moxxi thesis dissertation

Facilitating physical rehabilitation in the home through inclusive design

by

Fabiola Einhorn

A thesis submitted to the faculty of Parsons The New School for

Design, in partial fulfillment of the requirements for the degree of

Master of Fine Arts in Design and Technology

Katherine Moriwaki & Andrew Zornoza Thesis Studio, Spring 2015,

Melanie Crean & Ethan Silverman Thesis Studio, Fall 2014

Thesis production website:

www.moxxirocks.com

TABLE OF CONTENT

KEYWORDS

ABSTRACT

CONCEPTUAL FRAMEWORK

PHYSICAL REHABILITATION IN THE AGE OF ROBOTICS

PROTOTYPING & USER TESTING / PHASE I

Deconstruction > Construction

Facilitating Consistency Through Haptics

How Kinetics Pertain to an Animate Object

Duration & Empathy

Real-time Feedback

01-01

01 -01

01 -02

03 -09

10 -16

11 -11

12 -13

14 -14

15 -15

16 -16

THE AESTHETICS OF USE

PROTOTYPING & USER TESTING / PHASE II

Health is Balance

Positive / Negative Form

A Physical Data Visualizartion

Testing with My Users

FINALIZING THE FORM

CONCLUSION

BIBLIOGRAPHY

ATTACHED DOCUMENTS

Task Analysis

User & Physical Therapist Questionnaire Responses

Sketchbook

17 -26

27 -36

28 -28

29 -29

30 -30

31 -35

36-42

43-44

45-48

49 -62

49-51

52-62

63-64

ABSTRACT

KEYWORDS

Moxxi is a simple, intuitive, animated

rehabilitation sculpture designed to help

primarily the elderly and disabled going

through physical rehabilitation in the home.

Available for rent from a physical therapist or

available for purchase, Moxxi tracks your

exercises and stimulates mirror neurons by

performing the exercises with you. If the user

has not performed their required exercises for

the day, Moxxi will get eager to move in the

presence of the user as a non-obtrusive

reminder. As different weight classes are

exchanged at the users therapist office, a vast

number of upper extremity and torso

strengthening or range of motion exercises are

supported. Most importantly - designing

inclusive and empathetic medical devices for

the home that can be part of your interior

decoration, facilitates communication with

caretakers and helps turn a patient’s home into

a person’s home.

01

Connected health, empathy, aesthetic usability

effect, user experience design, product design,

volition, physical therapy, telerehabilitation,

inclusive design, therapy aids, wellbeing,

affective computing, 3d printing,

empowerment informatics, robotics,

kinetics, psychology.

CONCEPTUAL FRAMEWORK

A person with a physical disability typically

feels entrapped due to restrained impact on

their direct environment, and having some of

their abilities taken away from them greatly

effects their independence. The aftermath of

an injury is mentally extremely burdensome,

and this is fortified by the constant action that

physical rehabilitation requires. Being a

caretaker myself, I have witnessed the

hardships tied to this constant struggle. If you

were to think of rehabilitation as an algorithm,

deconstruction of the body is the dominant

value - constantly working to deconstruct

what you have been working so hard on to

construct. Hence, time works against you. If

you are passive in the process, the body will

deteriorate. Fast recovery for the elderly is

especially crucial, as they are more prone to

secondary complications due to their physical

state. Moreover, experiencing persistent illness

often results in people’s self concept

becoming tied to either the past or the

present. This is not surprising, as the present

becomes very monotone, and joyful

conversations in the home easily get shaded

over by caretaker’s concern about medical

conditions. This paper explores the ways in

which kinetic movement through an object

can help motivate, provide companionship and

be a logistical aid through your rehabilitation

plan, in order to make room for more positive

energy.

02

PHYSICAL REHABILITATION IN THE AGE OF ROBOTICS

For six years I have been a caretaker and

witness of my mother being bound to bed,

physically trapped in her own body. She is

merely one of the millions of people around

the world that has woken up after a serious

injury, infection or stroke with little or no

mobility due to inactivity of the neuromuscular

system. Through the process, I realized that

one of the main reasons my mother didn’t

recover as quickly as expected was the lack of

motivation to perform her exercises.

Conversation in the home turned to nagging,

and health practitioners have confirmed that

patients most commonly report the same

problem. Spinal cord injury is one of the most

common reasons for disability, of which more

than 88 percent rehabilitate in the home. So

how can we help people empower their own

rehabilitation and in hand alleviate much of

03

the stress that caretakers go through? As

patients are reimbursed earlier from the

hospital, it is vital to bring a more holistic

healthcare practice that considers the

aftermath of injuries into the home. Most of

these patients face depression and are often

very reliant on caretakers and physical

therapists constantly checking in on them.

Closely monitored care becomes difficult to

attain as only about half of the patients have

health insurance that covers this. As over 18

million Americans have physical disabilities

making them the second largest minority, it

becomes evident how many people struggle

with rehabilitation in isolation. Most of these

people are over 65 years old, as one in five

typically have immobility issues. The elderly

represent the fastest growing segment of the

American population, making this issue

foreseeable at a greater scale. Moreover, this

user group is often overlooked when it comes

to design innovation.

I strongly believe that technology and design

has the ability to facilitate these often tedious

recovery plans, and moreover make the

experience more joyful. Healthcare products

have traditionally been designed with

aesthetics being secondary to functionality.

There is a lack of assistive devices today

demonstrating a clear awareness of the

contextual milieu that an immobile person

lives in. 40% of healthy consumers with

exercise machines use them much less than

expected; they often collect dust rather than

help improve muscle structure. The Kettlebug,

a micro-controller with tracking capabilities is

one of the few examples tackling this problem,

by detaching the electronic components so

that one can potentially use it for any device.

However, current telerehabilitation devices are

exceedingly focused on screen based

interactions, and generally only tackle one

specific muscle group at a time. There is a

04

clear lack of aids that are small, aesthetically

pleasing and help guide you through more

than one specific type of exercise. The

psychological and empathetic aspects of the

user experience with these devices has clearly

been neglected. Hence, I see it as my duty to

leverage my personal experiences with

physical disability and my background as a UX

researcher in advertising, to design better

experiences for the people that need these

types of technological aids the most.

Lygia Clark has been inspirational in terms of

her psychotherapeutic methodologies using

art as a vehicle to bridge the mind and the

body. This is a vital aspect of recovery as the

body has debilitatingly been broken down into

separate entities in traditional medicine since

the early 1800’s. Clark developed a

psychotherapeutic methodology she called

the “structuring of the self”, which she would

practice in private with her clients in order to

break the frontier between the body and the

object. Her work exemplifies how I would like

to use technology and the power of the object

in order to enhance the capabilities of the

mind through therapeutic practices. As one of

my main goals is to help facilitate physical

rehabilitation by treating a person from a

holistic point of view, it is paramount to

consider the psychological and physiological

aspects of care in parallel. Thad Starner’s

Mobile Music Touch demonstrates a step

forward in taking advantage of the brains

ability to heal quicker through passive haptic

feedback and visual cues. He developed a

glove that uses vibration motors to indicate

which keys on the piano to touch when

playing a simple tune. After only 30 minutes of

wearing, users were able to play a song they

never could play before. His team is currently

testing how this device can help people with

tetraplegia regain control and sensation in

their hands.

05

There is clear evidence that the brain has a

greater ability to heal than previously thought,

and that the activation of mirror neurons

indeed help speed up recovery even post the

critical stage of recovery, which is typically six

months. As Moxxi is designed to perform the

exercises with you and visually mimics your

movements, Moxxi presents great

opportunities for more efficient recovery

through the activation of mirror neurons. This

function not only makes the exercises more

fun and affords greater social attribution, but

presents vast opportunities in helping patients

diagnosed with stroke, meningitis and other

neurological deficiencies or even autism to

recover much more rapidly. Moxxi is designed

with the elderly in mind, but its function and

aesthetic invites even children to engage in

the rehabilitation practice in a more joyful

manner.

Research has shown how physical

embodiment of an object rather than virtual

fosters greater social engagement when

performing tasks. A study entitled “The

Benefits of Interactions with Physically Present

Robots over Video-Displayed Agents” by

students at Yale, showed clear results favoring

physical interaction when studying the impact

of a robot’s co-location on interactions

requiring trust and respect. Particularly

interesting were the results pertaining to a test

where the robot would assign an “unusual

task” to the participants in order to gage trust.

The robot would urge participants to throw a

book in a garbage can, and reaction times

were measured. Twelve participants

interacting with the physically embodied robot

placed the books in the garbage can, while

only five participants in the live-video and

augmented-video condition placed the books

in the garbage can. The study features

comprehensive data of a total of 59

06

participants, and their familiarity with robots

and technology was ranked low. The study

also points out that lonely people have been

observed to prefer interacting with a physically

present object. This is important to note, as

the elderly are at higher risk of feeling lonely

and often face post traumatic depression after

an injury. These findings clearly suggest how

beneficial physical presence can be in the

context of rehabilitation, yet there are so few

examples of products offering this currently on

the market.�One reason for this is cost. There is

a strong tendency to design robots with

evident anthropomorphic qualities, as multiple

studies like the one mentioned above show

results in favor of these compared to virtual or

screen based robots. Paro, an interactive robot

designed to provide the benefits of animal

therapy, cost $15 million to develop. Taizo [1],

one of the few robots designed to help the

elderly with calisthenics routines specifically,

has an eerie appearance and costs $8,000

1 07

[1] Taizo, a robot designed to lead exercises for the elderly.

apiece. Other service robots like Twendy-One

[2], Cosmobot or Autom all share similar

aesthetic qualities. The overarching problem

we are facing here is that the great majority of

these studies all include robots with clear

human-like features, and there is a lack of

documentation considering aesthetics and

mental wellbeing in the user testing phases.

I would like to argue that objects do not need

apparent anthropomorphic qualities to offer

greater social engagement and trust. Rather,

the inherent function of the object and its

movement is essential to how it is

experienced. Humans have since ancient times

associated movement with life, and an object

does not need to have eyes, arms or a mouth

to signify that it has decision making

capabilities to its user. Rosalind Park, one of

the pioneers of affective computing,

points out how

“Rehabilitation counselors, pastors, parents, and politicians know that it is not laws that exert the greatest influence on people but rather the drumbeat to which they march.”

08

I would like to see more studies exploring the

intersection of the medical realm and affective

computing, as many medical aids border the

line of the Uncanny Valley. Taking a step away

from anthropomorphic designs would also

allow costs to go down. Moxxi exemplifies a

way in which these features can be embodied

in a cheaper design, without the introduction

of a creepy human-like robot that

stigmatizes its use.

[2] Twendy-One, a human-symbiotic-robot designed for sitting-up motion support and grabbing items.

09

PROTOTYPING & USER TESTING / PHASE I

The following prototypes aim to validate

conceptual means and explore how

movement can be gratifying in the context of

performing exercises. By using a case study

approach in combination with empathetic

design methodologies, each prototype aims to

answer a specific question.

10

Deconstruction > ConstructionWhether you are going to the gym to build up

your body or staying in your home to re-build

it, the core concept is the same;

deconstruction is the dominant value. One

small step forward can quickly regress twice as

fast when not maintained, which I

hypothesized is the root cause for much of the

frustration experienced by my user. To

demonstrate this and to test how well people

identified with this notion, I created a writing

application with Processing that slowly erases

the letters that you have been typing on a

blank canvas[3]. This allowed me to test how

well I was able to isolate the problem and

communicate the conceptual framework

across multiple platforms and audiences. I

asked people to write about their thesis

statement, and the responses gathered after

seeing the text slowly disappear in front of

their eyes ranged from “this is very sad” to “it

makes me angry”. This prototype allowed me

to be more open with my user testing

strategy, as finding participants in my primary

target user group has been difficult due to

liability issues. Moreover, investing in the

resources to do so at this early stage is usually

not profitable. The common denominators

between a healthy user’s struggles to improve

physically and a physically hindered person’s

issues overlap enough to test certain aspects

of my mechanism’s functionality.

11

Facilitating Consistency Through HapticsTiming and repetition are crucial aspects, as

my research has shown that patients most

often report problems remembering to

perform the exercises as well as sticking with

the proper pacing and form through their

repetitions. Thus, I created a wearable that

goes on your elbow with a flex sensor

measuring the amount of times that you bend

the joint when doing a bicep curl[4]. As

consistency in psychical therapy is paramount,

I wanted to provide feedback through haptic

vibrations in order to notify the user when the

exercises were done right. By adding a timer

and counter, I was able to give different

vibrational feedback depending on the

intervals of the bicep curls. A good pace for

performing a set of 10x3 bicep curls lies

between 30-35 seconds. After 10 bicep curls

are executed, the user gets a long vibration

[3] Deconstruction>Construction prototype.

12

when the exercises are done right, two short if

they are done too fast, and two long if done

too slow. Secondly, I used origami with muscle

wire that contracts and expands according to

the current running through the thread in

order to simulate kinetics in an easy way.

When the set of 10x3 exercises were done, the

basic origami shape would jump. By asking

people to fill out a questionnaire before and

after as well as seeing them interact with the

device, I was able to gather that movement

indeed seemed gratifying. However, the

origami did not move extensively and most

users responded positively to the haptic

feedback, not the movement. In fact, all four

of my test subjects confirmed that haptic

feedback was useful in guiding them through

the exercises. These findings lead me to

investigate this notion more accurately

through my second prototype, which

demonstrated more kinetic capabilities.

[4] Origami, circuit breadboard with Arduino Micro, flex sensor, vibration motor and wearable.

13

How Kinetics Pertain to an Animate ObjectThis time I amplified the kinetic movement in

order to better understand how a design can

have presence through an interaction[5]. I

wanted to test my hypothesis; if an abstract

set of rectangular shapes would be enough to

provoke feelings of anthropomorphism, and if

so how effective this would be. Using the

same methodology as above, I was able to

gather that the object was indeed very

rewarding, and that people did treat it as “a

living thing”. However, users reported they

would have liked to see more real-time

feedback, and the flex sensor as a wearable

was uncomfortable and redundant.

[5] User test with kinetic object and resistance band.

14

Duration & Empathy

In my opinion, good design stems from

empathy. So the next natural step was to put

myself in my users situation to the greatest

extent that I possibly could. I challenged

myself to be my own observer in an

empathetic design probe, where I emotionally

detached myself from my legs for one full

day[6]. I aimed to put myself in the situation of

someone that has T9-T12 spinal cord injury,

which typically means that you have good

control of your upper body, but no control or

sensation in your legs. Although I have

witnessed my mother being bedridden for

over six years, the insight that I gained during

these twelve hours were invaluable to my

design approach. I found myself losing

perception of time as I was physically confined

to this one space. I also felt helpless, and

experienced stiffness in my legs much quicker

than expected. This lead me to incorporate

range of motion exercises in my next

prototype, as I experienced how crucial

stretching and simply moving around to

stimulate blood circulation is to our wellbeing.

But more importantly, how can I break up this

monotony? Although I could feel the stiffness

in my legs, I didn’t feel inspired to perform my

exercises. Rather I wanted to immerse myself

in something more escapist. So how can visual

and kinetic cues inspire my user to move?

[6] Durational prototype. In this still image I am getting help going to the restroom.

15

Real-time Feedback

With these aspects in mind, I wanted to nail

down the pure functionality and user

experience that such a device needs in order

to be effective. The findings above lead me to

consolidate my design into one contained

object. I created a 3D printed dumbell that

gives you real time visual as well as haptic

feedback in accordance to how timely you

have performed your routine. Incorporating a

gyroscope also allows my user to see if they

are holding the proper form. This way I am

able to test the pure functional aspects of such

a device without worrying about the

emotional aspects getting in the way of results

and vice versa[7].

[7] The dumbell lights up when the user has reached the outer limit of their repetition, and haptics give the user feedback on form.

16

1

THE AESTHETICS OF USEOver the winter holiday I brought my thoughts

and most recent prototypes to the

rehabilitation clinic where my mother currently

resides. The reality of a hospital environment

kicked in fast, and numerous valuable

conversations with physical therapists, other

patients as well as my mother quickly made

me realize how I needed to simplify my

project. My ambitions were over the roof,

wanting to create a modular system that

would adapt to almost any condition. I caught

myself attempting to be everything for

everyone - something common in the realm of

inclusive design. However, adding too much

functionality most often hinders beautiful and

functional design. Inclusive or universal design

has many contradicting principles, and I found

Graham Pullin's book "Design meets Disability"

useful in helping to sort out some of these

conflicts. Not only does the book have a

17

myriad of good examples, but he also suggests

a new approach to inclusive design, one that

very closely resembles my goals with Moxxi:

For we are all disabled somehow ...

"I would like to propose the term "resonant design" for a design intended to address the needs of some people with a particular disability and other people without that disability but perhaps finding themselves in particular circumstances. So this is neither design for just able-bodied people nor

design for the whole population; nor even does it assume that everyone with a particular disability will have the same needs. It is something between these extremes, not as a compromise, but as a fundamental aspiration".

18

At this point I needed to re-focus on the main

objectives of my thesis and what I strongly felt

needed to be worked on in the realm of

medical design. How might we�help our user

stay motivated through an affective kinetic

object? How can systems design and visual

mapping help a user stay consistent with their

form, pace and timing? How might we create a

positive form that does not have medical

connotations and feels like a companion to the

user? And last but not least, how can we offer

an externalization of stress through this

emotionally difficult time? Moxxi has

important tracking capabilities, but as devices

today already demonstrate the capabilities of

performing such tasks successfully in a

medical setting, the design aspects of Moxxi

are paramount. Naoto Fukasawa's philosophy

regarding designing products that require no

thought is highly relevant to my design, as

such a product truly allows for cognitive

inclusion. His Muji CD player is a classic

example of this, as the affordance and

mapping of the product intuitively invite the

user to pull the string in order to get the CD

spinning [8]. Moxxi similarly uses the familiar

form of a weight, to allow the affordance of

picking it up.

[8] Naoto Fukasawa’s Muji CD player.

19

"Fluidtime", a time piece by Crispin Jones and

Michael Kieslinger at the interaction Design

Institute of Ivrea, demonstrates our events

based perception of time and proposes an

alternative. This is crucial, as exercising

requires breaking up the habits my user

currently has in place. Moxxi is designed to not

be a distraction, simply indicate the users state

in a subtle manner. As Moxxi moves in the

presence of the user if they have not

performed the required exercises for that day,

Moxxi serves as an environmental reminder.

Pullin states in his book:

"In Fluidtime, the movement of an abstract object on the wall of the design studio reflected the progress of a communal

washing machine in the laundry block - meaningful if you knew what to look for, but otherwise discreet. Only when the washing cycle had finished and the machine was free for the next person to use did the display unfurl an array of bright blue ribbons. It was "Designed to be unobtrusive until it had significant information to impart".

20

With this in mind, Moxxi is in a sense a useful

and metaphorical indication of time in relation

to your body. However, it has been important

to introduce some fun aspects that

encourages the users to establish a personal

relationship with the object. Alessi has in this

sense been a great source of inspiration, as

they are known for designer objects with a

personal and humoristic touch. Many of their

tools exemplify how playful touches can truly

be integrated into a product to

communicate emotion.

However, my aim has been to take a step away

from the notion of a product, as they clearly

aim to make a task easier through specific

functionalities. This stands in conflict with my

concept, as I aim to get my user to tackle

rehabilitation from a different angle. Treating

rehabilitation as a problem that needs to be

solved induces a lot of mental stress in the

practice. Using an artistic approach allows for

more personal creative expression,

approaching it as a journey rather than a

problem. As I am walking the thin line

between product and art, it is crucial that my

object has room for expression. We all tackle

emotions differently and bond with the

physical world through different attracts.

Hence, Moxxi has an element of participation.

The weights of Moxxi are squishy like a stress

ball, inviting the user to engage with the

weight, and release stress whilst working on

muscle function.

Reuven Israel, known for conceptual

sculptures that resist categorization and

include colorful modular aspects, serves as a

great precedence. His artworks all include

components that spin, drill or surrender while

exploring metaphysical tropes through simple

geometry. At the time the stress balls were not

introduced into my design yet, but seeing his

21

Multipolarity exhibition [9] reminded me how

important the physicality of Moxxi would be.

The material choices reflect how Moxxi is

relatable, and I struggled to find a balance

between an object that feels dead, and an

object that has too many anthropomorphic

qualities, all whilst designing with specific

medical needs in mind.

It is a critical balance. One notion that explains

the phenomena of how we perceive life in

objects is that of Pareidolia. Pareidolia is the

effect we experience when we think that we

see a face in a cloud formation. The quote

below by David Hume, an 18th Century

Philosopher, explains it beautifully:

“There is a universal tendency among mankind to conceive of all beings like themselves, and to transfer to every object, those qualities, with which they are familiarly acquainted, and of which they are [9] Reuven Israel, Multipolarity (2014).

22

intimately conscious. We find human faces in the moon, armies in the clouds; and by natural propensity, if not corrected by experience and reflection, ascribe malice or good will to every thing, that hurts or pleases us.”

The artist Zimoun clearly demonstrates this

notion through his work. He is known for his

sound installations using raw industrial

materials such as cardboard boxes with

repetitive kinetic motion induced by motors

[10]. An interview with him in Halo magazine

describes his approach, how he is interested in

how mechanical devices can create living

structures and our control of these. By

repeating and multiplying simple actions

through robotic means, he is able to bring

these elements to life - inducing pareidolia. His

work reconsiders the place technology holds,

and makes us question our relationship to it

through simple algorithmic structures.

[10] Zimoun, 198 prepared DC motors, wire isolated, cardboard boxes 30x30x8 cm, (2012).

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Pinokio, by Adam Ben-Dror, is an ordinary desk

lamp in its appearance, but explores the

expressive and behavioral potential of robotic

computing through face detection. Pinokio is

aware of his environment and reacts to

people’s presence and even sounds. He likes

attention, and moves in ways that asks for it

when you are not giving him enough. He even

turns himself back on if you turn him off,

giving the user little control over the object.

Moxxi functions in similar ways in the way it

will not stop asking for a users attention when

the user has not performed the required

exercises for that day.

In the book Hertzian Tales, by Anthony Dunne,

several notions of critical design that pertain to

my project are discussed. By sacrificing the

inherent functionality of the device, we ask the

user to question our relationship to the object.

This route was conclusively not one that I took,

but I do intend to have the user critically read

the feedback that is given to them. My

intention here is to highlight that they

ultimately are the ones that are in control of

their bodies, and need to decide what is the

best route of recovery for themselves through

their intuition. It is worth mentioning the

critique on interactive user friendliness

brought up in Hertzian Tales, as being a

metaphor for the subtle enslavement of the

human being to ‘intelligent’ machines. Paul

Virilio is quoted:

“a programmed symbiosis of man and computer in which assistance and the much trumpeted ‘dialogue between man and the machine’ scarcely conceal the

24

premises :... the total, unavowed disqualification of the human in favor of the definitive instrumental conditioning of the individual”

speaks to the way in which we need to keep in

mind that we need to make an informed

decision about our health through the help of

devices, but keep our autonomy and follow

our inner emotions. In the human factors

world, it seems as though objects must be

understood rather than interpreted. This raises

the question: are conventional notions of

user-friendliness compatible with aesthetic

experience?�Perhaps with aesthetics, a

different path�must be taken: an aesthetic

approach might subsume and subvert the idea

of user-friendliness and provide an alternative

model of interactivity, Anthony Dunn argues.

There are different ways in which a more

poetic relationship with an object can be

obtained. “Estrangement” and “alienation,” are

notions discussed in Hertzian Tales. By locating

exactly where the interaction is happening and

where the transparency lies, we can

distinguish between an object that is

“dematerialized” and one that follows “Design

Primario”. A dematerialized object in this

context provides transparent interfaces by

hiding the technology in familiar objects - such

as a lamp or weight. Design Primario focuses

more on the software rather than hardware,

controlling levels of light, sound and

temperature to provide environmental

sensations. With this in mind, Moxxi is situated

in a space in between para-functionality and

product design. Its aesthetic invites the user to

reflect on its functions by the exposed interior

workings, yet not sacrificing its functionality.

25

Looking at Moxxi from a frontal perspective, its

functions appear to be magic. But if the user

peaks in on the side, its guts are exposed,

encouraging the user to reflect on internal

versus external, diagnosis versus symptom [11].

26

[11] Moxxi, side view.

PROTOTYPING & USER TESTING / PHASE II

At this point, I was still clueless in terms of

which form Moxxi would take. I strongly

wanted to explore my designs in a

methodological way, guided by my users. The

aim of these prototypes were to determine the

final form of the object. Three general

directions were explored in which a visual

language and feedback system could be

further developed [12]. Additional signifiers

could be added and amplified at a later stage,

but part of the challenge here was to give the

user just enough information so that it stays

abstract and doesn't become an annoyance. A

key concept overarching all of them is the

notion of balance in relation to wellbeing.

Below you can see my setup for demo day at

Parsons, which lead to a lot of interesting

conversations about which interaction could

be designed.

27

The black and white cylinder is a very

simplified exploration of balance through

motion, and received the most positive

reviews. Algorithmically, this is how it would

work:

1. If the user has done well, it rotates and lands

on the white side.

2. If the user has not done well, it rotates and

lands on the black side.

3. If the user is right on track, the circle is

perfectly balanced.

Health is Balance

[12] Three prototypes exploring balance and form.

28

The other black cylinder takes the route of a

more anthropomorphic form, inspired by the

actual deconstruction and construction your

body goes through. This one also explores

balance, but through form rather than motion.

Here you can see the internal workings of it to

better understand how the motion is

generated [13].

1. If the user has done well, the form is more

positive and expands vertically.

2. If the user had not done well, the form

deconstructs and contracts vertically.

3. If the user is right on track, the circle

is perfect.

Positive / Negative Form

[13] Positive / Negative form. Two servo motors, breadboarded circuit with Arduino Micro, wooden sticks.

29

The third one (hanging on the wall) explores

how a physical data visualization system could

emerge from balance. How could different

positioning of the ball into certain “pockets”

signify progress at different stages? How could

the ball in real-time motion be perceived as

rewarding or engaging?

1. If the user has done well, the ball rolls to the

rightmost pockets.

2. If the user had not done well, the ball rolls to

the leftmost pockets.

3. If the user is right on track, the ball is

balanced in the middle.

The methodology I used to communicate my

intentions were well understood, and the

notion of balance in conjunction with health

was well received. When explaining my

prototypes, I also demonstrated the idea of

using a lamp as an indication of how well my

user had performed. This could be done in two

ways; either through motion, or through light

intensity. This would allow for an additional

function, taking into consideration the afterlife

of the product, as at one point you would

hopefully be fully recovered from your physical

rehabilitation. This also allows the device to be

less stigmatized as a pure rehabilitation aid.

This idea was well received, as long as the

signifier did not effect the inherent function of

the light. Originally I wanted the light to shut

off if the user did not perform well, creating an

incentive to perform these vital exercises.

Taking this direction would make Moxxi fall

into the category of critical design, something

that ultimately did not seem fitting for an aid.

Conversations during demo day highlighted

the signifiers that would result when a user

had not done well. The aim is to not

discourage, but communicate the urgency and

severe consequences that could emerge if the

A Physical Data Visualization

30

user does not follow their routine. At this point

I was uncertain of how I would achieve this,

and knew it would be difficult to portray

progress without discouragement. Regardless

I wanted to take on the challenge, and went

into user testing in an attempt to solve

these problems.

A blend of empirical, non-empirical, qualitative

and quantitative methods listed below were

used to pinpoint the user flow. Starting with a

task analysis [see attached documents]

allowed me to think about each interaction

and how these would relate to create an

animate object. The scenarios below treat the

object as a companion that likes to move with

you, and is taught to move by you. The object

will not stop crying for attention until it knows

that you are recovering and the daily exercises

are done. The object moves as a reflection of

you in real time while performing your

exercises, and you are able to move back in

time in order to amplify your progress. This

idea came from interviews with target users,

as one of them described how the most

rewarding part was to be able to compare

their progress from months in the past, by

photos their therapist had luckily taken. Real

time interaction with the object allows for a

more tangible dialogue between the object

and user. Moreover, physically mapping the

progress could greatly help amplify a

users progress.

After this was done, I designed two

questionnaires; one for users and one for

therapists. Sending out the questionnaires

allowed me to recruit suitable participants for

the user test, an interview and a card sorting

exercise to determine the information

Testing With My Users

31

architecture of the web platform [15]. The

questionnaire for users asked people to rate

what they found were the most important

aspects of the device, and indeed form, pacing

and timing were the most difficult for users to

keep up with. Results also confirmed that

eight out of ten users could imagine buying a

device that would remind them to do their

exercises, but cost was an important factor.

They all approved of the idea of a device that

would help them stick to their exercise

regimen, but were not big fans of the light [see

attached documents].

The user testing was made with a paper

prototype of Moxxi, and “Wizard of Oz”

prototyping techniques allowed a moderator

to act as the computer seamlessly behind a

piece of foam core [14]. In the following pages

you will find the three scenarios designed for

the test.

[14] Paper prototype of Moxxi, Wizard of Oz user test.

32

SCENARIO A

User gets introduced to the product step by

step in order to minimize bias and gauge the

affordance of the product.

Central questions:

- How does the product feel?

- How anthropocentric is the product to

the user?

- Is it motivating?

Script:

What is your first impression of this object?

What do you think this object is/how would

you use it? [Device is moved back and forth by

Computer and user is given the product

description, user scenario and performs the

exercises.] How did that feel? Why?

How would you compare this to performing

the exercise with a regular weight? Why?

How did the movement of the object influence

the experience? Why?

SCENARIO B

User goes “back in time” to see how their

performance compared to three weeks ago.

Central questions:

- Is this comparison rewarding to the user?

- How well is the user able read to the data?

- What is the-signal-to-noise-ratio?

Script:

You now want to see how well you have

progressed, how would you imagine the object

could convey this? I would now like you to

pretend that you want to know about your

progress. What would you do with the object?

Why? By dialing the knob a few steps back, the

device will replay your exercise from that time.

The object will shake with frustration when

you experienced pain. [Activity might be

repeated if user had a faulty conceptual model

of use] What did you think about this as an

33

indication of your progress? Why? What are

some other things that you noticed? Why?

SCENARIO C

The device does not shut off its lights at the

end of the day when the user is ready to go to

bed.

Central question:

What does the user do in this scenario?

Script:

As an ambient light, this object turns on each

morning and will not shut off its light until you

have performed your set amount of exercises

for the day. Where would you place it in your

home? Why? Now I want you to imagine you

just got home and you have forgotten to

perform your last set for the day. You are ready

to go to bed, and it reminds you by not

switching its light off. What would you do?

Why? How do you feel about this

functionality? Why?

Results from Scenario A were overwhelmingly

positive, all six participants loved the idea of

an object that performs the exercises with you

by rocking back and forth, and thought it was

fun and intuitive. Many participants seemed to

understand the interaction through the

recognition of a metronome. However, results

from Scenarios B were confusing to some

users, as there were many questions about

mapping. Scenario C showed that most users

would switch the light off anyway, and

questions arose about how the object could

remind the users in different ways.

Physical therapists were amazed by the idea of

a device that would help them keep track of

their patients progress, as this is central to

their occupation. Commonly they need to

tackle a patient that is not being honest about

34

how they perform their routine, as they often

like to cheat through such tedious exercises.

An aid of this sort would minimize error and

provide visual cues, which was very

appreciated. They also noted that they have

never encountered a similar device. The

questionnaire I sent out also gave me some

information about what weight classes to

design for, and how many of their patients use

weights. As rehabilitation entails recovering

from an injury, weights usually start at 2

pounds, and don’t go up much higher than 8

pounds. A slight majority of patients use

pulleys rather than weights, but this only

because it helps them keep the proper form,

and I was able to confirm through my

interviews that all those patients would be

able to use Moxxi just as well. Therapists

typically check in with patients once a week,

and were happy to see how Moxxi could

facilitate this communication, especially as

many people are not compensated for the

weekly check-ins through their insurance (see

attached document #3). The findings above all

confirmed my previous research, and I was

very happy to get some quantitative results.

[15] Physical therapist doing a card sorting exercise after an interview.

35

FINALIZING THE FORM

The above allowed me to go into the final

phase of prototyping. I knew at this point that

Moxxi was going to have an internal gear

function and a round base, rocking back and

forth as this proved to be successful both in

user tests and in terms of concept. I started by

playing around with plexiglass as I liked to

display the functionality and guts of Moxxi [16].

As it moved back and forth, there was indeed

an element of playfulness and one could get a

sense of it being an animate object. The

organic movement here was induced by the

balancing forces and the momentum it has.

However, there was something crucial missing

in the form, as it did not yet follow the

function. This is where I needed to

re-introduce the weight as a central piece of

the sculpture, without inhabiting any kinetic

movement. I came across UM collection’s

“Craft System” series - a playful and

36

anthropomorphic set of meticulously designed

lamps [17]. The materials perfectly reflected

what I had sought after, with the exception of

them being less tactile.

This gave me the idea to attach light bulbs to

the sides of the weight [18]. This would free me

from using LED’s, something that I wanted to

stay away from as these strongly convey a

sense of product and notifications.

[16] Moxxi, experimentation with transparency. [17] UM Collection’s Craft System.

37

But as the user tests clearly demonstrated that

participants were not fond of the light, and the

incorporation of light complicates the design, I

realized that a reminder could much better be

achieved through movement only. Moreover,

there is an abundance of objects pertaining to

the internet of things that use light as a

signifier. Movement presents a more subtle

indication and is more strongly tied in with the

attributes of Moxxi - an object that moves with

you. The only remaining reason I previously

preferred the light was the fact that it would

consider the afterlife of the object. What

happens when the user has completed their

recovery plan? This step is essential, as any

closure of a life event or relationship. Not only

is this important for my users mentally, but it

also presents an opportunity to critique on the

material relationship we have to products

most commonly in the digital realm. As cost is

a concern, Moxxi can be rented through your

physical therapist and is constructed with

sanitizable materials. Although Moxxi would

be returned to your physical therapist at the

end of rehabilitation, the users can be assured

that Moxxi will help someone else in need.

Moreover, the remembrance of an injury

wouldn’t linger on in their home and collect

dust like most exercise aids do today.

With the bottom of Moxxi determined, I now

[18] Prototype of Moxxi with light bulbs as weights.

38

needed to focus on the design of the weight.

Dumbells are inherently quite unattractive in

terms of form, and feel cold to the hand. I

wanted Moxxi to encourage you to pick up the

dumbell and perform your exercises. As an

element of participation and release of stress

is essential to my concept, making the weights

in the form factor of a stress ball felt natural

[19]. This way, users might even want to play

around with the weight, while simultaneously

strengthening the muscles of the hand. This

form of exercise is most commonly used with

stroke patients, as the hand contains vast

amounts of tactile nerves and stimulates the

whole arm, increasing coordination. Using a

new flexible PLA allowed me to play with a

shape that feels good to the hand, yet keep it

sanitizable. Printing with this new material

presented some problems. Not only is 3D

printing for consumer use relatively new, but

using a new material that the printers are not

adapted to yet resulted in poor printing results

[19] Moxxi, dumbell / stress ball close up.

39

at first, as the filament would tangle up in the

nozzle and gears. By disassembling the motor

when feeding the filament and using a simple

paper clip to make it feed from the top, I was

able to hack the printer to make it work better

[20]. I also experimented with different types

of resistance, by algorithmically changing the

infill. This way, therapists are also able to

recommend stress balls with different types of

resistance depending on the users condition.

The weights were designed based on the

graphic identity of Moxxi, highlighting

individualism through recovery. The two circles

intertwine as a symbol of companionship, and

the organic shape was inspired by the pressure

a hand would induce on the weight. By

importing the logo into a 3D modeling

software, the shape was directly translated.

Each weight attachment/stress ball has a

slightly different look and feel. These contain

different weight classes, distinguished by

bright colors, to add a playful touch. This way,

the user gets to visually see their progress

through color differentiation.

The handle of the weight was printed with

40

[20] 3D printing process.

normal PLA and sanded to resemble the white

matt acrylic used on the front of Moxxi.

Modeling and printing screws also presented

some difficulties, as the handle needed to be

modular in order to access the electronics

inside. My first attempt included printing the

screw in two parts, but since the material

tends to warp when cooled down, this was

unsuccessful. In the end, I added the

electronics through a door on the handle,

allowing me to print the piece as one.

Finally, all my research and conceptual

framework was reflected in the aesthetics and

functionality of Moxxi [21]. The weight allows

for a mental stress relief, and the object does

not look like a rehabilitation aid - rather a

sculpture. The different weight attachments

allows for a wide range of exercises to be

supported, and the user can naturally progress

in their rehabilitation plan. The kinetic body of

Moxxi moves in a friendly and non-obtrusive

way, perfectly reflecting the attributes a friend

would have when wanting to exercise with the

user. Last but not least, haptic feedback allows

the user to know if they are not holding the

proper form, through an imbedded gyroscope

and accelerometer. As vibration is commonly

used as a warning system, especially in game

controls, the haptics remind the user to

be cautious.

Finally, all my research and conceptual

framework was reflected in the aesthetics and

functionality of Moxxi. The weight allows for a

mental stress relief, and the object does not

look like a rehabilitation aid - rather a

sculpture. The different weight attachments

allows for a wide range of exercises to be

supported, and the user can naturally progress

in their rehabilitation plan. The kinetic body of

Moxxi moves in a friendly and non-obtrusive

way, perfectly reflecting the attributes a friend

would have when wanting to exercise with the

41

[21] Moxxi, final prototype.42

CONCLUSION

The deep desire to create a sculptural yet

functional animate object as a form of stress

relief through your rehabilitation plan was

motivated by witnessing my mother go

through the hardships of losing her abilities.

Throughout the process, my encounters with

physical therapists, patients and caretakers

have confirmed the strong need for such an

aid. I feel fulfilled by the joy that was conveyed

during user tests, as people clearly expressed

how an object like Moxxi has the strong

potential to make their lives a little easier. I

recently came across a podcast from NPR’s

Invisibilia, telling the heartbreaking story of

Martin Pistorious, who was trapped in his body

for over twelve years. He had contracted

meningococcal meningitis, just like my

mother, and gradually lost all his abilities …

even speech. His parents took care of his

vegetative body for years, while he gradually

43

came into consciousness without their

knowing. Today, technology enables him to

communicate through a speech computer,

and he has written a book about his story

called Ghost Boy. His story strongly reminded

my of my mother’s, as she woke up from the

hospital only able to move her pinky finger.

Although Martin’s case is extreme, the same

feelings of being entrapped affects all people

after an injury when they have lost some of

their abilities. As a society, we have a strong

tendency to associate power with physical

abilities. Martin, my mother, and millions of

people worldwide are victims of mental and

physical abuse due to their inabilities. Physical

form is one of the greatest ways in which we

decode our world, thus leading to these

people being stigmatized. When I introduced

my mother to Moxxi, her first question was “So

you control the outcome of how it moves?”.

There is so much talk about letting people with

a physical disability regain agency, regain

control. However, if this is not possible

through their own bodies yet, reminding them

that they do have agency through an external

object can help them sustain mentally. It is my

desire to comment on the way the medical

industry has over the past centuries had a very

cold, logical approach to healthcare. Our

bodies heal through our mental wellbeing, and

rehabilitation aids need to acknowledge this

through a certain undertone of warmth and

human touch. A physical object can never

replace this, but it can remind us of the

approach that needs to be taken on the path

to recovery.

44

The Accessible Future, Marca Bristo and

Hughey Walker (Washington: National Council

on Disability, 2001)

Designing Accessible Technology, ed. John

Clarkson and Patrick Langdon (Cambridge:

CWUAAT Editorial Committee, 2006)

Designing for Dynamic Diversity - Interfaces

for Older People, ed. Peter Gregor and Alan F.

Newell (Dundee: Department of Applied

Computing, 2002)

Gertraud Dayé, “Meeting the Challenges of

Demographic Change” in Assistive Technology

Research Series Volume 27, ed. J.F.M.

Molenbroek (Amsterdam: IOS Press, 2011)

Books

BIBLIOGRAPHY

45

Graham Pullin, Design Meets Disability

(Cambridge: MIT Press, 2009)

Madeleine Schwartzman, Seeing Yourself

Sensing: Redefining Human Perception

(London: Black Dog Publishing, 2011), 10-25.

Andy Clark, Natural Born Cyborgs: Minds,

Technologies and the Future of Human

Intelligence(Oxford: Oxford University Press,

2003), 7-77.

Kathy Chamraz, Good Days, Bad Days:The Self

and Chronic Illness In time (US:Library of

Congress Cataloging-in-Publication Data,

1997), p 167-256

Studies in Health Technology and Informatics,

Volume 145: Advanced Technologies in

Rehabilitation, ed. A. Gaggioli and E.A. Keshner

(Amsterdam: IOS Press, 2009)

McCullough and Cynthia S., Evidence-Based

Design for Healthcare Facilities (Indianapolis:

Renee Wilmeth, 2010)

Tara Parker-Pope, “With the Right Motivation,

That Home Gym Makes Sense” The New York

Times (2009), accessed November 2, 2014,

http://www.nytimes.com/2009/01/06/health

/nutrition/06well.html?_r=1&

Katie Hafner, “A Tiny Stumble, A Life

Upended”, The New York Times (2014),

accessed November 3, 2014,

http://www.nytimes.com/2014/11/04/science/

a-tiny-stumble-a-life-upended.html?_r=0

Journal Articles & Edited Volumes

46

Michael Kimmelman, “In Redesigned Room,

Hospital Patients May Feel Better Already” The

New York Times (2014), accessed September

27,

http://www.nytimes.com/2014/08/22/arts/de

sign/in-redesigned-room-hospital-patients-m

ay-feel-better-already.html?_r=0

Westerholm, Barbro. “ Robotar och

övervakning i vården av äldre – etiska

aspekter” Rapport av Statens medicinsk-etiska

råd, Stockholm, Sweden, 2015,

http://www.smer.se/wp-content/uploads/201

5/02/Smer-2014_2_webb.pdf

Aisen Caro Chacin, “Sensory Pathways for the

Plastic Mind” (MFA Thesis, Parsons the New

School for Design, 2013)

Johansson BB, “Current Trends in Stroke

Rehabilitation - A Review with Focus on Brain

Plasticity,” 147-159.

Tanya Markow Thais, “Mobile music touch:

using haptic stimulation for passive

rehabilitation and learning” (Ph. D. diss.,

Georgia Institute of Technology, 2012)

Ilse J. W. van Nes and Alexander C. H. Geurts,

“Short-Term Effects of Whole-Body Vibration

on Postural Control in Unilateral Chronic Stroke

Patients”, 868-873.

Wilma A. Bainbridge. “The Benefits of

Interactions with Physically Present Robots

over Video-Displayed Agents.” Technical

Report., Springer Science & Business Media,

2010.

R. W. Picard. “Affective Computing.” Technical

Report., MIT Media Lab, 1997.

Papers & Dissertations

47

“Take Healthcare off the Mainframe” Ted Med

talk by Eric Dishman, accessed November

29th, 2014,

http://www.ted.com/talks/eric_dishman_tak

e_health_care_off_the_mainframe?language

=en

“Statistics for National Mobility Awareness

Month“ National Mobility Awareness Month,

accessed Oct 27, 2014,

http://www.nmeda.com/wp-content/uploads

/2012/03/NMAM-Statistics.pdf

“Spinal Cord Injury Facts”

BrainandSpinalCord.org, Resources and

Information for Brain & Spinal Cord Injury

Survivors, accessed November 26th, 2014,

http://www.brainandspinalcord.org/media-ce

nter/FactsAboutSCI.html

Carlos Loyola, Licensed Physical Therapist with

his own practice, interview by author,

Brooklyn, NY, September 3, 2014.

Dr. David Medina Tato, Head of Business

Development at Boehringer Ingelheim,

interview by author, Brooklyn, NY, August 28,

2014.

Angelina Gennis and Chaiwoo Lee, Post

Doctoral Associate and Principal Investigator

at the MIT Age Lab, interview by author,

Brooklyn, NY, September 11, 2014.

Laura Lucido, Physical Therapist at the Bronx

VA Hospital, Spinal Cord Unit, interview by

author, Brooklyn, NY, November 12, 2014.

Numerous conversations and workshops with

medical practitioners and storytellers at the

Narrative Medicine Digital Storytelling Lab at

Columbia University, November 15, 2014.

Websites & Videos Interviews

48

ATTACHED DOCUMENTS

Pre-purchase

1. User is recommended to use product by

physical therapist due to a certain condition.�

- User questions the efficiency of the device�

and asks for customer reviews.�

- User questions the price point of the product

and evaluates the cost benefit of the product.�

- User questions if the product meets�

accessibility requirements according to their

needs.�

- User questions where to place the device in

their home.�

- User is excited to use the product as they

believe it could help them stay on track and

get better quicker, and�the product appears

49

Task Analysis: Physical (numbered) and cognitive�(listed below)

fun to use due to the aesthetic usability effect.�

2. User decides to purchase�the�product, and

user and physical therapist together come up

with a rehabilitation plan and calibrate the

device.�

- Exercises are demonstrated by the therapist

and a manual is given.

3. User takes product home.�

- If the user is able, he will take the product

home. Otherwise, shipping is arranged.

4. The device wakes up by simulating natural

sunlight.

- User is able to set a wake up schedule for

their week online.

- If the user does not want to do so or does not

have access to a computer, the device will

brighten according to local sunrise.

7. User wakes up by gradual light.�

Non-chronological tasks

8. User performs their routine�with haptic

feedback, and the device moves with them. �

The user is nicely guided by the feedback

system and does not have to count repetitions.

The user might multitask whilst doing their

exercises due to the task being less cognitively

straining.

9. User wants to get information on their

progress.

The user turns the dial to have the object

move how they did several weeks ago, and is

so reminded of their progress.

10. User leaves the room and goes about their

day.

11. User is reminded to perform their exercises

by their caretaker, housemate�or partner, as

they pass the device and see that it is not

dimmed as much as it should be for this time

50

of the day.

- User receives text message or phone call.

- User receives verbal and/or physical

reminder.

12.�User is reminded to perform their exercises

by the device during the day.

Device moves�when user is near�as an

indication of exercises needed to be

performed. User interprets this as it is eager to

move.

13. User forgets to perform the exercises at the

end of the day and is reminded by the device�

through light, as it does not dim all the way

down until the daily goals are met.

- User is encouraged and gratified that the

device reminded them of this, and performs

their routine on the spot.�

- User is tired and wishes that the device had

reminded them earlier, so user ignores prompt

and falls asleep with the light on.�

- User is irritated and disappointed, and so

does not perform the exercises and either

moves the device or falls asleep elsewhere.�

51

User & Physical Therapist Questionnaire Responses

52

Cicles collected from

different people in order

to determine the organic

look and feel of the logo.

63

Sketchbook

Technical sketch and

concepting of

Moxxi’s interior.

64

moxxi thesis dissertation

Documents