Understanding the Socio-cultural Challenges and Opportunities for Affordable Wearables to Support Post-Stroke Upper-Limb Rehabilitation: A Qualitative Study

I'm  missing if this is for monitoring and as such, virtually worthless in getting survivors recovered or for help in movements.

 Understanding the Socio-cultural Challenges and Opportunities for Affordable Wearables to Support Post-Stroke Upper-Limb Rehabilitation: A Qualitative Study

Rahat Jahangir Rony; Shajnush Amir; Nova Ahmed; Samuelson Atiba; Nervo Verdezoto Dias; ValerieSparkes; Katarzyna Stawarz

Abstract

 

Background: 

 

People who survive a stroke, in many cases require upper-limb rehabilitation(ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services inthe Global South are often not affordable or easily accessible. For example, in Bangladesh, theaccess to and use of rehabilitation services is limited and influenced by cultural factors andpatient’s everyday lives. In addition, while wearable devices have been used to enhance ULRexercises to support self-directed home-based rehabilitation, this has primarily been applied indeveloped regions and is not common in many Global South countries due to potential costs andlimited access to technology. 

Objective: 

Our goal was to understand better physiotherapists’, patients’ and caregivers’experiences of rehabilitation in Bangladesh, existing rehabilitation practices, and how they differfrom the rehabilitation approach in the United Kingdom (UK). Understanding these differencesand experiences would help to identify opportunities and requirements for developing affordablewearable devices that could support ULR in home settings. 

Methods: 

 

We conducted an exploratory study with 14 participants representing key stakeholdergroups. We interviewed physiotherapists and patients in Bangladesh to understand theirapproaches, rehabilitation experiences and challenges, and technology use in this context. We alsointerviewed UK physiotherapists to explore the similarities and differences between the twocountries and identify specific contextual and design requirements for low-cost wearables forULR. Overall, we remotely interviewed 8 physiotherapists (4 in the UK, 4 in Bangladesh), 3 ULRpatients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formalcommunications and personal contacts. Each interview was conducted online, except for twointerviews, and audio was recorded with consent. A total of 10 hours of discussions weretranscribed. The results were analyzed using thematic analysis. 

Results: 

 

We identified several sociocultural factors that affect ULR and should be taken intoaccount when developing technologies for the home: the important role of family who mayinfluence the treatment based on social and cultural perceptions; the impact of gender norms andtheir influence on attitudes towards rehabilitation and physiotherapists; and differences inapproach to rehabilitation between the UK and Bangladesh, with Bangladeshi physiotherapistsfocusing on individual movements that are necessary to build strength in the affected parts, andtheir British counterparts favoring a more holistic approach. We propose practical considerationsand design recommendations for developing ULR devices for low-resource settings. 

Conclusions: 

 

Our work shows that while it is possible to build a low-cost wearable device, thedifficulty lies in addressing socio-technical challenges. When developing new health technologies,it is imperative to not only understand how well they could fit into patients’, caregivers’, andphysiotherapists’ everyday lives, but also how they may influence any potential tensionsconcerning culture, religion, and the characteristics of the local healthcare system.