Development of a mHealth System for Post-Stroke Upper Limb Rehabilitation in Medically Underserved Populations: An Iterative Usability Study

Hughes, Charmayne; Hintze, Amy; Padilla, Alejandra; Mariscal, Tatiana; Warner, Sam; Sera, Michael; Peng, Tony

doi:10.1109/ghtc.2018.8601786

Cited by 10 publications

(17 citation statements)

References 25 publications

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“…In addition, to improve uptake and scalability of the outREACH sensor for tele-rehabilitation purposes, we have considered the barriers to, and enablers of, stroke tele-rehabilitation from the perspective of sub-Saharan African healthcare professionals and stroke patients (cf. Hughes et al, 2018, 2019a,b). For example, in Hughes et al (2019b), a user-centered approach was used to determine possible features that US- and Ethiopia-based rehabilitation clinicians felt should be implemented into the outREACH system.…”

Section: Discussionmentioning

confidence: 98%

“…Results of that study indicated that Ethiopian clinicians felt that integrated sensors that collect quantitative data about movement quality and strategy would be a very important feature and should be included in a stroke tele-rehabilitation system. As this project moves forward, efforts will be focused on integrating the sensor into the outREACH mHealth application that leverages tele-monitoring and tele-consultation in order to improve rehabilitation access and care in sub-Saharan Africa stroke patients (Hughes et al, 2018, 2019a,b).…”

Section: Discussionmentioning

confidence: 99%

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Development of a Post-stroke Upper Limb Rehabilitation Wearable Sensor for Use in Sub-Saharan Africa: A Pilot Validation Study

Hughes

Louie

Sun

et al. 2019

Front. Bioeng. Biotechnol.

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The development of context-appropriate sensor technologies could alleviate the significant burden of stroke in Sub-Saharan African rehabilitation clinicians and health care facilities. However, many commercially available wearable sensors are beyond the financial capabilities of the majority of African persons. In this study, we evaluated the concurrent validity of a low-cost wearable sensor (i.e., the outREACH sensor) to measure upper limb movement kinematics of 31 healthy persons, using an 8-camera Vicon motion capture system as the reference standard. The outREACH sensor showed high correlation (r range: 0.808–0.990) and agreement (mean difference range: −1.60 to 1.10) with the reference system regardless of task or kinematic parameter. Moreover, Bland-Altman analyses indicated that there were no significant systematic errors present. This study indicates that upper limb movement kinematics can be accurately measured using the outREACH sensor, and have the potential to enhance stroke evaluation and rehabilitation in sub-Saharan Africa.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Development of a Post-stroke Upper Limb Rehabilitation Wearable Sensor for Use in Sub-Saharan Africa: A Pilot Validation Study

Hughes

Louie

Sun

et al. 2019

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

show abstract

“…Similar studies carried out within other medical fields have also detected and addressed several issues regarding the feasibility and usability of mHealth interventions. Among these, several also used an iterative approach, which is an established usability strategy . Altogether, this highlights the necessity of development and usability studies when creating mHealth interventions.…”

Section: Discussionmentioning

confidence: 99%

Biofeedback Treatment App for Pediatric Migraine: Development and Usability Study

et al. 2020

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Objective.-The objective of this study was to develop and investigate the usability of a biofeedback treatment smartphone app for adolescent migraine sufferers.Background.-Biofeedback is effective in treating pediatric migraine. However, biofeedback is not widely used due to the necessity of a trained therapist and specialized equipment. Emerging digital technology, including smartphones and wearables, enables new ways of administering biofeedback.Methods.-In a prospective open-label development and usability study, 10 adolescent migraine sufferers used a newly developed biofeedback app with wearable sensors that measured their muscle tension, finger temperature, and heart rate. Three iterative rounds of usability testing, including a 2-week home testing period, were completed. A biofeedback algorithm, combining and optimizing the 3 physiological modalities, and several algorithms for sham-treatment were created. Usability was evaluated statistically and summarized thematically.Results.-Five of ten participants completed all 3 rounds of usability testing. A total of 72 biofeedback sessions were completed. Usability scoring was consistently high, with median scores ranging from 3.5 to 4.5 on a 5-point scale. The biofeedback optimization algorithm correlated excellently to the raw physiological measurements (r = 0.85, P < .001). The intervention was safe and tolerable.Conclusion.-We developed an app for young migraine sufferers to receive therapist-independent biofeedback. The app underwent a rigorous development process as well as usability and feasibility testing. It is now ready for clinical trials.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…With this in mind, future work will employ a user-centered approach to design a simple, clear, and culturally relevant mobile application available in both English and Amharic (official language of Ethiopia). In addition, we will work to refine the algorithms and integrate them with the outREACH mobile application (15,(29)(30)(31) so that upper limb kinematics can be characterized on-line. Despite the numerous barriers for individuals with acquired brain injury, participants provided overall positive feedback regarding the possibility to continue post-acquired brain injury care in their home environment with the outREACH sensor.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Upper Limb Motor Function in Ethiopian Acquired Brain Injured Patients Using a Low-Cost Wearable Sensor

et al. 2019

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Acquired brain injuries place a significant burden on sub-Saharan African rehabilitation clinicians and health care facilities. While wearable sensors have the potential to alleviate these issues, many are beyond the financial capabilities of the majority of African persons and clinics. To bridge this gap, we have developed a low-cost wrist-worn sensor (the outREACH sensor) capable of accurately measuring upper limb movement kinematics. In this study we evaluated the extent to which the outREACH sensor is sensitive to the hand performing the task (unimpaired, impaired) and level of impairment (mild, moderate) in 14 Ethiopian persons with acquired brain injury (mean age = 51.6 ± 12.2 years, 1 female, 13 male). Participants performed an object manipulation task with both the impaired and the unimpaired limb, and reaching performance was measured using standard kinematic measures (i.e., movement time, spectral arc length, peak velocity, peak acceleration, mean velocity, mean acceleration). Overall, movements were smoother and faster when performed by the patient's unimpaired limb. In contrast, maximum velocity did not differ between the two limbs. Moreover, the outREACH sensor was sensitive to differences in performance-based upper limb impairment. Fugl-Meyer assessment for upper extremity scores were significantly correlated with movement time, spectral arc length, and peak velocity. Upper limb movement kinematics can be accurately measured using the outREACH sensor. The outREACH sensor can be a valuable addition to standardized clinical measures that provides rehabilitation clinicians with information regarding initial upper limb impairment level and changes in function across the rehabilitation lifespan.

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Development of a mHealth System for Post-Stroke Upper Limb Rehabilitation in Medically Underserved Populations: An Iterative Usability Study

Cited by 10 publications

References 25 publications

Development of a Post-stroke Upper Limb Rehabilitation Wearable Sensor for Use in Sub-Saharan Africa: A Pilot Validation Study

Development of a Post-stroke Upper Limb Rehabilitation Wearable Sensor for Use in Sub-Saharan Africa: A Pilot Validation Study

Biofeedback Treatment App for Pediatric Migraine: Development and Usability Study

Quantitative Assessment of Upper Limb Motor Function in Ethiopian Acquired Brain Injured Patients Using a Low-Cost Wearable Sensor

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