[ARTICLE] Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke – Full Text

Abstract

Background

Wearable activity monitors that track step count can increase the wearer’s physical activity and motivation but are infrequently designed for the slower gait speed and compensatory patterns after stroke. New and available technology may allow for the design of stroke-specific wearable monitoring devices, capable of detecting more than just step counts, which may enhance how rehabilitation is delivered. The objective of this study was to identify important considerations in the development of stroke-specific lower extremity wearable monitoring technology for rehabilitation, from the perspective of physical therapists and individuals with stroke.

Methods

A qualitative research design with focus groups was used to collect data. Five focus groups were conducted, audio recorded, and transcribed verbatim. Data were analyzed using content analysis to generate overarching categories representing the stakeholder considerations for the development of stroke-specific wearable monitor technology for the lower extremity.

Results

A total of 17 physical therapists took part in four focus group discussions and three individuals with stroke participated in the fifth focus group. Our analysis identified four main categories for consideration: 1) ‘Variability’ described the heterogeneity of patient presentation, therapy approaches, and therapeutic goals that are taken into account for stroke rehabilitation; 2) ‘Context of use’ described the different settings and purposes for which stakeholders could foresee employing stroke-specific wearable technology; 3) ‘Crucial design features’ identified the measures, functions, and device characteristics that should be considered for incorporation into prospective technology to enhance uptake; and 4) ‘Barriers to adopting technology’ highlighted challenges, including personal attitudes and design flaws, that may limit the integration of current and future wearable monitoring technology into clinical practice.

Conclusions

The findings from this qualitative study suggest that the development of stroke-specific lower extremity wearable monitoring technology is viewed positively by physical therapists and individuals with stroke. While a single, specific device or function may not accommodate all the variable needs of therapists and their clients, it was agreed that wearable monitoring technology could enhance how physical therapists assess and treat their clients. Future wearable devices should be developed in consideration of the highlighted design features and potential barriers for uptake.

Background

Individuals with stroke commonly face mobility limitations, beginning at stroke onset [1] and continuing past discharge into the community [2], and demonstrate a range of gait deviations due to altered motor control and resulting compensatory movement patterns [3]. Improving walking quality and quantity is a major focus of therapy [4], as doing so can improve mobility, fitness, quality of life, and prevent secondary complications [5, 6]. One avenue to target walking for individuals with stroke may be to utilize wearable monitoring technology, as previous research has shown that application of an activity monitor can improve user self-efficacy and physical activity levels in various patient populations including older adults, breast cancer survivors, and those with chronic obstructive pulmonary disease [7,8,9,10,11]. Additionally, wearable monitors have been increasingly utilized by therapists and researchers to assess various outcomes relating to exercise and physical activity, [12, 13] within therapy and between visits, to ensure exercise targets are met [14].

The majority of currently available wearable monitoring technology has not been developed specifically for stroke-related impairments and movement patterns. For example, consumer activity monitors are often limited by a minimum walking speed or movement amplitude in order to provide accurate and reliable feedback [15, 16]. Research efforts have attempted to adapt available wearable monitoring technology to meet the needs of individuals with stroke with increasing accuracy, from simple solutions such as wearing hip-situated fitness trackers at the ankle [17, 18], to developing software algorithms to analyze captured data to recognize movements patterns specific to stroke [19,20,21]. The advances in wearable monitoring have reached a point at which designing stroke-specific wearable monitoring technology is a realistic priority to assess outcome and enhance rehabilitation interventions [22].

Much of the efforts to design stroke-specific wearable monitoring technology has so far focused on the hemiparetic upper limb [23,24,25,26]. This is unsurprising, as many individuals with stroke report long-term upper limb deficits or disability [27], and upper limb recovery has been identified as a top research priority from the perspective of individuals with stroke and their health professionals [28]. Conversely, limited efforts have been made in applying sensing technology to design stroke-specific wearable monitors for the hemiparetic lower limb. Research has shown that accelerometry can be reliable and valid in measuring physical activity after stroke [29], and new technologies to quantify foot pressure, leg motion, and muscle activity are being shown to be applicable to stroke [30, 31]. Thus, there is a gap in wearable monitoring technology for individuals with stroke, between what can be designed to improve rehabilitation of the lower extremity and what is currently available.

In order to develop devices that fill this niche, it is important to involve end-users in the development process from the onset to ensure initial efforts are relevant to the individuals who will ultimately use them, [32, 33] which inevitably are individuals with stroke and their physical therapists. This user-centered design approach is optimal for identifying relevant factors and technical aspects that should inform design choices [32, 33]. Thus, the objective of the current study was to identify important considerations in the future development of stroke-specific lower extremity wearable monitoring technology for rehabilitation, from the perspective of physical therapists and individuals with stroke.[…]

 

Continue —->  Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

 

[WEB SITE] An Epilepsy Tracker So Beautiful, It Could Be Sold In An Apple Store

   

Wearables are getting smarter. Once considered little more than glorified pedometers, the wearables coming out of 2015 are going to be considerably more powerful. So powerful, in fact, that they might save lives.

That’s what the Embrace aims to do. A wearable created by the computing company Empatica, the Embrace isn’t just an attractive looking smartwatch that can do all the usual fitness-tracker tricks. It’s designed to help epileptics track and manage their seizures without feeling stigmatized.

“With the Embrace, we didn’t want to design a medical device someone living with epilepsy would be ashamed of,” explains Mladen Barbaric, a designer at Pearl Studios, which helped make the Embrace a reality. According to Barbaric, the Embrace was the result of a question: can you make a device that everyone would want to wear, even if you literally have to?

In appearance, the Embrace is about as minimalist as you can get. A thin square of metal held on your wrist with an understated magnetically clasped band, the Embrace can be used as an understated watch, telling time according to the position of two small LEDs in the central ring. Like other wearables, it connects to a smartphone app, giving you metrics on your fitness, your sleep patterns, and more.

WHY DO PEOPLE WHO ARE SICK, HAVE TO HAVE UGLY DEVICES, WHILE THE PEOPLE WHO ARE HEALTHY GET BEAUTIFUL DEVICES THAT AREN’T VERY USEFUL?

But where the Embrace differentiates itself from the competition is as an epilepsy tracker. According to statistics released in 2012 by the Institute of Medicine, one out of every 26 people in the United States will suffer an epileptic seizure in his or her lifetime. And seizures are dangerous: more people die from epileptic seizures every year than in a house fire. Yet even though there’s no shame to owning a smoke detector, many epileptics feel stigmatized by wearing epilepsy trackers.

“I became really obsessed with this question: Why do people who are sick have to have ugly devices, while the people who are healthy get beautiful devices that aren’t very useful?” Empatica founder Matteo Lai tells me. “Are people living with a chronic condition not worthy of the same design, quality and sophistication that we’re all used to? We wanted to have a device that could be sold at the Apple Store, but that was designed to save lives.”

Continue –>  An Epilepsy Tracker So Beautiful, It Could Be Sold In An Apple Store | Co.Design | business + design.