Development of an Upper Extremity {Stroke Rehabilitation mHealth Application for sub-Saharan Africa: A Usability Study

Hughes, Charmayne; Mariscal, Tatiana; Baye, Moges; Belay, Gashaw Jember; Hintze, Amy; Padilla, Alejandra; Warner, Sam; Sera, Michael; Gordon-Murer, Chloe

doi:10.23919/istafrica.2019.8764867

Cited by 5 publications

(4 citation statements)

References 13 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.

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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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“…Stroke patients and their caregivers may have different perceptions about the features that should be in an mHealth system for post-stroke upper limb rehabilitation. To address this limitation, we have collected usability data from stroke patients and caregivers from both the United States and Ethiopia, 54,55 in which a medium fidelity prototype of the outREACH system developed based on the findings of the present study was tested. Last, we obtained information from potential users of the outREACH system via online survey.…”

Section: Discussionmentioning

confidence: 99%

Developing an mHealth app for post-stroke upper limb rehabilitation: Feedback from US and Ethiopian rehabilitation clinicians

Hughes¹,

Padilla²,

Hintze³

et al. 2019

Health Informatics J

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Stroke is the leading cause of adult disability worldwide, with 70 percent of survivors exhibiting residual impairments of the upper limb that require frequent in-person visits to rehabilitation clinic over several months. This study explored rehabilitation clinician's preferences for design features to be included in an mHealth-enabled app for post-stroke upper limb rehabilitation. Data were collected via online survey, sampling participants from Ethiopia (n = 69) and the United States (n = 75). Survey results indicated that Ethiopian and US rehabilitation clinicians have different opinions about the importance of design features that should be included in a stroke tele-rehabilitation system which are likely due to differences in culture, the availability of human and physical resources, and how the field of rehabilitation is organized and managed. Our results, thus, indicate that mHealth technologies must be tailored to the geographical and cultural context of the end users.

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Development of an Upper Extremity {Stroke Rehabilitation mHealth Application for sub-Saharan Africa: A Usability Study

Cited by 5 publications

References 13 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

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

Developing an mHealth app for post-stroke upper limb rehabilitation: Feedback from US and Ethiopian rehabilitation clinicians

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