Each year, approximately 1 million people suffer a Cerebral Vascular Accident (CVA) in Europe alone, making stroke on the biggest burdens to health and social care. Improving the quality and efficiency of rehabilitation programs is one of the fundamental strategies for a better and cost-effective healthcare system.
ARCADE proposes leveraging interactive and digital technologies to create context-aware workspaces to improve physical rehabilitation practices. The project explores the use of interactive rehabilitation equipment and context- aware environments that support both physiotherapists’ and patients’ activities. This project is supported by Fundaçãoo para a Ciêcia e Tecnologia (FCT), project ARCADE: Augmenting Rehabilitation Centers with Context-Aware Digital Environments (PTDC/CCI-COM/30274/2017).
Date: Jun 24, 2019
Authors: Hugo Nicolau, Daniel Simões Lopes, Joaquim Jorge, João Guerreiro, Inês Santos
Keywords: CVA, stroke, rehabilitation, interactive technologies
We present LocomotiVR, a Virtual Reality tool designed with phys- iotherapists to improve the gait rehabilitation in clinical practice. The tool features two interfaces: a VR environment to immerse the patient in the therapy activity; and a desktop tool operated by a physiotherapist to customize exercises and follow the patient’s per- formance. Results revealed that LocomotiVR presented promising acceptability, usage, and engagement scores. These results were sup- ported by qualitative data collected from participating experts, which discussed high levels of satisfaction, motivation, and acceptance to incorporate the LocomotiVR in daily therapy practices. Concerns were related to patient safety and lack of legal regulation.
It is estimated that 55% to 75% of individuals who experience a stroke have persistent impairment of the affected upper limb (UL). It is needed to identify training strategies allied with interactive systems for retraining motor function of the UL. Virtual reality (VR), using either immersive or nonimmersive technology, seems to be one of those promising strategies. Virtual reality allows patients to have close-to-reality experiences, providing them varied, engaging, and realistic experiences. For the physiotherapist, the use of the interactive technologies is a challenge which can improve treatment adherence, allow new environments adapted to patient needs, abilities and goals, as well as different task options. The objective of this analysis was to systematically review the benefits and limitations of VR towards motor recovery of upper limb in post-stroke population. Randomised controlled trials were researched in Pubmed and PEDro databases, between January 2009 and January 2019, using the following keywords: "Virtual reality", "video games", "upper limb" and "stroke". We included articles that used immersive and nonimmersive technology in upper limb recovery after stroke, and which compared VR with others modalities We excluded all articles in which the patient received home based intervention or community rehabilitation programs. All included clinical trials had level of evidence equal or superior to 6 score, assessed by PEDro scale. Fifteen studies met the inclusion criteria. Only three studies considered immersive VR. The training of functional tasks appears to provide the greatest benefits in upper extremity function with improvements in joint range of motion, hand motor function, grip strength, and dexterity. Two studies indicated that long-term improvements persist at follow-up. None of the studies reported any significant adverse effects. There is moderate to high evidence that supports the beneficial effects of VR on stroke patient upper limb motor recovery. However, more studies are needed to determine what kind of VR systems are the most appropriate, particularly which ones may contribute or affect cortical reorganisation. It is also needed to identify the most adequate frequency, duration and intensity for the sessions.
Physical rehabilitation plays an essencial role in recovering from a stroke, but it can become repetitive and boring. We present an innovative sound-based prototype for real-time sonification of an upper limb exercise. The prototype is designed to engage stroke survivors in upper body exercises and influence their body perceptions. We ran a preliminary study with ten healthy participants to validate our sonification approach. Findings suggested that movement sonification has the potential for patient engagement and positively influences perceived body weight and capability. Moreover, the proposed approach holds promising results for future research with stroke survivors.
An uprising trend of Personal Informatics has leveraged mobile applications to help users track their wellbeing; however, these digital solutions focus on quantitative data, lacking the insights provided by qualitative data in paper notebooks. We propose to digitally augment a paper diary to allow both analogue and digital data, bridging the gap between qualitative and quantitative data tracking practices to support better awareness and reflection on health data. As a first case-study, we designed a self-tracking tool to help college students manage their wellbeing by increasing self-awareness and easing help-seeking behaviours. Next, we conducted a longitudinal study to validate the tool’s effectiveness and analyse its acceptability. Results show that our approach helped students by allowing moments of selfreflection and self-awareness. Additionally, our findings suggest that qualitative data is most useful when important events and abrupt changes to wellbeing occur. Preference for paper or digital diaries is highly user-dependent; however, most participants favoured a digital-only tool with notetaking capabilities.
The recent uprising trend of remote approaches to group physical activity has shown how these strategies lack social engagement. Following a user-centred design process grounded on the Playful Experience (PLEX) Framework’s dimensions, we developed an augmentation of video conference-based group exercise to enhance the social dynamics of high-intensity interval training. We conducted a user study (N = 12) to analyse the effect of our approach on the perceived playfulness of the experience, enjoyment, and effort of participants. Results show an increase in the PLEX Framework dimensions of Competition and Sensation. Additionally, our findings suggest positive trends in the participants’ enjoyment and effort, thus raising new design implications related to the design space of videoconference group exercise interfaces.
Health conditions, both chronic and acute, are often accompanied by disability-like impairments that might affect mobility, cognition, or perception. These impairments are often pernicious because they are difficult to isolate, vary in intensity and extent over time, and are under-investigated. Here, we make the case that solutions to these impairments are often impervious to traditional accessibility solutions and thinking, and that new solutions are needed. We present argumentation and case-studies, which build the case for a different category of impairments called ‘Health-Induced Impairments and Disabilities’ (HIID). The distinction between traditionally defined disabilities and HIIDs is essential because an understanding that this category of impairments is fundamentally different both in cause and nature affects the effectiveness of the accessibility solutions we provide. Here, we intended to outline the ’problem’ space and elaborate on the four main characteristics of HIIDs (as we see them) to provide delineation and clarity. It is the only way we can enact on robust solutions within this problem space, being: (1) Combinatorial Impairments; (2) Dynamic Impairments varying in Magnitude and Extent; (3) Impairments as a Comorbidity; and (4) Socio-Technical. We intend to outline these characteristics with third-party cases to serve as exemplars of the problems faced. We do not provide research solutions, or indeed any novel empirical evidence. Instead, we define a place for discussions to begin. Therefore, this work is better understood as a position paper or a call-to-action. We make the case that addressing the disability (caused by the underlying illness) is often ineffective; what we need to do is address the illness directly which will in turn address the disability through their transitory relationship.
There are over 80 million stroke survivors globally, making it the main cause of long-term disability worldwide. Not only do the challenges associated with stroke affect the quality of life (QoL) of survivors, but also of their families. To explore these challenges and define design opportunities for technologies to improve the QoL of both stakeholders, we conducted semi-structured interviews with 10 survivors and one of their family members. We uncovered three major interlinked themes: strategies to cope with technological barriers, the (in)adequacy of assistive technologies, and limitations of the rehabilitation process. Findings highlight multiple design opportunities, including the need for meaningful patient-centered tools and methods to improve rehabilitation effectiveness, emotion-aware computing for family emotional support, and re-thinking the nature of assistive technologies to consider the perception of transitory stroke-related disabilities. We thus argue for a new class of dual-purpose technologies that fit survivors’ abilities while promoting the regain of function.
The design of graphical user interfaces has been evolving from skeuomorph interfaces – which use elements that mimic the aesthetics and functionality of their real-world counterparts – to minimalist and flat designs. Despite the growing popularity of these new design approaches, they can be challenging for older adults who experience a decline in visual and cognitive abilities. Still, little is known about user performance, aesthetic perception, and preference of older adults, particularly in comparison to younger users and traditional skeuomorph interfaces. In this paper, we examine the performance and aesthetic perception of older (65-77 years old) and younger (20-40) adults with three design approaches: skeuomorph, skeuominimalist, and flat design. Results show flat design is either slower or less accurate than traditional skeuomorph interfaces for older adults across three tasks: visual search, identifying clickable objects, and multiple page navigation. Younger adults were less susceptible to performance differences between design approaches, but still subject to “click uncertainty” with flat interfaces. Skeuominimalism did not show clear performance benefits over flat design or skeuomorphism, while the latter reduced the performance gap between age groups. Finally, younger adults preferred the simplicity of skeuominimalism, while older adults preferred skeuomorph interfaces because of the perceived usability, beauty, and trustiness.
In this preliminary study, we propose visual biofeedback techniques for representing compensatory movements that are commonly found in upper limb rehabilitation exercises. Here, visual biofeedback is represented by stick figures adorned with different graphical elements to highlight abnormal motor patterns. We explore 4 visual biofeedback techniques for analysing movements designed for neuromotor rehabilitation of the upper limb. Co-design sessions were conducted next to 5 rehabilitation professionals. The resulting visual designs were then evaluated by 3 other physiotherapists, each evaluated the visual biofeedback of two types of compensatory movements: arm elevation-flexion and cephalic tilt. Results indicate that although there is a preferred technique, participants suggested to design a novel representation that should incorporate features from different sources, thus designing a hybrid visual biofeedback technique.