Personalized
Stroke Rehabilitation
Domestic Kit.
The
Challenge.
How to develop the design of an inclusive product, for the domestic context, that promotes the
rehabilitation of individuals who have suffered a stroke?
The
Outcome.
Redo is a master thesis project and resulted in a rehabilitation kit that comes with four levels of difficulty with jugs and cups of different ergonomic shapes and recreates an activity of daily living (in the actions of filling, pouring, and drinking), thus allowing each user to carry out rehabilitation exercises.
Year
2021
Duration
Research - 2 year Master Thesis project (Part1)
Redo App - 3 Weeks (Part 2)
Role
Research; Product & Branding Design
Tools
Figma; Adobe Ilustrator & Photoshop
The Design
Process.
This project here presented was the result of my master thesis where the main question of the investigation was to understand what role can Design have in the Rehabilitation sector, specifically, the rehabilitation process and journey of stroke survivors.
The overall process approach to this investigation was heavlly influnced by the Design Thinking methodology, mindset, and tools (the Stanford D.School approach).
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.
Ergonomic
Analysis.
User experiments and
ergonomic analysis.
Several experiments were conducted with users where they were subjected to various tests of grip strength, balance, and performance when exercising in the act of drinking through glasses and jugs of different shapes, handles, and textures.
Collecting samples of
ergonomic prints
The study of palm position, strength, and dimension were essential elements that stipulated a better ergonomic understanding of the current pattern of sequelae of each subject, influencing the rationale of the drawn shapes.
Study of everyday objects and reabilitation products
This type of object design does not encourage physical recovery in the long run, as it simply provides an easy-to-use solution.
​
- Rigid aesthetics where the function prevails over form;
​
- These objects provide partial and temporary recovery;
User Testing
Clay modelling.
To start prototyping I used clay modeling to start creating different forms that ergonomically adapt to the hand, which allowed a good basis for the study of an ergonomic position and correct angle of the hand and fingers.
Prototyping
Prototyping consisted of several phases to understand what exercises were essential to incorporate and how many objects needed to be designed to achieve a minimum viable standard for rehabilitation.
User Testing.
Alongside the prototyping phases, there were several user tests conducted to get feedback from every prototype created. This phases consisted in 5 different phases of user testing with different users and healthcare professionals
Redo your life starting at home.
The Solution.
Redo is a rehabilitation support kit, to help the recovery in the domestic context, for people who have difficulty handling objects or suffer from physical paralysis in the upper limbs (arms and hands).
Daily and periodic rehabilitation is one step closer to a speedy recovery.
Redo was designed to assist the user in their rehabilitation in the domestic context in parallel with their physiotherapeutic treatment.
This kit recreates a daily life activity (in the actions of filling, pouring, and drinking) thus allowing rehabilitation exercises to be carried out with each use.
Redo provides levels of difficulty for an evolutionary recovery.
The kit comes with four levels of difficulty with jugs and cups of different ergonomic shapes.
The inclusive design of the pieces allows the user to handle the objects alone and at the same time carry out rehabilitation exercises in the actions of filling, pouring, and drinking.
The kit can be customized by the user, who can choose an option in each level and customize his kit according to his needs.
Aesthetics
Process.
This section focuses on the process behind the aesthetics of the objects designed as well as the complementary graphic aesthetics that create the overall feeling and experience for the user.
Form.
The form of the objects designed and the overall aesthetics of this project were heavily studied.
One of the main objectives was to destigmatize the current rigid and very functional-driven forms of rehabilitation objects.
Two types of traditional jars/cups influenced the function turned into form of the objects designed in this project. All these jugs and cups feature a puzzle to insert the liquid inside which provided great inspiration for transforming the traditional way of visualizing everyday objects into a playful and challenging way.
A major inspiration for this project was the designer Shiro Kuramata's work and philosophy. For Kuramata the form was not the main interest, stating that the function of design should not be based only on its practicality, its charm/beauty must also be considered functional.
The goal of kuramata was to create objects that look light, transparent, almost floating in the air itself, breaking gravity, creating a relationship with the object and the environment, playing with transparencies and light construction.
Shiro Kuramata's influence on color.
Mise-en-scène.
is the stage design and arrangement of actors in scenes for a theatre or film production, both in visual arts through storyboarding, visual theme, and cinematography, and in narrative storytelling through direction.
Composition.
These references were great inspirations for this project due to their great cohesion through composition, lighting, storyline, and the overall feeling that the user can connect to its meaningful message.
Redo is designed to encourage users throughout their recovery.
Sunrise
One of the main objectives of this project was to incentivize people to continue their rehabilitation besides the difficulties that come along the way of recovery.Therefore, projecting hope and envisioning a brighter future.
Sunset.
The colors that make this gradient simulate the sunrise and sunset. Meaning that redo will be by the user’s side from the beginning of the day until its end.
Secondary Gradients.
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