HealingHand.Tech

Stroke Patient Rehabilitation App

This app was a group project designed specifically for a client, where the focus is on the rehabilitation of stroke patients. This particular project's challenges were not only the design of the app itself, but figuring out how to work with a team and seamlessly blend multiple voices and ideas into one cohesive functioning app where we all felt heard and were proud of the product we produced.

The Challenge

The client has created an app for rehabilitation for stroke victims focusing on utilizing motion sensor capture and gamification to improve upper body mobility. The client needs to utilize UX Research and UX Design best practices to improve user experience specifically as it relates to adoption and consistent, repeat usage/engagement via streamlined easy to use processes.

Product Goals

Implement a rigorous research based human design centered methodology to conduct secondary research to discover what the current best practices are with similar stroke rehabilitation solutions, and primary research to define user experience needs.
This research will be combined with usability testing with stroke survivors and their family caregivers to ensure that the redesign of the solution has a sufficiently varied and tested pool of users, and their user needs are represented in the product and its iterative testing phases.

Business Goals

Define, find and observe users of these stroke rehabilitation apps via remote testing to determine how to create the optimal user experience while meeting the medical needs of the patients, and the business needs of the client.
In this case, as a startup, the business need of the client is to have a working prototype that implements human centered design best practices for stroke rehabilitation patients to show a validated concept to potential clients, investors, and partners in the medical field.

Identifying Users

Our total user group are stroke patients who are 40+ years old.
75% of stroke victims are 65+ years of age
They experience difficulties in accessing rehab centers.
Many of them are unemployed after a stroke and are budget-conscious because of their current situation, so even if they have access to the rehab center, the price can be a limiting factor.
The patients are shocked and lost both mentally and physically. Each patient shows a difference in motivation level. Some experience post-stroke depression with no motivation.
However, the younger stroke survivors tend to be more motivated as they want to return to work. The survivors want an easy but efficient way to recover.
The faster they start rehab, the better the outcome will be. The survivors want independent and easy access to rehab.
The company plans to advertise through hospitals, rehab units, and support groups.
Some would be tech-illiterate and, thus, would need an app that is easy to use and provides clear instructions.
It is essential to remember that ⅓ of stroke patients have some visual impairment, so the accessibility for visual impairment is crucial.

Refining Pain Points & User Needs

Pain Points

Frustrated with physical limitations post stroke
Physically and emotionally depleted from stroke event
Emotionally depleted and with limited control over body and mind due to stroke event
Users face isolation in their rehabilitation process
Users receive minimal rehabilitation in the hospital post stroke event and are left to themselves for additional rehabilitation work
Users are often un-employed or under-employed post stroke event and have limited resources to spend on rehabilitation services

User Needs:

Flat navigational access to their rehabilitation exercies
Elegant design requirement that all major elements of app navigation can be completed in the least amount of steps
Want to feel connected to a community of individuals in similar rehabilitation scenarios
A simple, non-intimidating and comfortable way to rehabilitate themselves in order to acheive their rehabilitation goals and return to their "norm"
A continued guidance in the process of rehabilitation after leaving the hospital

Roles & Responsibilities

Yasmina Boulahcen - UI/UX Designer & Researcher

Jennifer Moon - UI/UX Designer & Researcher

Rebecca Noh - UI/UX Designer & Researcher

Insung Song - UI/UX Designer & Researcher

Greg Stevens - UI/UX Designer & Researcher, Project Manager

Raisa Pokrovskaya - Client

Scope & Constraints

Some restraints that our team faced were finding a large quanitity of actual stroke patients to test this stroke patient-based app with. Although in the end we did manage to test the app with a couple of actual stroke patients, there wasn't nearly as many participants as the team would have liked, and additionally, this project was under a strict 40 hour, 4 week time constraint.

Process & What We Did

We followed a UX process to create the solution in an iterative manner in order to conduct testing at all levels of development utilizing the research and findings from primary and secondary research. This was a constant iterative process based on data, and focused on usability that met the goals discovered during research and testing.

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“We must design for the way people behave, not for how we would wish them to behave.”

― Donald A. Norman

Research

“Clock Yourself” Physiotherapy

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Likes:

Different training programs are available for simple movement, cognitive function, coordination, complex combinations, and athletic agility.
It includes the instruction videos for each game with a character showing the movement.

Dislikes:

Not clear what the different categories mean in the settings.
It does not have audio for the instruction videos. Audio may be crucial for visually impaired stroke survivors.
The activity log doesn’t have any visual element, so it looks bland.
It doesn’t have a progress section.

Action items:

Add an instruction video with a character so that the survivors can reflect on themselves.
Add audio to the instruction video.
Include games with different levels.
Use graphs to show the progress.

“Kaia Health” (Virtual Physical Therapy Assistant)

Likes:

Provides personalized, daily therapy sessions based on the user's own pain levels, pain locations, psychological, and educational needs.
During workouts, users activate cameras on their phones. Algorithm tracks patients’ movements real time, providing instant feedback & guidance
Able to directly communicate with certified coaches & medical providers (on-call)
Track improvement & performance levels by browsing the ‘progress’ tab.
Able to browse different therapy workouts if users aren’t interested in the daily sessions or are done with today’s session.
Has clinically proven results for improving pain, anxiety, and stress reduction

Dislikes:

The app isn’t universally available; it is exclusive to users who are part of specific insurance plans & employers
The therapy programs are strictly exercise routines. Users may be less motivated to stick to the therapy plans (less enjoyment)
No rewards available after completion (less motivation)

Action items:

Provide personalized game sessions everyday
Similar to Kaia’s Algorithm, enable game characters to give demo & instant feedback to users by tracking their movements
Enable chat function so users can communicate with doctors & therapists
Allow users to browse and select other games if they aren’t interested in the daily session
Allow users to track their own progress & performance levels

“Rehabit” (Self motor-rehab app)

Likes:

Most recommended app among therapist and hospitals
Design meets best practices and Accessibility standards.
Provides the how and why behind stroke recovery tips, making it easy and satisfying to adopt healthy habits into your lifestyle.
Offers Easy-to-read daily articles and educational material on stroke rehab, behavioral health, lifestyle, nutrition, mindfulness, and more.
Exercise content is tailored to the user capabilities to help them stay focused, consistent, and successful.
help guide users to stay on track with your personal wellness goals

Dislikes:

No messaging feature to help users communicate with their therapists
No rewards available after completion (less motivation)

Accessibility

Summary of Accessibility Heuristics Audit :

Due to the fact that this is a solution that is to be used by stroke patients, considerable time was spent in research on WCAG best practices. In our research and discovery process, we identified four main challenges for stroke survivors in accessibility and usability.

As we are conducting a product redesign for the client, we then compared the existing prototype with our findings, and conducted a usability heuristics analysis based on the existing client prototype and solution.

Targeted Disability Considerations:

Users with low vision and Color Blindness
Users with digital literacy issues

Users with Hearing Difficulties
Users with Information Processing Difficulties

Here is the link to a more in depth explanation and further research that was conducted for accessibility

Usability Accessibility Heuristics Audit/Research

Material Design

User Flows

Onboarding

Character Selection

Profile

Games | Daily Exercise

Wireframes

Wireframe screens were provided by the client. The wireframing could not be utilized from a usability standpoint. Since the users are essentially Stroke Survivors, the amount of overwhelming information and visuals does not match their accessibility needs. However the provided wireframes were used as a guide and base to visualize and understand the client's vision.

Design System

Among multiple Ideation sessions, the team conducted a thorough research on building the right Visual Style Guide that represents the Brand’s attributes, Identity, and meets Accessibility standards using a set of contrast testing. The color palette is designed to match both Light and Dark modes.

After a lot of ideating between the team members, this was the final selection for our finalized style guide

First Round of High Fidelity (pre testing)

Applying the style guide that the design team decided on, we applied the color scheme and the buttons, and the UI elements to the app.
We simplified features from the original frames due to accessibility reasons, time constraints, and reduced the cognitive overload of too much, repetitive information
The largest initial change from the original provided wireframes to the high fidelity wireframes was the change of the home screen.
The client originally wanted a “playroom” type of home screen.
The design team felt like this would be cognitive overload to the user, and we decided on a more simplistic, familiar type of home screen.
Providing the user with multiple paths to navigate the app, not just in the nav bar, was something the design team was adamant about including to further promote user accessibility.

High Fidelity Round Two

After testing, we found a number of changes to make to our initial screens. Some of the key points and changes that were made were:

Onboarding | Shorten the process or add option to enter an activation code (provided by therapist)
Games | Merge games into today’s exercise
Today’s exercise | Shorten navigation, make instructions (videos) optional / skippable length.
Chat | Add chat with friends function

Some quotes from the user testing session really showed the user's concerns with the app and certain aspects.

"The onboarding and set up takes too long. I want to be able to sign in and get to my daily exercises more quickly. That's my main goal when I open the app."

"The most important things to me are being able to get online and start working on my exercises to make progress as soon as I can on the application."

"I want the social aspect of multi-player and also being to message/communicate with other people going through rehabiliation process."

Final Iterations

After our first round of testing and iterations, the team was able to test another three rounds with different individuals that had either been stroke patients themselves, or were close family members with stroke patients.

Throughout each of the testing rounds, we made changes that were most beneifical to the user and additionally, we also included changes that our client had voiced that she wanted as well after viewing the initial screens.

Some of the changes that were carried out included:

Second Round of User Testing

Confused between profile vs. home room (A & B testing required in round 4 testing)
Need to change wording/add more explanation for calibration
Add summary/explanation after clicking events

Third Round of User Testing

Clarify what the code is for.
Add a “device connection was successful” screen.
Choose between the profile vs. home room.
Make text size bigger for “edit profile screen”
Calibration - see if the animation would help
Change wording for character description, such as “relatedness”

Fourth Round of User Testing

Make “Homescreen” the “Profile” due to results of A/B testing
Increase contrast of bottom navigation to help people with low vision
Gary had trouble seeing some of the Icons in navigation due to low vision. *Should we increase contrast/weight?
Gary also had some issues in the exercises section, he couldn't see some of the gray type that is a summary of what the exercise is due to low vision. *So we might want to increase the contrast/weight there?
Gary also noted that the image with balloons in the games section was hard to see. Suggested we make it “brighter”
*Could increase opacity, to increase viability/contrast?
When asked to navigate back to his profile (now going to be the homescreen) Gary clicked on the Avatar.
*Should we add navigation back to the homescreen from the avatar in the prototype?
Will need to add “settings” icon to “Homescreen” and link that to “settings” screens in prototype
Gary clicked on the Avatar when it was available in the upper right.
*We should add navigation back to the homescreen from the Avatar when it is in the upper right of the screen, in the prototype.

In the final iteration of the homescreen, we designed this gamified version of the home screen, reminiscent of the wireframe that our client had provided for us.

Our client really prioritized the gamification of the app and sincerely wanted a homescreen that felt a lot like an avatar's home room because she wanted the user to feel encouraged by viewing the avatar and striving to fully recover.

We wanted to keep the visuals modern and sleek while still implementing the game style. It was challenging to find a design that felt fresh and new and inviting, while still keeping in mind the accessibility standards and trying to not overload the user with information and visuals.

I believe we found a happy medium and created an inviting environment.

“I like this app design because it is warm, not belittling, it is soothing.”

“People with brain injuries want to feel comfortable. We don’t want to feel like we are being reminded of how we are now, versus how we used to be”.

“People with brain injuries need an app that is simple to use and brings them along slowly.”

After each round of testing, our design team thoroughly thought out each of the tester's concerns and requests and implemented the best, most comfortable and easiest way to navigate the app.

Balancing what was best for the user, while still keeping what the client wanted into account was a challenge, but I wholeheartedly believe that our team put together a really cohesive and simple, yet inviting and accessible app that the user would enjoy and that our client could be proud of.

Conclusions

In this process we learned about which elements of the original prototype were most critical to the user experience, and which elements that they did not see as critical to the user’s rehabilitation goals and needs. The insight that surprised us the most was that the families of the stroke rehabilitation patients also wanted access to this application, in order to encourage their family members recovering from stroke to continue in their process. This allowed for more engagement and positive encouragement for the user in relation to emotional design while giving peace of mind to the families of the stroke victims that their condition would improve through use of the app.

The most challenging thing about this project was to find the specific users designated to test the application in the research plan and convert them to test the application. This was solved by asking our client to help us connect with stroke survivors in Ireland. Also, our design team used message boards to recruit relevant usability testers in the U.S. to give us a reliable cross section of individuals to test.

All in all, I believe that this app was a success and I know that our team produced a product to the best of our abilities within the constraints. I am proud of the product we were able to produce for our client. In a more personal stance, I found it incredibly rewarding to work with a team and form some new friendships along the way. It was an honor to get to see how other designers worked and how they saw design from their little part of the world. I was truly grateful for this experience.