Conditions by R. L Huckstep
5. https://www.infoworld.com/article/3224868/what-is-kotlin-the-java-alternative-
explained.html
6. Patterns of weight distribution under the metatarsal heads by E. J. Luger, M. Nissan, A.
Karpf, E. L. Steinberg, S. Dekel
7. https://www.sciencedirect.com/science/article/pii/S1877705816306531/pdf?
md5=d4c327dd3d14620572ea63f8d07aeca8&pid=1-s2.0-S1877705816306531-main.pdf
by Tkachenko Bril A.1 *, David V.1 , Scherer M.1 , Jagos H.2 , Kafka P.1 , Sabo A.1
8. https://api.flutter.dev/flutter/widgets/ListView-class.html
9. https://getstream.io/chat/docs/flutter-dart/?
utm_source={google}&utm_medium={cpc}&utm_campaign=GOO|S|NB|IN|ALL-EN|Core
%26utm_adgroup=DSA%26utm_custom%3D16899291777%26utm_content
%3D593073241663%26utm_term%3D%26matchtype=%26device=c
%26location=1007743&_bt=593073241663&_bk=&_bm=&_bn=g&gclid=CjwKCAjwq5-
WBhB7EiwAl-HEkikc0yhmOwSWxeulcDfo_YJ7VWpBdHyl-
6bfoivGB2c3Cid5QMYwKRoCLWIQAvD_BwE
10. https://www.geeksforgeeks.org/flutter-tutorial/

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