Limited Use Only. How Can the Design of an Everyday Object Evoke an Initiation of Use in Chronic Stroke Survivors

Stroke causes significant damage to the brain and affects 15 million people annually worldwide. Symptoms commonly affect one or both limbs on one side of the body, limiting ability to perform daily activities. The preferential use of the less affected limb for performing everyday activities in the form of compensatory movement is a common phenomenon after a stroke and can lead to a “learned nonuse” of the affected arm and hand. This learned behaviour can be overcome by applying a physical restraint on the less affected arm to initiate use of the affected one. Stroke interventions that use physical restraint are criticised for being labour intensive and expensive and having a limited focus on the home environment of the stroke survivor. This study aimed to design everyday objects that restrain movement to initiate the use of the affected arm and hand. It was undertaken from a pragmatist theoretical perspective, using a human-centred design approach to develop an understanding of the users’ needs and create design solutions that addressed the observed problem. A qualitative multimethod approach helped understanding of how the restraining effect needs to be delivered to initiate use of the affected arm, and which everyday objects are key in daily activities post-stroke. The research through design methodology was employed for developing expansive and serial design prototypes to test how the restraint could be incorporated into a design prototype. The prototypes were evaluated with health professionals and chronic stroke survivors to validate the intended initiation of use. Findings of this study indicate that the development of learned nonuse is multifactorial and occurs over time. The current use of restraint in clinical practice focuses on reminding the survivor to use the affected arm and hand rather than physically restraining its use. It was emphasised by the therapists that a behaviour change is a crucial element in overcoming learned nonuse in the long-term. The evaluation of the design prototypes indicated that the design of the object needs to take into consideration the conceptual model the user has of the object and the interaction needs to be feasible to perform for the stroke survivor. Five different design strategies were developed to restrain movement and elicit an initiation of use. The restraining effect that is evoked by the design strategies can vary between the different users. Additionally, the object needs to provide sufficient feedforward to initiate the use of the affected arm and hand, increase self-efficacy beliefs, provide a repetitive and increasingly challenging movement, provide feedback and sensory input to secure engagement in the process. A behaviour change is an essential element to overcome the learned nonuse in the long-term. A behaviour contract was, therefore, incorporated in the form of the design components to facilitate such a change. At this stage it is unclear which strategy offers the greatest potential to evoke an initiation of use and if the behaviour contract contributes to overcoming the learned nonuse. Further studies are needed to increase the restraining effect and usability of the design prototypes and validate the long-term impact.