Background
Early engagement in upper limb rehabilitation following stroke may contribute to improved long term motor recovery. Many factors influence acute stroke clients’ ability to achieve an adequate dose of movement both within and outside of designated therapy sessions. Previous work demonstrates that interactive technology can increase engagement with rehabilitation – but how can this be implemented in an acute stroke unit when your client doesn’t have much movement to start with?
Aims
To design and develop a simple rehabilitation system that enables, motivates and engages clients in an acute stroke ward to perform in-bed semi-supervised and supervised upper limb rehabilitation movements. The device must direct and record movements, be flexible to meet client needs and pre-functional abilities, be useable in the acute stroke ward and increase engagement with rehabilitation movements.
Methods
An iterative co-design process was used at the Launceston General Hospital Stroke Unit. Each new design iteration was guided by client and therapist feedback. Field notebooks recorded client and clinician feedback. Actigraph accelerometers were used to measure arm movements.
Results
Key design characteristics identified through the co-design process were: app setup efficiency (pre-established movement patterns with ease of customisation), flexible app screen layout (matching physical layout of sensors, customisable information presentation), customisible feedback options, movement sensor requirements (adaptable, sensitive), and creating an in-bed therapy surface (stable, removeable, supports system, enables client movement). High repetition counts were observed in clients during system testing.
Conclusion
Progressive design improvements through co-design allowed many environmental and client barriers to be overcome. Simplicity combined with flexibility were key contributors to use. This work provides the knowledge required for further development of systems to increase the dose of early upper limb rehabilitation.