How to develop at-home rehabilitation platform for people with stroke

Harvard Move Lab- Supported by NSF Convergence Accelerator (Phase 1)
My role: User Research Lead
Team: Technical Lead, Software Developer, Machine Learning Scientist, Biomedical Engineer, Occupational Therapist
Date: Jan 2023- Jul 2023

Background

In the US, there are 7 million people who have had a stroke with 5 million having lasting upper limb impairments.
There is a significant amount of research that demonstrates high-intensity use of the affected arm is required for recovery of arm function, but the current standard of care does not allow for this.

Jane’s story

62 years old
Former school teacher
alone
5 years ago
Right

Age:
Job:
Lives:
Had stroke:
Affected arm:

Therapy:

  • Variety of therapy: a combination of speech, physical, and occupational therapy. Occupational therapy in particular was focused on learning how to adapt to performing daily life activities and regaining function of her affected arm.


Pain point:

  • After 1 and half years, her insurance stopped reimbursing her for therapy, so she stopped going.

  • Though Jane continues to independently practice some of the exercises she learned, she’s seen little improvement in her affected arm. Over time, she’s learned to adapt to using only her non-affected arm for most daily activities since it is more practical.

Research method

Goals:

  • First round of interviews:

    • Understand user motivation in using their affected arm

  • Second round of interviews:

    • Acquire feedback on our device concept

Interviews:

  • 12 people who had stroke

  • 6 occupational therapist

  • 7 other stakeholders

Focus groups:

  • 2 with stroke survivors

Field research:

  • 2 home visits

Our Device Concept

We developed a wearable rehabilitation device designed to encourage use of the affected arm during daily life by augmenting a user’s ability to reach and hold objects with a balloon-like soft wearable that can be inflated or deflated in parallel with a user’s volitional movement.

Here, there are four different versions of wearables that we tested with our users to get their feedback during the second round of interviews.

Research Findings

  1. Understand user motivation in using their affected arm 

  • Insurance does not cover high-volume rehab.

  • Goal-oriented rehab is effective.

  • Being able to perform activities of daily living is important.

📢“I stopped going to therapy after my insurance gave up on me”
- Stroke patient 
📢“Patients are most motivated by positive feedback”
- Therapist
📢“I set personal goals for using my affected arm [...] but it’s not practical when I’m in a rush”
- Stroke patient

2. Acquire feedback on our device concept

  • It should be a single arm donnable device. 

  • Shoulder is important joint to support for arm rehab

  • It is suitable for at-home rehab.

  • The device should be lightweight.

📢“I would need to be able to put this on with one hand”
- Stroke patient
📢“The shoulder is the most important part of the arm to support”
- Therapist
📢“I see this as a home rehab device” 
- Therapist

Result

  • Secured a three-year, $5 million grant for Phase 2 based on user research insights and validation.

  • Translated user feedback into product stories and requirements, leading to meaningful prototype improvements.

    • Increased donnability of the wearable device from 50% to 86%, enhancing ease of use.

    • Guided the development team to prioritize reducing the device’s weight, addressing user comfort concerns.

  • Initiated development of a digital therapeutic feature to help users track and understand their progress.

  • Began designing study protocols for the next phase, in which users will wear the device during daily routines.

Eldercare
ReNeu