Hand rehabilitation for stroke rehabilitation

How can a prototype rehabilitation aid be re-designed using inclusive design principles for better user experience and manufacturability?

A stroke can occur at any time and any age. There are two types: one that is caused by a blockage that stops the blood flow to the affected part of the brain, and the other from internal bleeding in the brain. A much higher proportion of strokes is caused by the first category, which can result in a number of symptoms including the loss of sight, problems with speech, weakened use of, or even paralysis, of one side of the body. Some stroke survivors, may only have very slight (or ‘flicker’) movements available in the affected hand, impacting upon simple everyday activities such as getting dressed in the morning or holding a cup of tea. A stroke survivor may only be able to manage movements that you can barely see.

gripAble is a project about hand rehabilitation following a stroke. Currently, people who are undergoing physiotherapy following a stroke are given seemingly simple exercises, for example pegs to unclip, but if they are only able to manage a flicker movement, even these can seem herculean. Starting with tasks that are way beyond someone’s ability can also discourage them from practising the exercises, leaving them disheartened and frustrated. Conversely, for those who have the ability to finish the task, it can quickly become tedious, causing them to lose interest in practising the exercise. A stroke patient might only have around 40 minutes a day with a physiotherapist or occupational therapist, leaving extended periods where they must rely on self- motivation to undertake these exercises.

Using Gamification
When a stroke survivor has only a flicker movement, the brain has not fully figured out how to ‘rewire’ the function to grip yet, but in theory, the more they practise this movement, the better the return of function. The gripAble is a games controller that communicates directly with an app on a tablet that lets the user play games. Employing gamification techniques in physiotherapy exercises that they can play on their own can engage and entertain stroke survivors so that they are more likely to want to practise.

Hawys Tomos from the Helen Hamlyn Centre for Design has been working with the biomedical engineering team at Imperial College, who invented the technology to make the gripAble function, to support the development of the design and the usability of the games control. The manufacturing costs of the gripAble also presented a design challenge for the HHCD team because they wanted the product to be something that can be used at home, not just in hospitals. For this to be an inclusive product, it is most important that it is also affordable.

Testing with Occupational Therapists
In order to find out how stroke survivors would interact with objects placed in their affected hand, Hawys enlisted the help of patients in the stroke rehabilitation ward in Charing Cross Hospital who would test the many prototypes that were made. Feedback was fundamental to this project, both from the patients and also from the physiotherapists and occupational therapists, because it is not enough to know whether the product is simply comfortable for the patient to use, it’s also important  to find out whether the healthcare professionals think it can be improved so that it maximises on the rehabilitation potential.

The outcome is a lightweight games controller that can be easily opened for cleaning whilst keeping the electrics safely contained. To minimise the manufacturing costs of the product, materials have been selected carefully and the shape of the product has been kept simple and functional. From the bed to the armchair, the gripAble can be used at different stages of recovery to strengthen and improve stroke sufferers’ physical ability and independence.

Research Associate: 
Hawys Tomos

Healthcare Research Leader:   
Jonathan West


Imperial College London