Motivating Mobility - An exploration of developing upper limb rehabilitation

technology tailored to individual stroke patients needs

A. Hughes1, J. H. Burridge1, M. Balaam2, E. C. Harris2, S. R. Egglestone3, T. Nind4, A. Wilkinson5, S. Mawson5

1University of Southampton, UK, 2University of Sussex, UK, 3University of Nottingham, UK, 4University of Dundee, UK, 5Sheffield-Hallam University, UK

Introduction and purpose Half of all patients commencing stroke rehabilitation have marked impairment of the hemiplegic arm, with only 5% of those with severe paralysis regaining useful function1. Current opinion in motor learning, reinforced by clinical evidence supports the use of repetitive movement practice, feedback and goal orientation to improve rehabilitation2-3. This study aims to motivate people to practise their rehabilitation by extending their activities using a combination of technology and interactive personal games. The multi-disciplinary team comprises physiotherapists, design engineers and computer scientists.Methods Two chronic hemiplegic stroke participants were selected via an interview and screening criteria. Ethical approval and written informed consent were obtained. Participative user centred design techniques were used over three months to assess patients’ rehabilitation aims, movement abilities and interests. Notes, photos and video were recorded using the pseudonyms “Solomon” and “Sophie”. The technology was then deployed in the participants’ homes for four weeks, with outcome measures (Fugl-Myer Assessment, Teler, Readiness to change and Motivation for Device Use, taken pre and post use (see Table 1).

Results Two prototype technologies were designed:i) A chess game in which Solomon uses his hemiplegic hand to select a piece using a pressure sensitive sensor, whilst the unaffected hand keys in the move. The therapeutic aim was to allow Solomon to repetitively practice a pinch and release grasp.ii) A device enabling Sophie, a severely impaired patient, to play with her toddler using her hemiplegic arm to guide balls down a shute. The therapeutic aim was to increase the use of her hemiplegic arm in two handed activities.

Conclusions A user centred approach enabled technologies to be designed with stroke patients which addressed their rehabilitation aims as well as their real life interests. These technologies have been successfully deployed in the home for one month with clinical outcome measures being taken before and after the deployment. Data was also collected by the system. A semi structured interview was conducted with the participants after the deployment to assess users’ perceptions of the technology.

Future Work •To address issues raised in the

interview •To adapt the technology to

reach a wider audience

References: (1) Barreca S, Wolf SL, Fasoli S, Bohannon R. Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical Review. Neurorehabil Neural Repair 2003; 17(4):220-226.

(2) Winstein CJ, Rose DK, Tan SM, Lewthwaite R, Chui HC, Azen SP. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: a pilot study of immediate and long-term outcomes. Arch Phys Med Rehab 2004; 85(4):620-628.

(3) Magill RA. Motor Learning - Concepts and Applications. 5th ed. McGraw-Hill International Editions; 1998.

This work is supported by the Engineering and Physical Sciences Research Council (EPSRC), grant no. EP/F00382X/1

Figure 1: Chess sensor technology developed for Solomon

Figure 2: Ball funnel game developed for Sophie and

child

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Diary (Written, Audio, Visual)