Master of Science

thesisStroke is a leading cause of death and adult disability in the United States. Survivors lose abilities that were controlled by the affected area of the brain. Rehabilitation therapy is administered to help survivors regain control of lost functional abilities. The number of sessions that stroke survivors attend are limited to the availability of a clinic close to their residence and the amount of time friends and family can devote to help them commute, as most are incapable of driving. Home-based therapy using virtual reality and computer games have the potential of solving these issues, increasing the amount of independent therapy performed by patients. This thesis presents the design, development and testing of a low-cost system, potentially suitable for use in the home environment. This system is designed for rehabilitation of the impaired upper limb of stroke survivors. A Microsoft Kinect was used to track the position of the patient's hand and the game requires the user to move the arm over increasing large areas by sliding the arm on a support. Studies were performed with six stroke survivors and five control subjects to determine the feasibility of the system. Patients played the game for 6 to 10 days and their game scores, range of motion and Fugl-Meyer scores were recorded for analysis. Statistically significant (p<0.05) differences were found between the game scores of the first and last day of the study. Furthermore, acceptability surveys revealed patients enjoyed playing the game, found this kind of therapy more enjoyable than conventional therapy and were willing to use the system in the home environment. Future work in the system will be focused on larger studies, improving the comfort of patients while playing the game, and developing new games that address cognitive issues and integrate art and therapy

An interactionist framework for understanding the acceptance, rejection and use of health and care technologies

My research makes an empirically informed, theoretical contribution to understanding how health and care technologies are accepted, rejected and used by older people and stroke survivors. Current research on health and care technologies such as telecare and telerehabilitation systems has not tended to investigate questions such as what the technologies mean to users, how users appropriate and interact with the technologies on a daily basis, and the significance that these technologies can have within the context of users' everyday lives. Drawing on key concepts from structural symbolic interactionism, the life course perspective and the domestication framework, my research explores the relationships between users and technologies in contexts. These relationships are negotiated through interaction, are meaningful and unfold over time as individuals navigate the life course. A collective case study research design is adopted focusing on how users appropriate and interact with telecare and telerehabilitation systems. Two cases are supported by data from qualitative interviews with older people (n=19) and stroke survivors (n=4), respectively. Data analysis is conducted in light of an analytical framework, which draws attention to users' interpretations of the technologies, and the processes of meaning making and social interaction. These processes shape a technology's acceptance, rejection and use. Findings suggest that individuals interpret health and care technologies in different ways and that meaning is constructed through processes of appropriation and interaction. It is through interaction, with technologies and with others, that meanings are negotiated. These meanings are shaped by individuals' identities and roles, and their agency and capacity to participate in situated action. I contribute an interactionist framework that conceptualises these complex relationships. The framework provides a means of exploring and understanding the acceptance, rejection and use of health and care technologies that does not under- or over-play individual agency or the affordances and 'scripts' of these technologies