ReforMe

Setting

The University of Sydney

Semester 2 2016

DECO3200 - Interactive Product Design Studio

Created by Christopher Simpson, Isabella Bain and Zachary Bacon

Project Background

The objectives for the third year assignment was to in 12 weeks design a solution that would help support the health and well-being of a user. Through the use of interactive technologies carried on the body and/or embedded in the user’s environment. Our goal was to find an area of health that we were interested in and then explore avenues that we could implement a solution to help improve user’s mindfulness, health and wellbeing.

Solution Overview

ReforMe is a wearable technology solution and mobile application that assists in the rehabilitation of musculoskeletal disorders (MSD) currently focusing on knee rehabilitation. Moving into the area of smart clothing, patients wearing ReforMe are able to track, analyse and report their rehabilitation while having the support our application. Utilising an Electromyography (EMG), Flexible variable resistor and a customer built pressure sensor we are able to track rehabilitation exercise targets, maintain exercise schedules, recommended activities and build a supportive community around the user. ReforMe’s ‘Social Forest’ reflects the communities combined rehabilitation progress, empowering and rewarding their hard tiresome journey.

Grounding Research & Project Justification

Disorders (MSD) are injuries and disorders that affect the human body’s movement or musculoskeletal system (muscles, tendons, ligaments, nerves, discs, blood vessels). Currently 28% of Australians are effected by some spectrum of MSD. Presently the blanket definition allows for the consideration of all risk factors that may accompany injuries, instead of only one. This definition also opens up the conversation about the shared responsibility between the employer and employee, with MSD being the single largest category of workplace injuries. In 2011 MSD was responsible for almost 30% of all worker’s compensation costs in the U.S., with direct costs to companies up to 50 billion dollars.

Due to the increasing demographic with the decision was made to focus on lower limbed MSD, however maintaining the long term Potential that this solution would be transferable to a more inclusive of all MSD/ Rehabilitation patients in the future. As stated by the Australia Institute of Health and Welfare between 2004 and 2014 within Australia there was a 32% increase of knee replacement surgery. 2 in 10 MSD patients had also reported experiencing a poorer quality of mental health and general wellbeing during surgery and rehabilitation time.

After finding these specific statistics pointing at our chosen target audience we were able to define our problem statement as being; To create a wearable technology solution for lower body musculoskeletal disorders (MSD) to better educate, assist and enhance the patient experience during their physical rehabilitation therapy.

Using this as the foundation we now defined our primary user as early age professionals recovering from lower limb related MSD injury returning to their normal daily activities. The pain points we identified included; a possible rehabilitation time of 7 weeks to 7 months on average, possible direct costs of $15,000 to patient and indirect cost of $75,000 per patient.

For us to best support our users it was paramount that we created a product that would not identify or red-flag patients as being effect by or suffering from MSD and the negative community stigma that can come from this.

The best approach was to embed extrinsic motivation into our system, defined as techniques such as badges, competition, money and rewards as it is most effective “for simple, rote tasks” - Kumar and Herger, like the rehabilitation process. Our system would discreetly notify, motivate and track the user’s movements so that they could make a stronger, faster and more successful recovery while working in tandem with the physiotherapist.

Additional Research

Mindfulness

Mindfulness can help improve physical health across a range of methods. These techniques can be applied to physical therapy as patients are required to spend large amounts of time doing exercises to reform muscle growth and general strength in the body. By using mindfulness techniques in combination with these exercises patients are able to improve mental space and general health and wellbeing.

Motivation & Gamification

There are two main types of motivation: Intrinsic motivation which involves motivation via autonomy, mastery, learning and finding meaning or Extrinsic Motivation techniques such as badges, competition, money, rewards. Kumar and Herger explain that “extrinsic motivational techniques are effective for simple, rote tasks” and that “for complex problem-solving tasks, people are intrinsically motivated by a sense of autonomy, mastery, and meaning.’’ (2013). Based on this definition ReforMe will be designed to encompass extrinsic due to the rote nature of rehabilitation exercises. Another key concept when utilizing gamification in design is flow. Flow is the balance between frustration and boredom. Kumar and Herger state, “When a task is too difficult, it causes people to be anxious. When a task is too easy, it causes boredom.” (2013) A state of heightened focus and immersion is achieved when the balance between the two is just right. This is known as the flow state.

4 Types of Fun

Hard fun which provides the opportunity for challenge, mastery and feelings of accomplishment

Easy fun inspired by exploration and role play

Serious fun refers to purposeful play and changes how players think, feel, behave and make a difference in the real world

People fun provides an excuse to hang out with friends

User Research

Key Quotes from Physiotherapist (Stakeholders)

Factors stopping recovery: Job requirements, sitting posture, core strength, motivation, education.

Current Technology: The ViMove (existing EMG based solution) is fiddly and hard to use in clinical practice and expensive to give to people to take home. Dependent on pain patterns, muscle imbalances, posture

Activities during recovery: increase reps/sets, added free weights, progression of exercise difficulty – Clamshell, bridge, singe leg bridge, wall squat, squat, plank, double leg raises, sit up

Attitudes during recovery: Changing depending on how well you educate their situation – initially start with a time line so they know what is going on/coming up – kind of hard to begin.

Key Quotes from Patients (Users)

“Most stressful part was the first 8 weeks post the operation - not being able to do anything active as my arm was in a sling which limited my daily activities a whole lot.”

“Annoying part is having to do exercises that can hurt a bit, I forget to do my at home rehab exercises not once a day but at least 3 times which is difficult when you have a full day of things to do as it's easy to forget.”

“My muscles had deteriorated quite substantially so I had to build them back using the therapy band and going to the gym. It was really tedious and boring. A lot of simple exercises.”

“Towards the end of my recovery I just wanted to get back into running and playing sport. I slacked off on the excursuses using the therapy band and things like calf raises beaches I just wanted to run”

User Research Takeaways

Key Demographic

18 to 58 year old MSD patients who are undergoing an average of 3-8 months of rehabilitation.

Current User Pain Points

• Rehabilitation exercises are really tedious and boring.
• Many of the exercises are relatively simple, but repetitive.
• Users often forgot to complete rehabilitation exercises.
• Users attitudes changed depending on how educated they were on the recovery process.
• Initial rehabilitation time line vary on a patient by patient basis.

In order to gauge our users pain points a series of surveys and interviews were conducted. These targeted patents (users) and physiotherapists  (stakeholders) who were dealing with musculoskeletal disorders. Questions to users focused on their attitudes, pain points and experiences within their current process during rehabilitation and questions to physiotherapists related to what is currently being implemented during rehabilitation, their attitudes towards this process and some of the key exercises that are required for successful rehabilitation. During this phase question were kept broad to allow research on a range of musculoskeletal disorders to be collected so that future integration could be incorporated.

User Needs

• Regularly perform rehabilitation exercises.
• To be Educated to make more informed decisions.
• Reminders to do exercises outside of physical therapy.
• Guides to completing prescribed exercises.
• Ability to track and record recovery performance during exercises sessions.
• Ways to report how exercises are going to patient’s physical therapists for more accurate ongoing support.
• Motivation to complete prescribed exercises.

System Constraints

• The system needs to be small, light, discrete, not ‘appear medical’ or challenge the identity of the user. (Red Flag)
• The wearable technology needs to be able to be seamlessly integrated into users daily lives.
• Systems needs to be cost effective and be widely availability for patient use.
• The interface needs to be simple and easy to use.
• System need to be uplifting and motivating the user in an overall positive way.

Final Design Statement

To create a wearable technology solution for lower body musculoskeletal disorders (MSD) to better educate, assist and enhance the patient experience during their physical rehabilitation therapy.

Technical Experiments

1. EMG Sensors

An electromyography sensor measures the electrical activity of a muscle. It is important that the sensor is located on the right part of the muscle to get the best reading possible. Best placement is on the midline of the muscle belly between an innervation zone and a myotendon junction. It is also best to clean the skin thoroughly before applying the electrode. The electrodes also have to be stuck onto the skin with a sticky adhesive, which poses a problem for integration into a wearable such as a sock. It takes away part of the ease of using a piece of clothing like a sock, which is easily removable.

2. Accelerometers

Accelerometers measure acceleration. They are often useful for sensing vibrations and orientation. Accelerometers can measure two types of acceleration, static and dynamic. Static acceleration is used to determine the orientation, and dynamic acceleration is used to measure how fast the device is moving. Accelerometers could be used to measure the angle of a knee joint by having an accelerometer attached to the leg and measuring the static acceleration.

3. Flex Sensors

Flex sensors can be used to measure bending, by the resistance increasing as it bends. A flat flex sensor has a resistance of 30kΩ and when bent to 90º the resistance will increase to as much as 70kΩ. Flex sensors are limited in that they can only flex in one direction. Flex sensors could be useful for measuring the angle of a joint.

4. Pressure Sensor

Also called Force Sensitive Resistors. The amount of pressure that is applied to the FSR varies the resistance of the sensor. The harder the force, the lower the resistance. The weight range of an FSR varies from sensor to sensor, but most commercially available sensors will have a weight range of 0.1kg-10kg. These sensors aren’t reliably accurate, and are best used to detect pressure rather than measure it. An array of FSR’s attached to a sole in a shoe could be useful for determining which areas of the sole are receiving the most pressure.

Initial Design

High Fidelity Mock-up

Usability Testing

The first type of testing completed during and throughout the development of ReforMe  was usability testing with the focus on making our designs, products and services as accepting into the user’s lifestyles (these users being patients, physiotherapists and the support team). This was to maximize the chance of early adoption receiving the right support from our desired target market. This was demonstrated when we organised a meeting a with a sport rehabilitation and MSD specialist from the University of Sydney (Due to commercial associations they asked not be named when publishing ReforMe results). During this interview we had a lot of positive feedback with the high endorsements going to the application design and the extensive range of sensors we incorporated into the wearable producing highly accurate tracking

Project Evaluation

Functional Testing

Secondly we completed Functional testing, this was to see how the physical components were interacting with the system. As the prototype was built to be representative of a scalable system it was important to ensure what the data being produced was accurate and relevant to what ReforMe’s users needed. During testing, the flex sensor provided an accurate response to movement within the knee which showed in our tests while the EMG sensor had minor data issues but maintained consistent results once the sensor was fitted properly to participants. The data produced was effective in measuring muscle tension allowing us to know if the user needed to push themselves further or inform them they were working too hard enabling the prompting of rehabilitation technique improvements. During one stage it was identified that the store bought pressure sensor limited the ability to detect where weight was being placed on the bottom of the foot. This was resolved through the creation of a custom pressure sensor that not only reduced our fabrication costs but increased the accuracy our data. Combining all of these sensors within a sock proved to us and the user to be a reliable, resistant and unobtrusive method.

Usability Testing Video

Click Through Prototype

Christopher Simpson

Development Lead

Zachary Bacon

Research/Project Team

Isabella Bain

Design Lead