interaction design for rehabilitation

Interaction Design for RehabilitationPanos Markopoulos Eindhoven University of Technology University of Technology Sydney

Intelligent User Interfaces Limassol March 16, 2017

Economics of healthcare

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/ industrial design

Interactive rehabilitation technologies

↑ Training intensity ↑ Training variety ↑ Patient independence ↑ Patient engagement ↓ Reduced workload for clinical staff ↓ Reduced cost

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Motor and behavioural learning

Ying Li, Willem Fontijn, P.Markopoulos (2008) A Tangible Tabletop Game Supporting Therapy of Children with Cerebral Palsy. In Proceedings Fun n' Games 2008, Springer LNCS 5294, 182-‐193. 4

CP games on TagTiles board

5Dhillon., Goulati., Politis, Raczewska,, Markopoulos, (2011). A set of customizable games supporting therapy of children with cerebral palsy. In Proc. INTERACT 2011, 360-361. Springer.

CONTRAST: Gamification of Arm-Hand Training for Stroke Survivors

7Jacobs, A., Timmermans, A., Michielsen, M., Vander Plaetse, M., & Markopoulos, P. (2013, April). CONTRAST: gamification of arm-hand training for stroke survivors. In CHI'13 Extended Abstracts

REHAP Tiles (UTS)

9Donker , Markopoulos, Bongers (2015) REHAP Balance Tiles: a modular system supportingbalance rehabilitation. Pervasive Health 2015.

/ industrial design

REHAP feedback

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Skill recovery after stroke

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Spontaneous Recovery

Functional brain mapreorganisationUse of pre-existing CC-connections, increased activityperilesional area

Nerve fibre sprouting &synaptogenesis

Increase synaptic efficacy

Increased activity in theundamaged ipsilateralhemisphere

Haematoma resorptionElevation of diaschisis

?

Mov

emen

t Affe

cted

Arm

and

Han

d

Increase Joint ROM

Improve Coordination

Increase Muscle forceReversal of maladaptivebiomechanical changes

True recoverymovement involves

same muscles

Compensationmovement involvesdifferent muscles

Acute

Subacute

Chronic

Stroke

?

Timmermans A., Seelen H., Willmann R. & Kingma H. 2009 Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design, JNER, 6:1,

SotA in rehabilitation technology

• To date no effect on activity level (Prange 2006, Kwakkel 2008, Mehrholz 2009)

• Reasons: – stimulus-response discrepancy – proximal OR distal approach – lack of real life sensory input – limited degrees of freedom, limited reach – cognitive problem solving processes related to real life

activities were not enough challenged

Timmermans , Seelen ,Willmann & Kingma 2009. Technology-‐assisted training of arm-‐hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design, JNER, 6:1 12

SotA in rehabilitation technology

…Technology for upper limb training needs to provide engaging, patient-tailored task-oriented arm training in natural environments with patient-tailored feedback that supports learning of motor skills (Timmermans et al 2009)….

…essentially an HCI challenge

13Timmermans Seelen ,Willmann , Kingma 2009 Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design, JNER, 6:1

TagTrainer

14Tetteroo (2013). TagTrainer: a meta-‐design approach to interactive rehabilitation technology. In End-‐User Development (pp. 289-‐292). Springer Berlin Heidelberg.

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Therapists*as*content*creators*

Te#eroo,'Timmermans,'Seelen,'&'Markopoulos,'P.'(2014).'TagTrainer:'suppor>ng'exercise'variability'and'tailoring'in'technology'supported'upper'limb'training.'Journal(of(neuroengineering(and(rehabilita1on,'11(1),'140.'

/ industrial design

Usage of TagTrainer

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Total nr o

f exercises created

0

5

10

15

20

Day of study (working days only)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Tetteroo, Vreugdenhil, Grisel, Michielsen, Kuppens, Vanmulken, Markopoulos,. . Lessons Learnt from Deploying an End-‐User Development Platform for Physical Rehabilitation. In Proc. CHI 2015 , ACM, 4133-‐4142

RES: posture monitoring during training

Delbressine, F., Timmermans, A., Beursgens, L., de Jong, M., van Dam, A., Verweij, D., ... & Markopoulos, P. (2012, August). Motivating arm-hand use for stroke patients by serious games. Proc.IEEE EBMC (Vol. 2012, pp. 3564-3567). 17

Developing wearables for rehabilitation

Q. Wang, W. Chen, A.A.A. Timmermans, C. Karachristos, J.B. Martens, P. Markopoulos (2015) Smart Garment for Posture Monitoring, IEEE EBMC, 2015. 19

Bootsman, Markopoulos, Qi, Timmermans, Posture correction for occupational low back pain prevention with smart garments, Submitted. (2016)

/ industrial design 24

Cervic Gear

Luca Giacolini, graduation project 2016TU/e Industrial Design 2016

/ Posture pillar, Mantas Palaima, M1.1 project, Industrial Design

/ industrial design

Interaction design process

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1 • Immersion in context of clinic • Learning from existing therapy • Co-‐design

2 • Iterative design • Stepwise increase testing realism

3 • Acceptance/Experience /Credibility/Expectancy • Observation • Pre-‐clinical testing

/ industrial design

Feedback Design

• Content – Knowledge of results versus knowledge of performance – Emphasis on successful performance

• Scheduling – Less is more, fading out

• Modality – Multimodal, stepwise, contextualised, customised

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/ industrial design

Challenges for human computer interaction

• Equity for multiple stakeholders • Participation and community • Organisational and legal constraints • Ethics of patient participation • Effectiveness of yesterday’s technology • Implementation in clinical settings • Adapting feedback and coaching to patient behaviour

• Sustaining engagement in the long run

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Credits

I.Politis, A.Goulati, B.Dhillon, A.Racewska, N.Chupriyanov (CP GAMES) D.Tetteroo (TAGTILES) A.Jacobs, A.Antal(CONTRAST) A.Timmermans R.Winters (Scribeo) M.Willems (CervicWare) Q.Wang, Jiachun Du, Qi Qi (Zishi) R.Bootsman (Back Up) V.Donker, B.Bongers (Rehap) Bruna Goveia de Roha, Oscar Tomico (Flow)

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interaction design for rehabilitation

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