The
Challenge.
Help and guide stroke survivors in their home rehabilitation recovery in order to stay motivated to continue to exercise after getting discharged from the hospital.
The
Outcome.
A digital solution tailored to the needs of each individual stroke survivor that personalizes rehabilitation plans and helps track their recovery progress.
Year
2023
Duration
Research - 2 year Personal Master Thesis project (Part1)
Digital Concept -
3 Weeks (Part 2)
MY Role
Research & UX Design
Tools
Figma; Adobe Ilustrator & Photoshop
Project
Background.
This case study was inspired on my master's thesis, which aimed to explore how design can affect the home rehabilitation of stroke survivors. The study led to the creation of inclusive products that combine daily tasks, like drinking, with manual rehabilitation movements to promote home rehabilitation. Further user testing showed that additional measures were necessary to motivate users towards rehabilitation. As a result, a digital solution was developed to support the current kit.
Project
Overview.
This project is an extension of my master's thesis in order to create a digital solution to help complement the Redo domestic rehabilitation kit.
Problem Statement.
Up to 70% of stroke survivors fail to complete the recommended home exercises program that helps them regain their motor and cognitive functions after being discharged from the hospital This is due to a lack of motivation and/or training resources, which ultimately reduces their chances of achieving the best possible outcome.
The goal.
The goal was to create a grayscale digital application that could provide personalized plans according to their specific needs while guiding its users with the correct technique and pairing them with the existing domestic rehabilitation kit.
What?
Who?
Why?
Redo is an app that provides rehabilitation plans that combine rehabilitation exercises with the Redo physical kit for stroke survivors.
For stroke survivors who have experienced mild to severe sequelae in their upper limbs.
After hospital discharge the waiting and reassessment periods physiotherapy treatments can go beyond 3 months, reducing the potential for the best recovery scenario for the individual.
High-Fidelity Prototype
Personalized Planning
The task flow developed for this project focused on the experience of personalized plan sessions catered to the needs of the users and tracking its results to give rapid information to users. Due to time constraints, the task represented begins after the user logs in and has already filled out a questionnaire and information about his current needs and objectives that he wants to achieve with his training.
As soon as the user opens the app he can see his session for the day and his progress so far.
Visual guide tutorials
After viewing their daily session, users can review and deselect specific exercises they do not want to do.
Each exercise will be played automatically with a 3 to 5-minute rest in between each exercise. the user at all times can stop the session and return to it later.
Results Screen
Once the user finishes their physiotherapy session, they can review their exercises and track their progress for each session. There is a specific section dedicated to tracking the user's progress, where all records of their plan are kept. This section also provides a history of the progress the user has made toward their established objectives prior to starting the plan. Additionally, users can compare their progress on a weekly basis across weekly sessions.
Library
Catalog
In case users want to add exercises or create their own plan, they can choose activities based on body parts and skill levels in the library section.
The Design
Process.
I followed the double diamond process as a foundation for this process and implemented some other UX methods like User stories and task flows.
Discover.
Research
Assumptions
User interviews
Affinity Mapping
Synthesis
Define.
Persona
Experience Mapping
User Stories / Epics
Task Flows
Develop.
Design Sketches
Wireframes
User Testing
Low-Fi Prototype
Deliver.
Grayscale Hi-Fi Interactive Prototype
Understanding
the problem.
In order to understand the problem space of stroke survivor rehabilitation at home it was important to understand the basic information entirety of a stroke event and the reality of the impact of its sequelae. As well as the necessary procedures and parameters to consider for a good recovery from the perspective of healthcare professionals. In order to understand the exercises and devices used in physiotherapy, it was concluded that they should replicate daily life tasks.
The rehabilitation of these individuals is not only carried out in a hospital or clinical environment but also in a home context, in fact, a variety of exercises are recommended to be carried out simultaneously with the treatment. However, in the domestic context, it becomes more difficult due to several factors such as the individual's motivation, the demand for physical capacity of the exercises to be performed especially at an early stage, and the dependence on third parties (many need help to carry out basic daily routine such as going to the bathroom).
15 Million people suffer a stroke every year worldwide.
According to the World Health Organization, 15 million people worldwide suffer a stroke each year. Of these, 5 million die and another 5 million are permanently disabled, ending up becoming an added responsibility for the family and the community. (World Health Organization, 2004).
1.7 Million people have at least one disability in
Portugal.
500,000 are unable to individually execute one daily task (see, hear, walk, memorize, bathe, dress alone or even understand others/ make yourself understood).
Rehabilitation has to be immediate and daily.
Recreation of Activities of Daily Living (ADL)
Rehabilitation must begin within the first 24 hours to begin the process of re-education and communication between brain cells and motor movements in order to reach to highest level of independence of the individual. One study followed 51 stroke survivors that could not walk 3 months post-stroke. After 2 years of long-term rehabilitation, researchers found that 74% of patients had regained their capacity to walk without assistance.
Performing rehabilitation exercises at home and using, or attempting to use, the stroke-affected upper limb during Activities of Daily Living (ADL) are the most effective ways to achieve high-dosage motor practice in stroke survivors.
"Currently, every hour in Portugal, 3 people are victims of a stroke, of which one does not survive."
Every year, out of every 1000 inhabitants, 2 suffer from a stroke and 41% of survivors become dependent on others and their disabilities (Sociedade Portuguesa do Acidente Vascular Cerebral, 2016 p. 9;11).
In Portugal, of the individuals who survived the first three months, only 20% are autonomous seven years later - generally speaking, a loss of approximately 12 years in the individual's quality of life is estimated 16% have a mild disability to moderate and the remainder have relevant disability or have died (Sociedade Portuguesa do Acidente Vascular Cerebral, 2016 p. 12).
Likewise, the National Stroke Association (Cit. by Pinto, et al., 2017, p. 26) states that among stroke survivors; 10% recover almost entirely, 25% recover with minimal sequelae, 40% are left with moderate to severe disability (requiring specialized care), 10% need long-term care justifying institutionalization and 15% die within the first month after the vascular episode acute.
It is concluded that despite the percentages of permanent sequelae being relatively high, the practice and investment in prolonged treatments and rehabilitation programs is recommended, as it increases the chances of the individual's independence and the reduction of their sequelae.
National Stroke Association
(Cit. por Pinto, et al., 2017, p. 26)
Understanding the User.
Sequelae of stroke differ depending on the type of stroke, the individual's medical history, and other factors. This project focuses on the recovery of the sensory-motor and functional function of the upper limbs, focusing on the recovery of hand grip strength. So, the interviews focused on stroke survivors who had paralysis in the upper limbs.
I interviewed 6 stroke survivors and 3 healthcare professionals (2 physiotherapists and one rehabilitation nurse). In order to get the full perspective of the right king of approach and exercises the patients should be doing at home.
Participant Criteria.
Stroke Survivors
- Stroke survivor (ideally of occurrence from 0 - 5 years)
- Actively on treatment
- Highly motivated to exercise
- Paralysis in the upper limbs
Healthcare professionals
- Rehabilitation clinics specific to stroke reahabilitation
- Physiotherapists and rehabilitation nurses
- Experience with different stroke survivors sequelae
Pains.
Behaviors.
Motivations.
Affinity mapping.
In order to organize the insights gathered from the interview process I organized them into pain points, behaviors, and motivations and further clustered them into themes. In the end the theme with the most relevant pain points and relevance was the lack of resources and support
Research
takeways.
The rehabilitation of these individuals must be continued, if there are stoppages it can be critical, slowing down the already existing progress. This is unfortunately evident in the current rehabilitation system in Portugal. These treatments are generally time-consuming: due to the patient's reassessment stops, the waiting time for the first treatment and to continue it.
The following insights highlight the significance and urgency of addressing the issue in the domestic context.
Interrupted rehabilitation
Within the journey of an individual who suffers a stroke, this continuity is not possible due to the long waiting periods to start physiotherapeutic treatment, after leaving the hospital, which can take 1 to 3 months to start.
1h Physiotherapy treatment 23h motionless at home
When the individual begins their physical therapy treatment they practice at least one hour of varied physical exercise, depending on the long-term effects of stroke however, in the majority of the cases, the rest of the day remains immobile.
Users have limited financial resources
Stroke survivors and their families have to research and financially invest themselves on several resources due to the lack of support and information from the National Healthcare system.
Lack of motivation to exercise at home.
Most products for rehabilitation are introduced in rehabilitation however focused more on muscle stimulation. Daily activity objects are adapted to the new individual conditions and do not stimulate physical recovery in the long term, as they simply provide an easy-to-use solution.
Overwhelming & decentralized
information
After being discharged, patients usually receive a booklet containing general information and exercises they can do at home. However, if any doubts arise, the user does not have immediate access to the assistance or the correct information.
Persona.
After completing my research and interviews, I created a persona to empathize with and showcase the potential target user groups' pain points, goals and behaviors.
Pain Points
-
Antonio feels frustrated for the lack of support and information once he left the hospital.
-
Feels lost and overwhelmed because he does not
know where to start when it comes to planning
a rehabilitation program at home.
-
Does not know how to track his progress
Bio.
Antonio is a 56 year old professor and a stroke survivor who had a mild stroke a few months ago. He is highly motivated to get back to his daily routine and activities, including working and driving. However, due the long waiting list for rehabilitation treatments and rehabilitation clinics in his area he still hasn’t began his treatment and he starts losing his motivation and stops rehabilitating because he does not know what to do.
He has been searching for alternative ways to continue his recovery at home but none that are affordable and that can keep track of his progress at home.
Goals & Motivations
-
Antonio is highly motivated to rehabilitate to return to his routine as fast as possible, but the treatment waiting periods decrease his motivation.
-
Antonio wants to regain his independence and be able to perform daily activities on his own without
relying on others for assistance.
Behaviors
-
Starts searching endlessly for alternative treatments,
products or clinics in order to start physiotherapy as soon as possible.
-
Exercises by himself, however not with the correct form and ends up hurting himself
-
Tries to measure and annotate his sessions with the help of family to understand if he is progressing.
-
Buys adaptive rehabilitation products but in the end they do not stimulate the personalized treatment that he needs.
How does motivation affect rehabilitation recovery?
Stroke
Survivor
The main pain of the user is not knowing if he is progressing and if the exercises that he is doing are being effective therefore decreasing his motivation through his rehabilitation at home.
Healthcare
Professional
Even though the main solution will be for the user (stroke survivor) it was relevant to create user stories for healthcare professionals since they are the ones who see and can evaluate one’s progress.
One of the main concerns for healthcare professionals is not knowing what the patient has already done and his growth.
How might we
help stroke survivors like Antonio better track their home rehabilitation progress so that they can stay motivated throughout their rehabilitation?
Defining a
Task Flow.
This task flow continues from the point where the user has already created an account and logged into the platform.
Ideation
Sketches.
After crafting user stories and pinpointing the main task flow that the user could potentially accomplish, In order to ideate further, I began sketching wireframes with pen and paper.
User Testing.
After finalizing the initial sketches, I moved on to build a mid-fi prototype to give me a better understanding of how each screen would work together. As part of the design process, the prototype underwent two rounds of usability testing with five participants in each round in order to gain real-time feedback to guide the design to an optimal user experience.
This initial prototype assumes that the user has already created an account and logged in to the app; the prototype focuses on testing the two critical functions mentioned in the user stories, which are: Guiding the user through their home treatment sessions and providing them with relevant progress information.
I conducted user testing by interviewing five individuals, even though, outside my target audience since the main focus of this particular user testing was to evaluate the effectiveness of the task flow for two primary functions:
- Starting a new rehabilitation treatment session and performing the corresponding videos:
- Entering data after the session to receive feedback and track progress across sessions.
​
For the user testing, most tasks were simple and easy to accomplish. However, the labeling and the wording made it difficult for the users to manage, but they completed and understood the tasks in question.
1. Homepage
Upon opening the app, the user is presented with the current day's session and their progress history. However, the initial prototype had some issues. The card carousel for today's session caused confusion as many users attempted to click on individual cards to view exercises or sections. Additionally, the statistics and details regarding the user's progress needed to be simplified and presented in a clearer and more direct manner, making it easier for them to identify areas in need of improvement.
V1
V2
3. Exercise page
In the initial version, when the user clicked on "start session," they were taken to the warm-up before the exercises, which caused confusion. It was unclear whether clicking "start" would begin the warm-up or the workout itself. To address this, the second version simplifies the process by playing a series of timed exercise videos immediately after the user starts the session.
V1
V2
2. Today's plan
When the user clicked on today's training in the initial version, they were confused about the layout. They were unsure if they could select individual exercises or if the workout would begin with the default layout and be unchangeable. Additionally, users were interested in knowing the total time required to complete the entire workout.
V1
V2
4 Results page
Upon completing the training sessions in the initial version, there was some confusion regarding the number of repetitions and minutes completed. The user's feedback highlighted the immediate need for more specific results to accurately gauge their progress, with professional feedback being preferred.
V1
V2
Next
Steps.
Improve results feedback feauture.
Since I had limited time to develop this solution, I focused on creating a visual tutorial sequence that explains how users can customize their planning. However, the next step in the task flow is to provide a coherent track history. Users said they would want to see more information on how to improve each exercise instead of given how much they completed.
Develop a human professional feedback feature
Users have expressed that they would like to receive more professional advice. Although the app provided feedback, they feel somewhat distant and alone. They would prefer to hear from a professional in the relevant field, or even their physiotherapist.
3rd round of User Testing
These mid-fidelity prototypes were only tested two times with 5 different users. The next round would be focused on testing the results and tracking history of the app. Additionally, the next round of testing would be to seek professionals in the area to create a database with eligible and approved exercises.
Develop Visual Design
Once the essential features for allowing users to adequately customize their rehabilitation plan have been determined, the following step would involve creating a UI Library and conducting testing to evaluate the app's performance with both users and professionals.
Thank you
for viewing!
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