Articles
Pulneo: Gamified Mobile Prototype with Acoustic Respiratory Activity Detection for Home-Based Physiotherapy
Abstract
Home-based respiratory physiotherapy requires repetition and feedback, yet many sessions are performed without direct supervision. This paper presents Pulneo, a gamified mobile prototype that detects respiratory activity on-device from acoustic signals and maps it to visual biofeedback during guided exercises. The model was trained on 69,634 balanced windows: 34,817 respiratory-activity windows from 1,061 healthy Coswara subjects and 34,817 negative windows from 5,608 UrbanSound8K files, using a group-wise 70/15/15 split with no subject or source-file overlap. On 10,347 test windows, the TensorFlow Lite INT8 model achieved 97.64% accuracy, 98.09% precision, 97.18% recall, 97.63% F1-score, and 99.65% ROC-AUC. Quantization reduced the model from 88,488 to 31,600 bytes (64.29%) while preserving 99.55% decision agreement with TFLite FP32. The application interprets the output as P(breathing) and applies a threshold calibrated on validation data (P ≥ 0.29). Pulneo does not distinguish inhalation from exhalation and has not been clinically validated; the findings support technical performance, not therapeutic efficacy. An author who is a physiotherapist with a master's degree in respiratory therapy conducted an internal conceptual review to delimit intended use, biofeedback interpretation, and safety requirements for future evaluations.
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Abadade, Y., Benamar, N., Bagaa, M., & Chaoui, H. (2024). Empowering healthcare: TinyML for precise lung disease classification. Future Internet, 16(11), Article 391. https://doi.org/10.3390/fi16110391
Bott, J., Blumenthal, S., Buxton, M., Ellum, S., Falconer, C., Garrod, R., Harvey, A., Hughes, T., Lincoln, M., Mikelsons, C., Potter, C., Pryor, J., Rimington, L., Sinfield, F., Thompson, C., Vaughn, P., & White, J. (2009). Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 64(Suppl 1), i1–i51. https://doi.org/10.1136/thx.2008.110726
Brown, C., Chauhan, J., Grammenos, A., Han, J., Hasthanasombat, A., Spathis, D., Xia, T., Cicuta, P., & Mascolo, C. (2020). Exploring automatic diagnosis of COVID-19 from crowdsourced respiratory sound data. In Proceedings of the 26th ACM SIGKDD international conference on knowledge discovery & data mining (pp. 3474–3484). Association for Computing Machinery. https://doi.org/10.1145/3394486.3412865
Chen, J., Yang, T., He, Q., Pang, M., Cao, Y., Liu, Z., Li, L., Liu, H.-I., & Bullen, C. (2025). The impact of gamified interventions on the management of chronic obstructive pulmonary disease: Systematic literature review. JMIR Serious Games, 13, Article e69510. https://doi.org/10.2196/69510
Cox, N. S., Dal Corso, S., Hansen, H., McDonald, C. F., Hill, C. J., Zanaboni, P., Alison, J. A., O’Halloran, P., Macdonald, H., & Holland, A. E. (2021). Telerehabilitation for chronic respiratory disease. Cochrane Database of Systematic Reviews, 2021(1), Article CD013040. https://doi.org/10.1002/14651858.CD013040.pub2
Davis, S., & Mermelstein, P. (1980). Comparison of parametric representations for monosyllabic word recognition in continuously spoken sentences. IEEE Transactions on Acoustics, Speech, and Signal Processing, 28(4), 357–366. https://doi.org/10.1109/TASSP.1980.1163420
Frownfelter, D., & Dean, E. (2012). Cardiovascular and pulmonary physical therapy: Evidence to practice (5th ed.). Elsevier.
Goodfellow, I., Bengio, Y., & Courville, A. (2016). Deep learning. MIT Press.
Holland, A. E., Mahal, A., Hill, C. J., Lee, A. L., Burge, A. T., Cox, N. S., Moore, R., Nicolson, C., O’Halloran, P., Lahham, A., Gillies, R., & McDonald, C. F. (2017). Home-based rehabilitation for COPD using minimal resources: A randomised, controlled equivalence trial. Thorax, 72(1), 57–65. https://doi.org/10.1136/thoraxjnl-2016-208514
Larson, E. C., Goel, M., Boriello, G., Heltshe, S., Rosenfeld, M., & Patel, S. N. (2012). SpiroSmart: Using a microphone to measure lung function on a mobile phone. In Proceedings of the 2012 ACM conference on ubiquitous computing (pp. 280–289). Association for Computing Machinery. https://doi.org/10.1145/2370216.2370261
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2015(2), Article CD003793. https://doi.org/10.1002/14651858.CD003793.pub3
Osadnik, C. R., McDonald, C. F., Jones, A. P., & Holland, A. E. (2012). Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2012(3), Article CD008328. https://doi.org/10.1002/14651858.CD008328.pub2
Oppenheim, A. V., & Schafer, R. W. (2010). Discrete-time signal processing (3rd ed.). Pearson.
Pryor, J. A., & Prasad, S. A. (2008). Physiotherapy for respiratory and cardiac problems: Adults and paediatrics (4th ed.). Churchill Livingstone.
Rabiner, L. R., & Schafer, R. W. (2011). Theory and applications of digital speech processing. Pearson.
Ravi, D., Wong, C., Deligianni, F., Berthelot, M., Andreu-Perez, J., Lo, B., & Yang, G.-Z. (2017). Deep learning for health informatics. IEEE Journal of Biomedical and Health Informatics, 21(1), 4–21. https://doi.org/10.1109/JBHI.2016.2636665
Rivas-Navarrete, J. A., Pérez-Espinosa, H., Padilla-Ortiz, A. L., Rodríguez-González, A. Y., & García-Cambero, D. C. (2025). Edge computing system for automatic detection of chronic respiratory diseases using audio analysis. Journal of Medical Systems, 49, Article 33. https://doi.org/10.1007/s10916-025-02154-7
Rocha, B. M., Filos, D., Mendes, L., Serbes, G., Ulukaya, S., Kahya, Y. P., Jakovljevic, N., Turukalo, T. L., Vogiatzis, I. M., Perantoni, E., Kaimakamis, E., Natsiavas, P., Oliveira, A., Jácome, C., Marques, A., Maglaveras, N., Paiva, R. P., Chouvarda, I., & de Carvalho, P. (2019). An open access database for the evaluation of respiratory sound classification algorithms. Physiological Measurement, 40(3), Article 035001. https://doi.org/10.1088/1361-6579/ab03ea
Salamon, J., Jacoby, C., & Bello, J. P. (2014). A dataset and taxonomy for urban sound research. In Proceedings of the 22nd ACM international conference on multimedia (pp. 1041–1044). Association for Computing Machinery. https://doi.org/10.1145/2647868.2655045
Sharma, N., Krishnan, P., Kumar, R., Ramoji, S., Chetupalli, S. R., Nirmala, R., Ghosh, P. K., & Ganapathy, S. (2020). Coswara—A database of breathing, cough, and voice sounds for COVID-19 diagnosis. In Interspeech 2020 (pp. 4811–4815). International Speech Communication Association. https://doi.org/10.21437/Interspeech.2020-2768
Shih, C.-H., Tomita, N., Lukic, Y. X., Hernández Reguera, Á., Fleisch, E., & Kowatsch, T. (2019). Breeze: Smartphone-based acoustic real-time detection of breathing phases for a gamified biofeedback breathing training. Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, 3(4), Article 152. https://doi.org/10.1145/3369835
Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D. C., Pitta, F., Sewell, L., Raskin, J., Bourbeau, J., Crouch, R., Franssen, F. M. E., Casaburi, R., Vercoulen, J. H., Vogiatzis, I., … Wouters, E. F. M. (2013). An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13–e64. https://doi.org/10.1164/rccm.201309-1634ST
Valladarez Muñoz, D. F. (2026a). Pulneo: Pipeline RAD para respiración [Código fuente]. GitHub. https://github.com/DavidValladarez95/pulneo
Valladarez Muñoz, D. F. (2026b). pulneo_app: Aplicación móvil gamificada para fisioterapia respiratoria domiciliaria [Código fuente]. GitHub. https://github.com/DavidValladarez95/pulneo_app
Warden, P., & Situnayake, D. (2019). TinyML: Machine learning with TensorFlow Lite on Arduino and ultra-low-power microcontrollers. O’Reilly Media.
Watson, J. S., Jordan, R. E., Gardiner, L., Adab, P., & Jolly, K. (2023). A systematic review of the effectiveness of interventions to promote referral, adherence, and uptake of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 18, 1637–1654. https://doi.org/10.2147/COPD.S396317
Zhantleuova, A. K., Makashev, Y. K., & Duzbayev, N. T. (2025). Optimizing MFCC parameters for breathing phase detection. Sensors, 25(16), Article 5002. https://doi.org/10.3390/s25165002