Empathic Avatars in Stroke Rehabilitation: A Co-designed mHealth Artifact for Stroke Survivors

Stroke is the second highest cause of death and disability worldwide. While rehabilitation programs are intended to support stroke survivors, and promote recovery after they leave the hospital, current rehabilitation programs typically provide only static written instructions and lack the ability to keep them engaged with the program. In this design science research paper, we present an mHealth artifact that builds on behavior change theory to increase stroke survivors’ engagement in rehabilitation programs. We employed a co-design methodology to identify design requirements for the stroke rehabilitation mHealth artifact, addressing stroke survivors’ needs and incorporating expertise of healthcare providers. Guided by these requirements, we developed design principles for the artifact pertaining to visual assets that are essential in immersing users in the design. We carried out a two-stage development process by having workshops and interviews with experts. Following this, a prototype was developed and evaluated in a series of workshops with multiple stakeholders.

[1]  Thomas C. Greene,et al.  Coloring the environment: Hue, arousal, and boredom , 1983 .

[2]  Rodzyah Mohd Yunus,et al.  Environmental Colour Impact upon Human Behaviour: A Review , 2012 .

[3]  Lena von Koch,et al.  The Meaning of Rehabilitation in the Home Environment After Acute Stroke From the Perspective of a Multiprofessional Team , 2007, Physical Therapy.

[4]  P. Valdez,et al.  Effects of color on emotions. , 1994, Journal of experimental psychology. General.

[5]  J. Bailenson,et al.  The Proteus Effect: The Effect of Transformed Self-Representation on Behavior , 2007 .

[6]  Mark H. Davis Empathy: A Social Psychological Approach , 1994 .

[7]  Ho-Kyung Kim,et al.  Understanding emotional bond between the creator and the avatar: Change in behavioral intentions to engage in alcohol-related traffic risk behaviors , 2016, Comput. Hum. Behav..

[8]  Hongki Kim,et al.  What If Your Avatar Looks Like You? Dual-Congruity Perspectives for Avatar Use , 2011, MIS Q..

[9]  C. Dickman,et al.  Diversity and Community Composition of Vertebrates in Desert River Habitats , 2015, PloS one.

[10]  Majid Dadgar,et al.  Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps , 2013 .

[11]  Dianne Cyr,et al.  Modeling Web Site Design Across Cultures: Relationships to Trust, Satisfaction, and E-Loyalty , 2008, J. Manag. Inf. Syst..

[12]  Abhishek Pandey,et al.  Medical Mobile Applications for Stroke Survivors and Caregivers. , 2015, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[13]  A. Haines,et al.  The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review , 2013, PLoS medicine.

[14]  Robert Riener,et al.  The Role of Serious Games in Robot Exoskeleton-Assisted Rehabilitation of Stroke Patients , 2015 .

[15]  Nick Haslam,et al.  Reasoning a folk psychological model of human nature and human identity , 2013 .

[16]  P. Eslinger,et al.  Empathy and social‐emotional factors in recovery from stroke , 2002, Current opinion in neurology.

[17]  R. Riedl,et al.  Parkinson Patients’ Initial Trust in Avatars: Theory and Evidence , 2016, PloS one.

[18]  Anson B. Rosenfeldt,et al.  The Home Stroke Rehabilitation and Monitoring System Trial: A Randomized Controlled Trial , 2013, International journal of stroke : official journal of the International Stroke Society.

[19]  Heinrich H. Bülthoff,et al.  Talk to the Virtual Hands: Self-Animated Avatars Improve Communication in Head-Mounted Display Virtual Environments , 2011, PloS one.

[20]  E. Noguera,et al.  Intramedullary spinal cord neurocysticercosis presenting as Brown-Séquard syndrome , 2015 .

[21]  Martin McKee,et al.  Health policy responses to the financial crisis in Europe , 2012 .

[22]  B. Spring,et al.  Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association. , 2015, Circulation.

[23]  David E Bloom,et al.  Noncommunicable diseases: a global health crisis in a new world order. , 2012, JAMA.

[24]  K. Sunnerhagen,et al.  Patients’ expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study , 2015, BMC Neurology.

[25]  Jun-Ah Song,et al.  Relationship between familiar environment and wandering behaviour among Korean elders with dementia. , 2009, Journal of clinical nursing.

[26]  Xiaozhou Wei,et al.  A Real Time Face Tracking And Animation System , 2004, 2004 Conference on Computer Vision and Pattern Recognition Workshop.

[27]  Alan R. Hevner,et al.  Towards a NeuroIS Research Methodology: Intensifying the Discussion on Methods, Tools, and Measurement , 2014, J. Assoc. Inf. Syst..

[28]  D. G. MacKay,et al.  Emotion, Memory, and Attention in the Taboo Stroop Paradigm , 2005, Psychological science.

[29]  Patrick Horain,et al.  Virtually enhancing the perception of user actions , 2005, ICAT '05.

[30]  Glenn Robert,et al.  Using Experience-based Co-design (EBCD) to improve the quality of healthcare: mapping where we are now and establishing future directions , 2014 .

[31]  Rose Wiles,et al.  Advantages and Disadvantages of the Home Setting for Therapy: Views of Patients and Therapists , 2000 .

[32]  Po-Yao Chao,et al.  An Empathic Avatar in a Computer-Aided Learning Program to Encourage and Persuade Learners , 2012, J. Educ. Technol. Soc..

[33]  Jan Vierendeels,et al.  Fluid-Structure Interaction Simulation of Prosthetic Aortic Valves: Comparison between Immersed Boundary and Arbitrary Lagrangian-Eulerian Techniques for the Mesh Representation , 2016, PloS one.

[34]  K. Hegarty,et al.  Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. , 2009, The Cochrane database of systematic reviews.

[35]  Alexandre N. Tuch,et al.  Perceived User Experience of Animated Transitions in Mobile User Interfaces , 2016, CHI Extended Abstracts.

[36]  M. McGuire,et al.  Risk Management and Healthcare Policy Dovepress Adherence and Health Care Costs , 2022 .

[37]  Brenda Laurel,et al.  Design Research: Methods and Perspectives , 2003 .

[38]  Maria Manuela Cruz-Cunha,et al.  Encyclopedia of E-Health and Telemedicine , 2016 .

[39]  René Riedl,et al.  Trust behavior in Parkinson’s disease: results of a trust game experiment , 2015, BMC Neurology.

[40]  Elizabeth O. Hayward,et al.  Emotional design in multimedia learning: Effects of shape and color on affect and learning , 2014 .

[41]  Rosa María Baños,et al.  How the physical similarity of avatars can influence the learning of emotion regulation strategies in teenagers , 2015, Comput. Hum. Behav..

[42]  Fred D. Davis,et al.  Trusting Humans and Avatars: A Brain Imaging Study Based on Evolution Theory , 2014, J. Manag. Inf. Syst..

[43]  S. Michie,et al.  The behaviour change wheel: A new method for characterising and designing behaviour change interventions , 2011, Implementation science : IS.

[44]  Robert Riener,et al.  Heart rate asymmetry and emotional response to robot-assist task challenges in post-stroke patients , 2011, 2011 Computing in Cardiology.

[45]  Karl F. MacDorman,et al.  The Uncanny Valley [From the Field] , 2012, IEEE Robotics Autom. Mag..

[46]  Pieter Jan Stappers,et al.  Co-creation and the new landscapes of design , 2008 .

[47]  Alan R. Hevner,et al.  Design Science in Information Systems Research , 2004, MIS Q..

[48]  Faber Birren,et al.  Color psychology and color therapy : a factual study of the influence of color on human life , 1961 .

[49]  Andrew K Przybylski,et al.  Can Nature Make Us More Caring? Effects of Immersion in Nature on Intrinsic Aspirations and Generosity , 2009, Personality & social psychology bulletin.

[50]  Brian Silver Virtual reality versus reality in post-stroke rehabilitation , 2016, The Lancet Neurology.

[51]  Patrick T. Vargas,et al.  Know Thy Avatar , 2014, Psychological science.

[52]  Sandra L. Calvert,et al.  The promise of exergames as tools to measure physical health , 2011, Entertain. Comput..

[53]  C. East,et al.  Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. , 2015, The Cochrane database of systematic reviews.

[54]  Lars Wallin,et al.  Implementation Science SYSTEMATIC REVIEW Open Access , 2022 .

[55]  Eunjoon Rachel Um,et al.  Emotional design in multimedia learning. , 2012 .

[56]  Mario Minichiello,et al.  Drawing to Aid Recovery and Survival , 2014 .