By the University at Buffalo
For stroke survivors, the road to recovery can be challenging, especially after leaving the hospital.
But a home-based rehabilitation system developed by University at Buffalo researchers is helping people recover from stroke at home with greater success than traditional approaches.
It’s called mRehab, and it consists of a smartphone app and 3-D-printed household objects – such as a coffee mug, bowl, door knob and key – that are customizable based on the patients’ needs. Its development over the past several years has been a collaborative effort among physical therapists, computer scientists and experts in inclusive design at UB.
mRehab was designed to guide individuals with chronic stroke through a home program, while providing them with feedback on their recovery and performance specifically pertaining to upper limb mobility. It’s the first at-home rehabilitation app that focuses on upper limb function. And it’s user-friendly, meaning patients are more likely to use it and stick with it, further improving their recovery.
“The use of technology to improve home-programs and long-term recovery is promising,” the research team concluded in a paper published over the summer in JMIR mHealth and uHealth. “It can benefit both individuals with stroke in improving function and the field of rehabilitation in better understanding long-term recovery.”
Improved Use of Upper Extremity
“We saw a shift in how participants performed with their upper extremity. So when we looked at functional activities, like picking up a pen, they made an improvement,” said Jeanne Langan, Ph.D., associate professor of rehabilitation science in UB’s School of Public Health and Health Professions and one of the lead developers of the mRehab system.
“Participants in our study were pleased that they made some progress with their upper extremity, and they were happy that they were helping to initiate changes in long-term care options,” Langan added.
After stroke, most patients enter a rehab facility, where a physical or occupational therapist helps them regain use of the affected extremity. But it’s difficult, if not improbable, that a therapist can provide direct oversight over the course of a patient’s long-term recovery. And it’s estimated that 30%-60% of stroke survivors continue to have limitations in upper extremity movements after traditional rehabilitation services.
When stroke survivors leave a rehab facility, they’re often provided with a Theraputty or Theraband to use as part of their at-home rehabilitation. Each participant in the mRehab study received those two items as part of their initial treatment regimen.
Traditional Rehab Programs Lacking in Feedback
“Most of them do not know where that Theraputty or Theraband is now. They stopped using it because it wasn’t that engaging,” Langan said. “They didn’t know if they were doing well or not, so they were very pleased with the feedback that the mRehab system gave them. They liked that it made a little happy noise every time they did something.”
“The idea was to create a simple and intuitive feedback method for the end users to be able to use the system,” added Heamchand Subryan, director of interaction design for the Center for Inclusive Design and Environmental Access (IDEA Center), housed in UB’s School of Architecture and Planning.
Subryan worked on the design of the physical objects used in the program, as well as the user interface for the mRehab app.
“If these prompts or feedback are easy for them to understand, it will be better for their overall rehab program,” he said.
Lora Cavuoto, Ph.D., associate professor of industrial and systems engineering, who also worked on the user-centered design and human factors, noted the research team has been integrating end user feedback as the design of the system has evolved.
mRehab study participants received a box containing a smartphone with the mRehab app loaded onto it, along with 3-D printed household objects. The box acted as a prop, guiding users through the exercises and activities. The objects were customized based on whether a participant was left- or right-handed.
“Much of the design of the 3-D-printed objects we created took into account how comfortable a user would be in actually using these objects as part of the home program,” Subryan said.
A More Reliable Snapshot of Progress
The program guides participants through activities of daily living – sipping from a coffee mug, for example. The app tracks the time it takes the person to complete each activity, and the smoothness and accuracy of their movements.
“When the user performs those activities, we can assess their performance and assign a quantitative score, which helps them understand any improvement they are making in their motor skills and functions,” said Wenyao Xu, Ph.D., associate professor of computer science and engineering in UB’s School of Engineering and Applied Sciences.
Toward that end, the app offers a more reliable snapshot of a person’s at-home recovery progress, Langan said.
“People exercise in different ways and different amounts. That’s why having a record of a user’s home program is so beneficial to their recovery. The app can track when they use it, and how many reps they do of a certain activity. When we gave out Theraputty and Theraband, we didn’t know how they were using it.”
The team has been refining the mRehab app and program since 2016. Members are continuing to review the data collected from their initial study, and plan to publish further research focusing on the usability and success of the mRehab app.