A Systematic Review of Usability and Accessibility in Tele-Rehabilitation Systems

The appropriate development of tele-rehabilitation platforms requires the involvement and iterative assessments of potential users and experts in usability. Usability consists of measuring the degree to which an interactive system can be used by specified final users to achieve quantified objectives with effectiveness, efficiency, and satisfaction in a quantified context of use. Usability studies need to be complemented by an accessibility assessment. Accessibility indicates how easy it is for a person to access any content, regardless of their physical, educational, social, psychological, or cultural conditions. This chapter intends to conduct a systematic review of the literature on usability and accessibility in tele-rehabilitation platforms carried out through the PRISMA method. To do so, we searched in ACM, IEEE Xplore, Google Scholar, and Scopus databases for the most relevant papers of the last decade. The main result of the usability shows that the user experience predominates over the heuristic studies, and the usability questionnaire most used in user experience is the SUS. The main result of the accessibility reveals that the topic is only marginally studied. In addition, it is observed that Web applications do not apply the physical and cognitive accessibility standards defined by the WCAG 2.1

Usability Evaluation of E-Motion: A Virtual Rehabilitation System Designed to Demonstrate, Instruct and Monitor a Therapeutic Exercise Programme

The importance of systematic usability evaluation of virtual rehabilitation systems cannot be underestimated. We have developed a virtual rehabilitation system with the functionality to guide a user through a therapeutic exercise programme. Progression is determined by users’ ability to replicate movements as demonstrated by an on-screen character. Visual and auditory corrective feedback is provided during exercise in order to improve the user’s postural control and biomechanical alignment. The objective of this study was to evaluate the usability of our system and subsequently implement modifications aimed at improving fidelity and ease of use. The first stage of our evaluation involved conducting an expert walkthrough with six experts currently researching in areas related to the system design. Following system refinement and modification we conducted a user evaluation study with twelve novice users using VRUSE, a computerised questionnaire-based usability evaluation tool for assessment of virtual environments. Results have provided a systematic evaluation of the system, provided information for guidance on system alterations and will allow comparison of usability levels with similar virtual rehabilitation systems tested with the same protocol

Usability Evaluation of E-Motion: A Virtual Rehabilitation System Designed to Demonstrate, Instruct and Monitor a Therapeutic Exercise Programme

The importance of systematic usability evaluation of virtual rehabilitation systems cannot be underestimated. We have developed a virtual rehabilitation system with the functionality to guide a user through a therapeutic exercise programme. Progression is determined by users’ ability to replicate movements as demonstrated by an on-screen character. Visual and auditory corrective feedback is provided during exercise in order to improve the user’s postural control and biomechanical alignment. The objective of this study was to evaluate the usability of our system and subsequently implement modifications aimed at improving fidelity and ease of use. The first stage of our evaluation involved conducting an expert walkthrough with six experts currently researching in areas related to the system design. Following system refinement and modification we conducted a user evaluation study with twelve novice users using VRUSE, a computerised questionnaire-based usability evaluation tool for assessment of virtual environments. Results have provided a systematic evaluation of the system, provided information for guidance on system alterations and will allow comparison of usability levels with similar virtual rehabilitation systems tested with the same protocol

Motion-Based Video Games for Stroke Rehabilitation with Reduced Compensatory Motions

Stroke is the leading cause of long-term disability among adults in industrialized nations, with 80% of people who survive strokes experiencing motor disabilities. Recovery requires daily exercise with a high number of repetitions, often without therapist supervision. Motion-based video games can help motivate people with stroke to perform the necessary exercises to recover. We explore the design space of video games for stroke rehabilitation using Wii remotes and webcams as input devices, and share the lessons we learned about what makes games therapeutically useful. We demonstrate the feasibility of using games for home-based stroke therapy with a six-week case study. We show that exercise with games can help recovery even 17 years after the stroke, and share the lessons that we learned for game systems to be used at home as a part of outpatient therapy. As a major issue with home-based therapy, we identify that unsupervised exercises lead to compensatory motions that can impede recovery and create new health issues. We reliably detect torso compensation in shoulder exercises using a custom harness, and develop a game that meaningfully uses both exercise and compensation as inputs. We provide in-game feedback that reduces compensation in a number of ways. We evaluate alternative ways for reducing compensation in controlled experiments and show that using techniques from operant conditioning are effective in significantly reducing compensatory behavior compared to existing approaches

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

The effectiveness of upper-limb wearable technology for improving activity and participation in adult stroke survivors : a systematic review

Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. Objective: This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. Results: In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants’ stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery

WiGlove : A Passive Dynamic Orthosis for Home-based Post-stroke Rehabilitation of Hand and Wrist

Stroke survivors often experience varying levels of motor function deficits in their hands affecting their ability to perform activities of daily life. Recovering their hand functions through neurorehabilitation is a significant step in their recovery towards independent living. Home-based rehabilitation using robotic devices allows stroke survivors to train at their convenience independent of factors such as the availability of therapists’ appointments and the need for frequent travel to outpatient clinics. While many robotic solutions have been proposed to address the above concerns, most focus on training only the wrist or the fingers, neglecting the synergy between the two. To address this, the WiGlove was co-designed to allow hemiparetic stroke survivors to train both the wrist and fingers in the comfort of their homes. The central hypothesis of this work is to investigate if a device designed using user-centred methods featuring aspects of usability such as easy donning and doffing and wireless operation, can act as a feasible tool for home-based rehabilitation of the hand and wrist following stroke. In order to aid this investigation, we tackled this task in three stages of usability and feasibility evaluations. Firstly, healthy participants tried the current state of the art, the SCRIPT Passive Orthosis, as well as the WiGlove, in a counterbalanced, within-subject experiment and attested to WiGlove’s improvement in several aspects of usability such as ease of don/doffing, suitability for ADL, unblocked natural degrees of freedom, safety and aesthetic appeal. Subsequently, a heuristic evaluation with six stroke therapists validated these improvements and helped identify issues they perceived to potentially affect the device’s acceptance. Integrating this feedback, the updated WiGlove was subjected to a six-week summative feasibility evaluation with two stroke survivors, with varying levels of impairment, in their homes without supervision from the therapists. Results from this study were overwhelmingly positive on the usability and acceptance of the WiGlove. Furthermore, in the case of the first participant who trained with it for a total of 39 hours, notable improvements were observed in the participant’s hand functions. It showed that even without a prescribed training protocol, both participants were willing to train regularly with the WiGlove and its games, sometimes several times a day. These results demonstrate that WiGlove can be a promising tool for home-based rehabilitation for stroke survivors and serve as evidence for a larger user study with more participants with varying levels of motor impairments due to stroke. The findings of this study also offer preliminary evidence supporting the effectiveness of training with the WiGlove, particularly in the case of the first participant, who exhibited a significant reduction of tone in the hand as a result of increased training intensity. Owing to the participant’s satisfaction with the device, it was requested by him to extend his involvement in the study by using the WiGlove for a longer duration which was facilitated

Review of control strategies for robotic movement training after neurologic injury

There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies

Proceedings of the 8th international conference on disability, virtual reality and associated technologies (ICDVRAT 2010)

The proceedings of the conferenc