JMIR Publications

ABSTRACT

Background:

Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite their increasing efficacy, there is a lack of uptake and sustained use of rehabilitation technologies in stroke rehabilitation. Poor usability and low user acceptance of the technology are thought to be contributing factors. As a result, there is a call for more user-centred design approaches to be used in the design and development of rehabilitation technologies.

Objective:

exciteBCI is a complex neuromodulatory wearable technology in the prototype stage that augments rehabilitation for people with stroke. The technology consists of a brain computer interface, a muscle electrical stimulator, and a mobile application. This study presents the evaluation phase of an iterative user-centred design approach that aims to i) explore users’ perspectives and experiences of exciteBCI, and how well it fits with rehabilitation and ii) facilitate modifications to exciteBCI design features.

Methods:

Iterative usability evaluation of exciteBCI was completed in two phases. Phase one consisted of a series of sprint cycles made up of single usability sessions with people with stroke (n = 4) and physiotherapists (n = 4). During their interactions with exciteBCI, participants used a ‘think-aloud’ approach followed by a semi-structured interview. At the end of each sprint cycle, device requirements were gathered, and the device was modified in preparation for the next cycle. Phase two focused on a ‘near-live’ approach in which two people with stroke and one physiotherapist participated in a 3-week programme of rehabilitation augmented by exciteBCI (n = 3). Participants completed a semi-structured interview at the end of the programme. Data were analysed from both phases using conventional content analysis.

Results:

Overall, participants perceived and experienced exciteBCI positively, and it was viewed as something that could be used in a rehabilitation context. Five interrelated themes were constructed from the data: 1) This is rehab, 2) Getting the most out of rehab, 3) It is a tool not a therapist, 4) Weighing up the benefits versus the burden, and 5) Don’t make me look different.

Conclusions:

The study offers several important findings which inform the design and implementation of rehabilitation technologies. These included: 1) the design of rehabilitation technology should support and enhance the therapeutic relationship between the patient and therapist; 2) social acceptability is a design priority in rehabilitation technology but its importance varies dependent on the use context; and 3) there is value in employing design research methods which support understanding usability in the context of sustained use. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12617001527358