MOTIVAID —
REHABILITATION DEVICE for SCAPHOLUNATE (SL) WRIST INSTABILITY PATIENTS
for Reinier Haga Orthopaedisch Centrum in 2021
Advanced Embodiment Design (AED) Course - 20 weeks
with Alies Schrroo, Eda Karaosmanoglu & Julia Pongratz
Design Coach: Ruben van der Horst
Client & Design Assignment
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The assignment was to (re)design a rehabilitation device that helps patients with SL (scapholunate) wrist instability conditions to perform physiotherapy exercises regularly and correctly. The product should also be compatible with the use case where it is owned by the hospital and used by the patients interchangeably.
The project was in collaboration with the Reinier Haga Orthopaedisch Centrum that provides expertise in the medical necessity and effectiveness of the revalidation exercises.
Injury & Target User
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The SL wrist instability happens when the ligament between two bones in the wrist is disrupted and the bones drift apart as shown in the illustration. This condition causes patients to experience severe pain, complications to keep their wrist stable, and inability to use their wrists normally in their daily life. The condition is often treated by physiotherapy exercises, which is a long recovery process. The target group is B2 type patients who do not follow their rehabilitation plan. They neglect exercising which in many cases results in surgery. A large part of these patients also has additional conditions such as anxiety disorder and depression on top of their wrist condition. The largest age group is between 20 to 30 years old, and 90% use brace during rehabilitation.
Exercise
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The exercises need to be performed 3 times a day for around nine to twelve months of treatment to strengthen the wrist muscles. Because of this, the brace needs to be removed during the exercises. It is essential that the hand stays in a straight, neutral position while it is moved up and down at a slow pace.
Effectiveness of the Feedback Mechanism of the Prototype
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The initial prototype helps patients during their exercise by giving real-time feedback. Patients have to follow a line on a digital interface by moving their arms up and down in a straight position. The sensors on the wrist and the palm unit can measure the position and angle of the wrist, and pace of the up-down movements.
Our research study with six user representatives suggests that the unclarity of the feedback mechanism was confusing and the feedback couldn’t be processed by most of the subjects. Keeping the focus away from the wrist and on the apart digital interface hindered the effectiveness of the exercise. Moreover, the participants mentioned the boredom they experienced during the use of the prototype due to monotonous, repetitve feedback.
Effectiveness of the Feedback Mechanism
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Our findings from a study conducted with six user representatives suggest that the clarity and usability of the feedback mechanism should comply with each other for a better user experience. The uncertainty in the feedback confused and couldn’t be processed by most of the subjects. Moreover, keeping the focus away from the wrist and on the digital interface hindered the effectiveness of the exercise.
Mapping User Experience
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A detailed analysis in the areas of product aesthetics, meaning, and evoked emotions was conducted by identifying 9 moments of product/user experience (micro, macro, and meta level of aesthetics, meaning, and emotion) for the current and the desired usage.
For the design intervention, it was decided to focus on the two moments of the product experience: macro level of emotion and micro level of meaning. By focusing on these moments both motivational and ergonomics aspects of the product experience were addressed.
Project Scope and Design Goal
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After thorough analysis of the initial design problem (the patients are not following their exercise plan and it results in surgery) in the light of the findings, a design goal was formulated. Next to the design goal, the design scope was defined to guide the ideation process.
Idea Generation
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The team utilised two methods for the ideation. The first one was using How-to questions that were derived from the problem definition. The team developed ideas for each How-to question and worked on improving each other’s ideas. The second method was Design with Intent (DWI). Since the main objective was changing the patients’ behavior towards the exercise, it was important to find ways to influence or manipulate their attitude. The results of the idea generation were added under the relevant How-to questions defined earlier.
Idea Selection & Combining
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C-Box matrices were used for each question to determine the most promising ideas in terms of their implementability and innovativeness to move on with. After placing ideas into C-Box matrices, a further selection of ideas was made to create the morphological chart to help come up with concepts.
Concept Selection
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As a conclusion of team reflection, expertise feedback, and the client preference, it was decided to choose the concept that merges brace use with the physiotherapy device. This concept involves the brace in the daily exercises to create a more convenient use case for the patients. Considering that 90% of the patients use the brace in daily life for the first three months, combining the exercise device with the brace is a promising option to increase engagement with the exercise plan.
With a pace animation and posture correction arrows, the display module help enable the patients to do their exiercises correctly. Besides, motivational messages received via the display module encourage the patients to exercise regularly.
Testing with Experts
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The test was conducted in the Reinier Haga Orthopedic Center in Zoetermeer with four doctors from the hospital, one of them had slight SL instability complaints. During the test, the participants tried out all the prototypes and expressed their opinions.
The selected option (marked with a star) offers a convenient usage with its easy ring module placement (push from the top) and its adjustable cord which makes the product adaptable for different hand sizes. The fact that it is adjustable and does not occupy the palm makes this option suitable for other exercises in the rehabilitation process.
User Experience Measurement
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During the research, the participants were asked to try out multiple prototypes contained improved features (including reminder animations, vibration patterns, closure mechanism, strap surface patterns, feedback about pace; posture correction; repetition count, completion, and motivational messages) and evaluate their experience.
The main research questions:
1. How comfortable are the wrist- and hand-attachment units of new design alternatives for the participants?
2. How engaging is the overall experience with the product?
1. How comfortable are the wrist- and hand-attachment units of new design alternatives for the participants?
2. How engaging is the overall experience with the product?
Wrist & Display Module Development
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For the further improvement of how the parts come together, several prototypes were made. The base/bottom part was designed to keep the straps and tip of the cord together. There were three options designed for the attachment of the display module to the display dock defined on the wrist module. The ‘press and release’ mechanism was chosen because of its easy placement and removal.
Strap Guide & Brace Dock
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Several iterations were made to improve the grip of the magnetic closure mechanism - the option marked with a start was selected. The brace holding dock was improved in a way that it is possible to implement it to the current brace making process at the hospital. Fastenars provide a strong grip that dock securely stays on the brace.
Final Product - MotivAid
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The MotivAid is a smart wearable rehabilitation device to improve the patients’ adherence to the SL (Scapholunate) wrist instability exercises. The product offers an innovative and holistic approach to increase the patients’ motivation and engagement towards the long rehabilitation process. Thanks to the features like pace animation, posture correction, and repetition, the product helps the patients exercise corrently. With the motivational and informative messages through the swappable display module and the mobile app, the patients’ engagement is increased and their perception of the effectiveness of the exercises improved. Besides, the communication network of patients and health professionals offers a holistic and accessible consultancy experience.
Reminder Function
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With its encouraging reminders, MotivAid facilitates the incorporation of exercises into the patients’ everyday routine. For the initial period of the rehabilitation process (3 months), brace use is highly common (according to the client 90% of the patients use brace during this period). To take advantage of this opportunity, the brace is turned into a smart product to remind the patients of the exercise times through the display module. The animations work together with vibration patterns to ensure that the patients notice the reminder.
Display Module Removal & Placements
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When it is time to exercise, the display module needs to be detached from the brace dock by using the release buttons and then the brace needs to be taken off. After putting the wrist module on, the display module is placed by simply pushing it into its dock. By doing that, the sensor in the finger module is connected to the display module.
Secure & Comfortable Attachment
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The patients should be able to wear the product easily and comfortably due to one-hand usage. The wrist module is worn easily on the arm above the wrist, thanks to the magnetic strap. The placement helps patients to have a better view over their wrist and prevents the wrist module from putting any pressure on the sensitive wrist.
Adjustability
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There are adjustable features to make the product fit in different hand and finger sizes. First, adjustable cord length: When it is too loose or too short the patients just need to pull the cord to adjust. Second, adjustable ring unit: Thanks to the steel spring wires in the ring unit, it is easily adjustable by squeezing it.
Exercise Correction & Repetition Count
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During the exercise, the pace animation enables patients to keep the right pace of the movements. The multimodal feedback mechanism ensures that the patients do the exercise correctly. When the wrist posture is wrong or deviated more than it is allowed to (defined by a physiotherapist), the product warns the user with visual and vibrotactile feedback. The directing arrow appears until the position is corrected. Besides, the counting animation is embedded in the pace animation.
End of Exercise
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At the end of the exercise, the product compliments the user by displaying “Well Done!”. After that, it informs the patient about their progress and achievements. Dividing the long rehabilitation process into different phases and setting goals for each phase make the process more credible.
IoT Architecture
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An Internet of Things (IoT) Architecture of the system was created to show how the data collected from sensors is transferred, processed, and stored during the data flow through the network of the product, the user’s mobile device, the cloud, and healthcare professionals.
Holistic Digital Interaction
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The patients receive motivating and encouraging messages from the device or the healthcare professionals based on their progress and improvement. Through the app the patients can follow their progress by detailed statistics, see the most frequent pain points, and receive tips to improve their performance. The app also provides a platform to communicate with the physiotherapist and other professionals in the healthcare network. The physiotherapists can set and adjust the exercise plan of their patients through the app. Physiotherapists can remotely follow their patients’ progress and communicate with them accordingly, offering a visit or complimenting their progress. This way, in-person visits can be used more effectively.
Working Principle & Easy Maintenance
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There are 2 IMU sensors in the product containing an accelerometer, magnetometer, and gyroscope to track the movements. One of these sensors is placed in the display module, the other one is in the finger module. They are connected with the wires located in the cord. These two 9DoF sensors together determine the position of the wrist. To give the right feedback they compare the data of the hand-sensor to the wrist-sensor.
With its highly modular design, it is easy to repair and replace the parts of the product. Besides, neoprene fabric of the initial prototype is replaced with TPU material for a longer life span.
Final Evaluation
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The final prototype was evaluated by two participants. The user representatives with a long-term rehabilitation history took part in the test. The participants were given brief information about the product and the exercise. They were asked to perform the exercise and during their performance, their opinions about the product features were asked. As a result of the test, the overall feedback mechanism of the product was found clear and understandable.
