Justin Gallagher

Developing a user interface for the iPAM stroke rehabilitation system

The increasing population of older people is leading to growing healthcare demands. Stroke is the commonest cause of severe disability in developed countries leaving one third of patients with long term disability. Rehabilitation is the cornerstone of recovery. Lack of rehabilitation manpower resources can limit recovery of limb function. However, technology can assist rehabilitation staff to deliver greater intensity of treatment. Robotic systems such as the iPAM robot can provide semi-automated arm exercises for people with complex impairments leading to loss of functional arm movement. Feedback to the patient about their performance, usability of the exercise “workspace” and motivating exercises are key aspects of the successful deployment of robotic systems within routine clinical use. We describe the development of the patient interface for the iPAM robotic system. Central to this development is user involvement (with rehabilitation professionals and people with stroke). Using user centred design methods which included use of questionnaires and one to one discussions, the user interface was changed from a simple screen showing a stick figure of the arm to a 3D scene with simplified indicators and feedback screens, providing feedback about performance and feedback about the quality of the movement. Patients were positive about the changes to the user interface, confirming that the feedback screens were clear, useful and motivating. The user interface can further be improved by adding more feedback about the quality of the movement.

Investigating the International Classification of Functioning, Disability, and Health (ICF) Framework to Capture User Needs in the Concept Stage of Rehabilitation Technology Development.

This study evaluates whether the International Classification of Functioning, Disability, and Health (ICF) framework provides a useful basis to ensure that key user needs are identified in the development of a home-based arm rehabilitation system for stroke patients. Using a qualitative approach, nine people with residual arm weakness after stroke and six healthcare professionals with expertise in stroke rehabilitation were enrolled in the user-centered design process. They were asked, through semi-structured interviews, to define the needs and specification for a potential home-based rehabilitation device to facilitate self-managed arm exercise. The topic list for the interviews was derived by brainstorming ideas within the clinical and engineering multidisciplinary research team based on previous experience and existing literature in user-centered design. Meaningful concepts were extracted from questions and responses of these interviews. These concepts obtained were matched to the categories within the ICF comprehensive core set for stroke using ICF linking rules. Most of the concepts extracted from the interviews matched to the existing ICF Core Set categories. Person factors like gender, age, interest, compliance, motivation, choice, and convenience that might determine device usability are yet to be categorized within the ICF comprehensive core set. The results suggest that the categories of the comprehensive ICF Core Set for stroke provide a useful basis for structuring interviews to identify most users needs. However some personal factors (related to end users and healthcare professionals) need to be considered in addition to the ICF categories.

Involving children in the development of assistive technology devices

Purpose. To investigate the implementation of a web-based survey for involving children in the design of assistive technology devices within the primary school environment. Method. Children were recruited within their normal school environment. They completed tasks within the survey that sought to gather their personal preferences about assistive technology devices. From six primary schools, 257 children (mean age = 9 years and 8 months, SD = 1.51; 123 males, 134 females) including children with cerebral palsy (N = 11), varying levels of deafness (N = 7), global developmental delay (N = 2) and Downs syndrome (N = 1) participated. Observations were taken whilst the children completed the survey tasks. Results. All children were able to complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters. Conclusions. The use of the web-based survey provided a novel means with which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. In order for the survey to be utilised more widely, issues that arose when involving children with disabilities need to be addressed.

A pilot single-blind multicentre randomized controlled trial to evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on the arm function of children with spastic cerebral palsy:

Objective: To evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on arm function of children with spastic cerebral palsy. Design: A single-blind randomized controlled trial design. Power calculations indicated that 58 children would be required to demonstrate a clinically important difference. Setting: Intervention was home-based; recruitment took place in regional spasticity clinics. Participants: A total of 15 children with cerebral palsy aged five to 12 years were recruited; eight to the device group. Interventions: Both study groups received ‘usual follow-up treatment’ following spasticity treatment with botulinum toxin; the intervention group also received a rehabilitation gaming device. Main measures: ABILHAND-kids and Canadian Occupational Performance Measure were performed by blinded assessors at baseline, six and 12 weeks. Results: An analysis of covariance showed no group differences in mean ABILHAND-kids scores between time points. A non-parametric analysis of variance on Canadian Occupational Performance Measure scores showed a statistically significant improvement across time points (χ2 (2,15) = 6.778, p = 0.031), but this improvement did not reach minimal clinically important difference. Mean daily device use was seven minutes. Recruitment did not reach target owing to unanticipated staff shortages in clinical services. Feedback from children and their families indicated that the games were not sufficiently engaging to promote sufficient use that was likely to result in functional benefits. Conclusion: This study suggests that computer-assisted arm rehabilitation gaming does not benefit arm function, but a Type II error cannot be ruled out.

Feasibility of school-based computer-assisted robotic gaming technology for upper limb rehabilitation of children with cerebral palsy

Abstract Introduction: We investigated the feasibility of using computer-assisted arm rehabilitation (CAAR) computer games in schools. Outcomes were childrens preference for single player or dual player mode, and changes in arm activity and kinematics. Method: Nine boys and two girls with cerebral palsy (6–12 years, mean 9 years) played assistive technology computer games in single-user mode or with school friends in an AB–BA design. Preference was determined by recording the time spent playing each mode and by qualitative feedback. We used the ABILHAND-kids and Canadian Occupational Performance Measure to evaluate activity limitation, and a portable laptop-based device to capture arm kinematics. Results: No difference was recorded between single-user and dual-user modes (median daily use 9.27 versus 11.2 min, p = 0.214). Children reported dual-user mode was preferable. There were no changes in activity limitation (ABILHAND-kids, p = 0.424; COPM, p = 0.484) but we found significant improvements in hand speed (p = 0.028), smoothness (p = 0.005) and accuracy (p = 0.007). Conclusion: School timetables prohibit extensive use of rehabilitation technology but there is potential for its short-term use to supplement a rehabilitation program. The restricted access to the rehabilitation games was sufficient to improve arm kinematics but not arm activity. Implications for Rehabilitation School premises and teaching staff present no obstacles to the installation of rehabilitation gaming technology. Twelve minutes per day is the average amount of time that the school time table permits children to use rehabilitation gaming equipment (without disruption to academic attendance). The use of rehabilitation gaming technology for an average of 12 minutes daily does not appear to benefit childrens functional performance, but there are improvements in the kinematics of childrens upper limb.

Employing the International Classification of Functioning, Disability and Health framework to capture user feedback in the design and testing stage of development of home-based arm rehabilitation technology.

ABSTRACT The purpose of this study was to evaluate the International Classification of Functioning, Disability and Health (ICF) as a framework to ensure that key aspects of user feedback are identified in the design and testing stages of development of a home-based upper limb rehabilitation system. Seventeen stroke survivors with residual upper limb weakness, and seven healthcare professionals with expertise in stroke rehabilitation, were enrolled in the user-centered design process. Through semi-structured interviews, they provided feedback on the hardware, software and impact of a home-based rehabilitation device to facilitate self-managed arm exercise. Members of the multidisciplinary clinical and engineering research team, based on previous experience and existing literature in user-centred design, developed the topic list for the interviews. Meaningful concepts were extracted from participants’ interviews based on existing ICF linking rules and matched to categories within the ICF Comprehensive Core Set for stroke. Most of the interview concepts (except personal factors) matched the existing ICF Comprehensive Core Set categories. Personal factors that emerged from interviews e.g. gender, age, interest, compliance, motivation, choice and convenience that might determine device usability are yet to be categorised within the ICF framework and hence could not be matched to a specific Core Set category.

Assessment of upper limb movement with an autonomous robotic device in a school environment for children with Cerebral Palsy

Robotic devices are becoming more prevalent in rehabilitation of neurological disorders. Studies focus on clinical measures alongside robotic intervention, but assessment data can be collected as the subjects are using the rehabilitation device. As part of an autonomous robotic rehabilitation device in primary schools, this paper introduces an assessment tool that can engage subjects and measure performance on a more granular scale across an 8 week intervention. The deployments are split in to two parts of single and dual use with a 4 week washout period in-between. Analysis of the scores achieved on the assessment task show improvement on the rehabilitation system, and the data can also be used as part of an adaptive algorithm for the robotic assistance. The data on this pilot study with 11 children with Cerebral Palsy shows that the assessment task can pick up trends of improvement across the deployments. Although the data is noisy, there is significant difference over the washout period, which shows that improvement is maintained after rehabilitation training. The order of single and dual use of the device did not influence the improvement. The simplicity of the assessment tasks makes implementation easy, and collects enough data over a short period of time for significant changes.

The Involvement of Primary Schools in the Design of Healthcare Technology for Children

There has been an increased emphasis on user involvement within healthcare technology development (Ram et al., 2007). Within the healthcare domain the term “user” can describe a range of different people across all ages; from patients and their families to healthcare professionals, NHS providers and commissioners of services. Within rehabilitation engineering, a “user” of technology is often characterised by the presence of a physical, cognitive, sensory or communication impairment. Although research has focused on the considerations of involving disabled adults in healthcare technology design (e.g. Orpwood, 1990) there has been little research directed towards the design and development of rehabilitation technologies with disabled children. Engaging children in the development of rehabilitation technologies has been reported (Hwang et al., 2004; Weightman et al., 2010), but there are still considerable gaps in our knowledge of the most efficient approaches to engage children in the design process of such technology.

Deploying a Two-Player System for Arm Rehabilitation in Schools

Cerebral Palsy (CP) is the commonest cause of disability among children in Europe (Johnson, 2002). Its effects and severity can be extremely varied, but a combination of arm impairments through weakness or spasticity and sensory deficits is common and can (i) significantly impair the ability of individuals with CP to carry out daily activities and (ii) create significant social barriers (Imms, 2008). Therapy is often used to aid the acquisition of motor skills, particularly in childhood, but a lack of physiotherapy resources means that this is often delivered through a self-managed home exercise programme. Exercises are frequently dull and repetitive, and children often lack the motivation to carry out these exercises, leading to poor compliance with the prescribed plan (Chappell and Williams, 2002).

Data sharing (DaSh) for collaborative learning in laboratories

Abstract In a set of independent student focus groups conducted at Leeds University by the Royal Academy of Engineering, a common concern regarding laboratory sessions was that an emphasis on assessment often meant that, due to time pressures, students concentrated on gathering data rather than understanding the underlying engineering principles. In 2008, with support from the Higher Education Academy Engineering Subject Centre, the DaSh system was developed to allow students to upload and share data, in order to promote collaborative and deeper learning. Data could be uploaded in real-time, via the internet, allowing results to be made available immediately for comparison with their peers’, whilst still in the laboratory in front of the equipment. This facilitated learning in two distinct ways. At a basic level, students were able to rapidly spot and correct measurement or calculation errors. At a more advanced level, conclusions could be drawn from the observation of hundreds of data points (rather than just five or ten), something that would otherwise have been impossible, had they worked independently. Following its positive impact on the student learning experience, data sharing was incorporated into a ReLOAD (Real Labs Operated At Distance) session, allowing the experiment to be repeated anywhere with internet access. DaSh was evaluated by comparing performance on similar sessions run with and without data sharing, observing behaviour within the laboratory, completion of questionnaires after the sessions and from focus groups. Through these methods, results have shown that the system has worked well, has been popular with the students and has been beneficial to their learning.