A Web-based Rehabilitation System Helping Patients Recover and Gain Self-awareness of Their Body Away from the Clinic

Project website: http://chi-goloko-team.wix.com/innomotion

CHI Student Design Competition 2014Luxi Chen, Ni Yan, Miranda Kiang, Anna Muth, Kruthi Sabnis KrishnaSchool of Information, University of Michigan

InnoMotion

PatientDo exerciseReview therapy progress

Homepage Exercise & Progress Patient’s Progress

Therapist Review patient’s progressProvide instruction

InnoMotion Overview

1. Rich interactions through gesture, voice and touch

InnoMotion Overview

InnoMotion Overview2. Practice Therapy Exercise

Click andChange

Assignment

See Today’s Progress

Instant Feedback During Exercise

Instruction VideoTo See CorrectGesture

InnoMotion Overview3. Track Rehabilitation Progress

Overview Progress

Bene�ts from Progress

InnoMotion Overview4. Get Exercise Instructions

Receive FeedbackFrom Therapist

Receive FeedbackFrom InnoMotion

System

Process

De�nition

Design Problem De�nitionProblem Scoping

Research

User InterviewA�nity Wall BuildingConceptual MappingPersona and Scenario

Ideation

SketchesStoryboards

Prototype

WireframeMed-Fi Prototype

Hi-Fi Prototype

Evaluation

User Testing (Med-Fi)User Testing (Hi-Fi)

User Testing (Med-Fi)User Testing (Hi-Fi) 5 patients

1 physical therapist

1 occupational therapist student

2 professors

Interview

Research

5 patients, 1 physical therapist, 1 occupational therapist student and 2 professors were interviewed. We concentrated on understanding the therapy process, the challenges faced while patients practiced therapy at home and the kind of communication that the patients have with the therapist. All the data collected was analyzed by building an a�nity wall.

Video: https://www.youtube.com/watch?v=ioqjVUBE1uc

Affinity Wall

Findings from Affinity Wall

Motivation

1. Is not motivated by virtual prizes

2. Wants meaningful rewards to keep him/ her motivated

3. Pretty painful procedure to stay motivated

ProgressTracking

1. Cares about milestone progressing. 2. Tries to reach the end goal as soon as possible. 3. Needs a reality check at all times.

Quality of

Exercise

1. Worried about doing exercise right at home 2. Needs continuous feedback from the therapists which costs a lot of money

3. Does not want to share the exercise details with anyone other than therapist

TherapyView

1. Needs a way to track patient’s progress data. 2. Doesn’t want to have overloaded documentations 3. Needs a better way to teach the exercise to the patient remotely.

Selected Personas

Liamthe Business Executive “I make goals come to

fruition.”

Age: 32Gender: MaleOccupation: Business ExecutiveIncome: $200,000 a yearFamily status: Single (and lovin’ it)Technical pro�ciency: 4 (Very good)Length of rehab: Long term (>1 year)

Insurance: 30 PT visits per yearMotivation level: 2 (Below average)Self-train at home: 2 - 3 (Unlikely - neutral)Frequency of self-training: 2 (Unlikely)Other caretakers involved: None

Find other patients like him: NoShare story and interact with others: No

Personality/description: Liam is an ambitious young business executive who is very goal-oriented. He lives an active life and is always doing something - whether it is a side-venture or attending a social event. He is also an avid outdoorsman, and loves partaking in outdoor activities. Though he is smart, driven and hard-working, sometimes Liam expects everything to go his way. Having been very successful in his life/career, he is not used to major setbacks. He is currently enjoying living as a well-to-do young bachelor.

Injury scenario: Liam loves rock-climbing and has of late picked up bouldering. While on a bouldering trip to Australia, Liam found himself at the edge of a precipice, hanging for his life. He had tried to use his right hand to reach up and grab a jutting ledge, but the rock on the ledge broke and instead deeply cut into his palm, rupturing his degen-erative �exor tendon. Luckily, his friends were able to pull him up. However, he now has a serious tendon injury in his right hand. After undergoing a successful surgery, Liam now faces the challenge of regaining regular movement in his right hand and has to pretty much relearn all of his �ne motor skills.

The Patient

Image Credits: http://us.123rf.com/400wm/400/400/nyul/nyul0911/nyul091101045/5983126-casual-businessman-talking-on-mobile-phone-isolated-on-white.jpg

Selected Personas

Jennythe Therapist

“Persevere and you will see results.”

Personality/description: Jenny loves helping people - which is what led her to study therapy in the �rst place. Growing up, her father had lost his left hand in a logging accident. She saw how di�- cult it was for him to do his daily tasks because he lost his left hand. Despite this di�- cult adjustment, her dad managed to overcome his disability and ended up switching careers to become a successful businessman. Inspired by her father’s story, Jenny hopes to be able to motivate and help others cope and get their lives back on track. She is very optimistic, understanding, encouraging and empathethic.

Injury scenario: Jenny, on average, sees about 15-20 di�erent patients at one time. More often than not, many are returning patients. The clinic she is working at is expanding, but has a shortage of therapists. Everyone is expected to take on at least 5 more patients. Given this mandate, Jenny has to be as e�cient as she can be, while still provid-ing the best care. She wants to see her patients get better and adapt healthily, but often notices the ine�cient appointment system her o�ce uses. Many times a patient would be given home exercises to practice, but come in for the next appointment not ready to move on. This wastes their insurance therapy allotment, while not allowing them to progress and gain independence as soon as they can. Jenny is hoping there is a system out there that can help.

Age: 29Gender: FemaleOccupation: Occupational TherapistSpecialization: Hands and upper limbsTechnical pro�ciency: 4 (Very good)Job Level: Seasoned therapist

Motivation to learn tech: 4 (Good)Other teammates: Supervisor and three other therapists on teamNumber of patients: 15-20

Interact with patients online: YesNetwork with other professionals: YesAccess to patient data online: Yes

The Therapist

Image Credits: http://static.facegfx.com/2013/sweet-smiling-female-doctor-image-download_247526736.jpg

Ideation Conceptual Mapping

In the initial stages, the �ndings from the a�nity wall were mapped to the di�erent features the application should have and a conceptual map was built. Each of the team members sketched out several di�erent ideas using this conceptual map.

The idea of building the real world experience into the application originated during these sketching and design brainstorm sessions.

Ideation Sketches

We drew a number of sketches around the idea of data visualization and patient and therapist portal.

Ideation Design Brainstroming

ExerciseMusic

1

3 4

2

After brainstorming for various designs for the exercises, we decided that all the exercises should be built around a common topic such as music, sports etc.

Exercise Senario

(Music)

ExerciseMusic

Exercise Demo

Exercise Design Demo:

http://vimeo.com/83521662

We choose music as our exercise design topic.

Each exercise is a music game with notes and scores.

Sitemap

The collective set of scenarios and fea-tures were mapped onto a user work �ow model as shown.

Liam's hand surgeon and doctor refer him to a therapist for physical therapy.

The therapist makes the decision that Liam needs to do exercises involving grasping and wrist rotation. She asks Liam to do exercises three times a day and estimates his two-week progress.

When Liam goes back and starts exercises at home, the system already has an account and exercise plan set up for him.

Scenario

1

Therapist creates a new patient pro�le.

Therapist assigns particular exercises to the patient with estimated therapy time, frequency, and estimated next meeting time.

Therapist completes pro�le and sends invitation to patient’s email.

Wireframe (Scenario 1: Therapist sets up for a new

patient)

Scenario

2

Now Liam has set up the in-home/portable system and is ready to begin!

After practicing diligently, Liam has reached his �rst goal/checkpoint! Our system noti�es his therapist for approval to continue to the next exercise/goal.Liam’s therapist sees the noti�cation, looks at his progress and approves for him to move on.

Patient chooses the exercise and prac-tices;the system dynami-cally shows the exer-cise data which he can send to the therapist for veri�ca-tion.

Wireframe (Scenario 2: Patient practises exercise)

Now that Liam knows he is doing the exercises right, he goes ahead with exercises. The system provides him encouraging words to keep continuing.

The therapist can set up a meeting if the patient needs new exercises or any consultation/guidance.

Scenario

3

The system detects the patient has reached the �rst checkpoint and displays his progress and explains what he can do to start leading a normal life like he used to before the injury.

The system noti�es patients that the system has sent a noti�cation to the therapist with information about a patient’s progress, and requests permission for patient to move onto next exercises.

Wireframe (Scenario 3: Patient

tracks progress)

Another month has now passed, and Liam is getting frustrated that he hasn’t reached his next checkpoint.

He thinks he is doing well, and performing all the exercises cor-rectly, but he is far from his next goal.

He begins to get bored and loses motivation.

Scenario

4

When the patient stops working out because of lack of motivation, the system alerts the therapist.

The therapist can set an appointment to motivate the patient or send in words of encouragement.

Wireframe (Scenario 4: Therapist manages patients)

His therapist receives noti�cation that Liam is not exercising very frequently. She checks Liam’s current progress and sends an encouraging e-mail to Liam.

Liam also receives an encouraging e-mail from his caregiver who receives noti�cation that he didn’t complete the tasks frequently.

Liam sees these messages, and decides to continue his exercises. He is again motivated and ready to work hard to regain full con-trol of his hand.

Scenario

5

Wireframe (Scenario 5: Patient is

motivated to do exercises)

Patient receives alert and motivation email from our system, caregiver and therapist.

InnoMotion system will try to motivate patient from di�erent perspectives including listing bene�ts of continuing exercise, other patient’s successful case and also listing potential loss of giving up exercise...etc.

Med-Fi Prototype

Interaction Demo: http://www.youtube.com/watch?v=xj75V19zdHo

Patient Portal

Med-Fi Prototype

Interaction Demo: http://www.youtube.com/watch?v=A87GENYXS10

Therapist Portal

Design Evaluation

We performed usability tests using medium � prototype with two patients and one therapist and we used the learnings from these tests to improve our high �delity prototype

For Med-Fi Prototype

Pre-test questionnaires and post-test questionnaires gave us an idea of the features that the users like/ dislike.

Design Evaluation For Med-Fi Prototype

Patient 1

Patient 1 : “There is a problem understanding exercise instructions. It will be helpful to have images involved in instruction.”

Patient 1: “There is no feedback on the quality of the movement during the exercise. I wish numbers would change while I do the exercise.”

Patient 2

Patient 2: “It is hard to click buttons because of the injury. So it would be better to have less buttons and have more hand gestures and voice command or other possible controls for Leap Motion.”

Patient 2: “Bar charts are boring. Users wanted to understand the exercise data and wants to see more realistic targets, more than just a doorknob.”

Therapist 1 Therapist 1: “Want some additional space for notes on the exercises to give to patients.”

Learning from Evaluation For Med-Fi Prototype

Hi-Fi Prototype

Demonstration Video Link: http://chi-goloko-team.wix.com/innomotion

Prototype Link: http://anniedream.com/InnoMotion/

Note: There is a di�erence between original interface with implemented Hi-Fi prototype

In the high �delity prototype, 1. Added a feature for the data to update dynamically while the patient performs exer-cises 2. Changed the instruction format3. Added innovative exercise designs to keep the patients motivated

We performed the second round of user testing with 3 patients and 2 therapists.

Design Evaluation For Hi-Fi Prototype

P1 Patient 1: “I like that I can receive messages from my therapists; that way I know I am doing the exercise right or wrong.”

P2Patient 2: “Real world target visualization tells me when I can actually start doing my work like I used to. That is very helpful, It keeps me motivated.”

P3Patient 3: “I want to be able to compare my performance against others with my condition so that I can be more motivated to com-plete the therapy, so I like that feature a lot.”

T1Therapist 1: “Likes recommended exercises. Encourages patients to work extra hard.”

T2Therapist 2: “I think this is a great idea and can be used to help more people do exercises easily.”

Learning from Evaluation For Hi-Fi Prototype

Image Credits: www.med.umich.eduwww.businessinsider.comhttp://play2learn2play.com

MiChartUniversity of Michigan Health

system’s clinic data management portal

S H BrownRemote monitoring and

quanti�cation of upper limb and hand function in chronic

disability conditions

Leap MotionDepth Sensing

CameraPlay2Learn2Play

DesignInspiration

In�uenceHealth System

Patients loved the idea of the application. Say if this was to be mass produced, the ideal situation would be that the therapists provide the patient with the Leap Motion device and the web application can be easily downloaded by any patient.

ExploreTechnology Limitation

This application idea can be extended to other technologies, like Wii, so that we can extend the impact of the application to other body parts as well.

FutureWork