Using co-design to modify an open-source rhythm game for upper limb rehabilitation after stroke

Abstract

This thesis investigates whether an open-source rhythm-based music game, modified with off-the-shelf interfaces, can serve as a low-cost and accessible platform for upper limb rehabilitation after stroke. Existing research outlines the urgent need for strategies for long-term upper limb rehabilitation interventions, particularly due to low adherence to at-home rehabilitation programmes. This research introduces the design and adaptation of innovative prototypes that combine music and gaming technologies for upper limb rehabilitation after stroke. It also delineates the significant gaps that exist in exploring the potential for existing music-based rhythm games to be used in this context and recommends future research emphasis on this basis.The research uses a participant-centred co-design approach to tailor the intervention, investigating the use of musical preferences and bespoke compositions to enhance therapeutic outcomes, and the adaptability of the intervention to accommodate different levels of hemiparesis.This study had a mixed-methods approach. Quantitative data were collected through the game’s inbuilt scoring system, demonstrating its ability to track essential formative and summative assessment metrics such as gameplay frequency, number of repetitions, and stroke survivors' scorebased progress within the game. The co-design process enabled participants to develop qualitative feedback methodologies that contributed to an iterative process of design, testing, response, and refinement.Findings highlight that long-term co-design is essential in creating effective, personalised interventions and that stroke survivors' lived experience is fundamental to include in intervention design. The intervention has the potential to facilitate a wide range of upper limb rehabilitation exercises through ‘end of movement range’ switch placements, which alleviates the need for stroke survivors to hold gaming controllers. While games that used participants' musical preferences were motivating, a method of visual, auditory and movement synchrony was developed. This further enhanced the intervention by synchronising exercise components with immersive original music compositions, pitch-based or rhythmic phrases and in-game visuals, with the goal to improving exercise timing, precision and adherence.The free open-source software is highly adaptable and can facilitate isolated, assisted, and unassisted upper limb exercises. Future research can focus on refining the gaming levels, enhancing interface mounting and including tools essential for stroke rehabilitation, such as compensation detection and online therapist intervention.This research contributes to the field of stroke rehabilitation by demonstrating the importance of co-design in prototype development and participant adherence, the synchronisation of music, movement and visuals in gaming rehabilitation interventions, and the customisation of an open-source rhythm game for upper limb rehabilitation after a stroke.</p