Jackie Hammerton

Developing and testing a telerehabilitation system for people following stroke: issues of usability

This paper describes user testing of a technological system which enables stroke survivors to independently undertake rehabilitation exercises at home. The prototype is based on advanced movement sensors which are worn by the user when performing prescribed exercises. Sensor data are transmitted to a computer which displays the users movements and progress. The number and type of sensors, methods of attaching them to the users body in the correct locations, the type of computer screen and the input devices were changed and refined as the project progressed in response to feedback from people with stroke, their carers and physiotherapists. Home-based testing of the system highlighted usability issues concerned with the appropriateness and acceptability of the equipment in domestic settings, the sensors and methods of attachment, and use of, and interpretation of the screen presentation. Users required education as well as support throughout the testing period. Increasing sophistication of the technological aspects of the system over time resolved some usability issues but also created others, as did meeting the aims of improved clinical utility. The interplay between technology development, clinical utility and usability must be taken into account for devices to be successfully developed for practice.

SMART project: Application of emerging information and communication technology to home-based rehabilitation for stroke patients

The SMART project, entitled ‘SMART rehabilitation: technological applications for use in the home with stroke patients’, is funded under the EQUAL (extend quality of life) initiative of the UK Engineering and Physical Sciences Research Council (EPSRC). The project aims to examine the scope, effectiveness and appropriateness of systems to support home-based rehabilitation for older people and their carers. In this paper, we describe the design and development of a low-cost home-based rehabilitation system. Through the project we have involved end users in the design process and this model can be applied to the design of other healthcare related systems.

A review of the evidence underpinning the use of visual and auditory feedback for computer technology in post-stroke upper-limb rehabilitation

Purpose. To identify and review the evidence to determine the current scientific basis underpinning the use of visual and/or auditory feedback for computer technology in home-based upper-limb stroke rehabilitation. Method. A systematic search was conducted using the following databases: CINAHL (EBSCO), MEDLINE (Ovid and CSA), PubMed, Science Direct (Elsevier) and Cochrane Library. Journals, book chapters and conference proceedings were also used in the systematic search. Relevant papers were critically appraised using the Critical Appraisal Skills Programme tool for randomised controlled trials/quantitative designs. Results. Four controlled trials were identified as being relevant. Although the evidence is scarce, existing findings suggest that extrinsic visual and auditory feedback may improve motor and functional performance. In addition, concurrent feedback, knowledge of performance, knowledge of results and explicit feedback may be key components in the promotion of improved performance. Conclusions. There is a paucity of evidence to inform the development and the use of technological systems for home-based stroke rehabilitation and specifically how such systems might be developed to provide best forms of feedback in the absence of a therapist. Further work is required to first investigate the efficacy of visual and auditory feedback using technology systems and second to explore their utilisation with the end user.

An Investigation into Stroke Patients’ Utilisation of Feedback from Computer-based Technology

Strokes are the largest single cause of disability in the UK (DH, 2007). It is estimated that the incidence of first strokes will increase by 30% between 2000 and 2025 (Truelson et al., 2006). Evidence indicates that intensive post−stroke rehabilitation improves function, independence and quality of life (Kwakkel, 2004; Pollock et al., 2007), but according to the Chartered Society of Physiotherapy, the demand for rehabilitation outweighs supply (CSP, 2007). Nevertheless, recent technological advances have promoted the development of tools that may potentially complement the direct efforts of therapists and could in the future even act as surrogates (Liebermann et al., 2006). They include robotassisted movement therapy (Kwakkel et al., 2008), virtual reality technology (Henderson et al., 2007) and inertial tracking devices (Mountain et al., 2010). These systems have the potential to provide consistent, detailed, individually adapted feedback to the user (Intercollegiate Stroke Working Party, 2008) in the absence of the therapist. However, much of the evidence supporting conventional post-stroke rehabilitation suggests that feedback is provided verbally face to face by a therapist and typically involves hands-on therapy (Hartvelt and Hegarty, 1996; Ballinger et al., 1999; DeJong et al., 2004; Wohlin-Wottrich et al., 2004). The demand for post stroke rehabilitation means that service demand cannot be met and other solutions are necessary. Additionally there are unanswered questions regarding the reliance that a stroke survivor can have upon a therapist for both motor learning skills (Magill, 2007) and the self management of the resultant longterm disability (Jones, 2006).