The first meeting generated data that was elicited via specific trigger questions. An example of one of the questions with a summary of the response gathered from the transcribed data is provided below in Table 4.3.
Table 4.3: Results from stage 2 of the analysis - an advisory group trigger question with a summary of the responses.
In stage 3 of the analysis a list of initial ‘higher order’ themes were created and coded.
Research question 1: What are the biggest challenges for you as therapists in the rehabilitation of the upper limb post-stroke?
Summary of Responses:
Keeping patients motivated
Matching treatment to patient’s expectations to maintain motivation.
Equipment to provide feedback for the patient otherwise can lose interest.
More severe patients tend to lose motivation due to lack of functional options possible for them.
Patient variation – ‘good shoulder no hand, good hand no shoulder.’
Increasing number of patients with a dystonic hand.
Maintaining soft tissue extensibility
Some differences noted in recovery between dominant and non-dominant hand
Fast turn-over of patients
76 A “theme” is a word or phrase used to summarise certain comments. For example, one theme that emerged was “type of patient that would benefit from the system” (PB). Table 4.4 displays all of the initial ‘higher order’ themes.
Table 4.4: Stage 3 initial ‘higher order’ themes with coding
The initial ‘higher order’ themes allowed the data from the advisory groups to be condensed under three broad headings that related directly to the design process. 1) Context for the design requirements i.e. data that provided background information for the design process; 2) Design requirements i.e. actual design features and 3) External factors affecting adoption. This ensured that the data from subsequent meetings was constrained in accordance with this process. The initial ‘higher order’ themes tended to reappear across a number of the advisory group meetings serving to reinforce the importance of these themes.
(AI) Adoption issues
(PWL) Practitioners wish list for FES system
(PB) Type of patient that would benefit from the system
(PP) Type of patient presentation
(TI) Treatment interventions
77 Table 4.5: Stage 4 initial ‘higher order’ themes mapped on to design process themes, (displayed as
the headings in bold), of the UL FES Rehab Tool. The codes from the initial higher order themes are also included.
1. Context for the design requirements
Codes for initial higher order themes
1.1. Patient presentation including those most likely to benefit from FES PP & PB
1.2. Current treatment approaches & beliefs TI
1.3. Patient motivational factors PB
1.4. Organisational influences FUR
1.5. Adoption issues as design inputs AI
2. Design requirements
2.1. Setup and user interface PWL
2.2. Patient biofeedback PWL
2.3. Within sessions adjustments PWL
2.4. Patient adaptation PWL
2.5. Performance feedback for therapist PWL
3. External factors affecting adoption
3.1 Adoption issues independent of design AI
Key: AI = adoption issues; FUR = factors affecting upper limb rehabilitation; PB = type of patient presentation; PB = type of patient that would benefit from the system; PWL = practitioners wish list for FES systems; TI = treatment interventions.
After each subsequent meeting the data were transcribed, coded and categorised under the existing themes or new themes were developed if there was sufficient data to support a new theme. The process was iterative in nature with the raw data being periodically reviewed against the themes to ensure their validity.
A summary of the results from the third advisory group meeting are displayed in 4.6 below:
78 Table 4.6: Summary of tasks, FES parameters and practice schedules for each category of patient, taken from the third advisory group meeting.
Type of Patient Tasks FES parameters Practice schedules
Early complex presentation, (in- patient)
Functional tasks e.g. washing, dressing, combing hair, reaching for a glass, cleaning teeth. Tasks that combined reach, grasp, manipulate, as well as weight bearing (possibly triceps or activate shoulder girdle muscles) and protective balance reaction movements for the upper limb. Adjust to minimise fatigue. Up to an hour x2 per day depending on levels of fatigue. Moderately severe patient, early stages residing at home
Functional tasks using objects from around the house incorporating reach and grasp, manipulate and release. If possible frequencies to match type of muscle stimulated. 30 -45 mins, 2-3 times a day Mild affected patient (wrist and hand only) residing at home
Functional tasks incorporating reach and grasp, manipulate and open/release of varied objects carried out in various planes/directions. Use of hobbies and employment needs.
If possible
frequencies to match type of muscle.
45mins- 1hour, 3-4 times a day but importantly to fit in with patient’s lifestyle.
Data from this meeting was also used to validate data from the first meeting e.g. types of patients that would benefit, use of other treatment approaches to compliment the UL FES Rehab Tool.
Results from the third and fourth meetings mapped directly onto the ‘higher order’ themes and ultimately the design process themes. Data from all meetings was compared with the relevant literature for that area to further validate the findings. The fifth meeting was used to validate the design requirements. Therapists were asked to rank them in order of importance with 0=not important and 4 = extremely important. Only 6 of the 11 clinicians were able to attend this final meeting. The results are presented below in Table 4.7.
79 Table 4.7: UL FES Rehab Tool therapists’ design requirements in rank order of importance
(when used in a hospital rehabilitation setting).
DESIGN REQUIREMENTS
0 = not important; 1= mild importance; 2= moderately important; 3= very important; 4= extremely important
Meeting
Number of therapist responses per order of
importance
0 1 2 3 4 Total No.
Takes less than 30 min to set-up 1, 3 6 24 Allows adjustment of device parameters in accordance with patients progress 1, 2 6 24
Device is comfortable to wear 3 6 24
Electrodes are easy to apply & position 1, 2 6 24 Sensors are easy to apply & position 3 6 24 Triggers stimulation on & off reliably 3 6 24 Stimulation is comfortable for patient 3 6 24 Patients are able to practise on their own where appropriate 1, 2 6 24 Device functions and interface are easy to understand 1, 3 6 24 Easy selection of muscles to be stimulated 1, 2 1 5 23
Device is easy to put on 3 1 5 23
Effective co-ordination of muscle stimulation (where multiple muscles involved) 3 1 5 23 Easy to adjust settings once administering treatment 3 1 5 23 Adjustable stimulation settings (e.g. frequency) 2, 3 2 4 22 Choice of functional upper limb tasks 1, 2 2 4 22 Sensors are easy to select and adjust 3 2 4 22 Stimulation intensity easily adjusted 3 2 4 22
Adjustable ramp settings 3 1 1 4 21
Wires unobtrusive - wireless preferred 3 1 1 4 21 Guides the user during the set-up process & highlights any incorrect parameter
settings
1, 2, 3 1 1 4 21
Device is easy to take off 3 3 3 21
Able to be used to treat a variety of patient presentations 1, 2 4 2 20 Aesthetically acceptable to patients 3 1 2 3 20 Intuitive set-up process that follows a natural & logical order with minimum
redundancy
1, 3 1 4 1 18 Bio-feedback serves to motivate the patient 1, 3, 4 1 4 1 18 Provides performance data that can inform treatment parameters & outcome measures 1,3 1 4 1 18
Good battery life 3 1 4 1 18
Choice of bio-feedback methods tailored to suit each patient 1, 2,4 3 1 2 17 Choice of sensors e.g. movement sensor, EMG, goniometer 2, 3, 4 1 5 17
Compact & portable 1, 3 1 5 17
Automated processes wherever possible (1 none response) 1, 3 1 2 2 16