A scoping review of design requirements for a home-based upper limb rehabilitation robot for stroke

Figures & data

Figure 1. Flowchart of study selection.

Table 1. Overview of selected studies

Study	Methodology	Participants or/and studies involved	Aim	Main findings A home-based upper limb rehabilitation robot needs to:
Hughes et.al, 2010^Citation26	Observation; interview; questionnaire	5 stroke survivors (average 4 years after stroke; 3 had a right hemiplegia and two on the left))	To design and develop a upper limb workstation by collecting users’ perceptions	Functionality requirements: provide repetitive movement; be usable in seated, standing or recumbent position; promote movement related to ADL; promote finger movements; promote whole upper limb movement Usability requirements: be easy to set up; usable at home; easy to don and off. Software requirements: have a user-friendly appearance; have a graphical performance outcome which motivates users; have multiple games to enhance users’ motivation Barriers: A home-based robot may reduce the frequency or timeliness of communication between stroke survivors and therapists; how to provide efficient and suitable robotic therapy at a users’ home (should stroke survivors’ treatment time at home be designed as a trial with a fixed duration, or should they be based on stroke survivors’ progress?)
Lu et.al, 2011^Citation32	Questionnaire	233 therapists (72% physiotherapists, 27% occupational therapists); most based in Australia (48%) and Canada (28%); over half had more than 10 years’ experience; most worked in clinical settings and 42% worked in the stroke survivors’ home	To identify the therapist’s requirements and preference for upper limb rehabilitation robot	Functionality requirement: be usable in any position (seated, standing or recumbent); facilitate arm movement in multiple planes (transverse and sagittal); Usability requirement: provide arm and hand stability; provide different handholds; be easy to transfer/move and store in users’ home; be compact size; suitable for home environment; be adjustable to individual needs; keep trunk stable; include all device accessories for installation and set up Software requirement: virtual ADL specific activities; adjust resistance and alignment based on users’ performance; provide fun games; provide feedback to users and therapists; provide separate interfaces for users and therapists; provide predefined functions.
Hochstenbach et.al, 2012^Citation31	Literature research; semi-structured interview	9 studies related to application of technology in upper limb rehabilitation of stroke survivors; 7 therapists mean experience >18 years in the Netherlands (6 worked in stroke rehabilitation, 1 worked in children’s rehabilitation)	To identify and provide guidance on rehabilitation technology criteria	Functionality requirement: accommodate individualized training goals based on to the patient’s ability; provide task-oriented ADL-related training; provide intense and repeatable training; Usability requirement: provide quick hardware installation and software setting; be portable or transferable but stable; be ergonomically acceptable; easy to operate Software requirement: provide variable type of, and difficulty of training or games; provide feedback on training performance to users and therapists; include games which motivate users; be easy and intuitive to use; have a clear introduction; be customizable to individual needs; provide pre-programmed training based on therapists’ suggestions; a system which can save individual therapy settings and users’ data; be human-friendly Safety: include an ‘emergency stop’ button; provide warning messages
Cristina et.al, 2012^Citation30	Interviews; focus group; observation	9 stroke clinicians for interviews (4 medical doctors, 2 occupational therapists, 2 physiotherapists and 1 nurse); 11 therapists for focus group; 9 stroke survivors for observation	To identify the requirements for computer games for upper limb rehabilitation	Functionality requirement: include a workspace within the users’ safe range of movement Usability requirement: be easy to use; Software requirement: actively involve the user; provide tasks or games with different levels of challenge; provide feedback of users’ performance; involve games that are simple and easy to understand, fun, fulfil the rehabilitation goals and relate to ADL; monitor users’ usage; the games should include clear introduction;
Prange et.al, 2015^Citation29	Literature research; Interviews	10 studies related to ADL tasks required for hand rehabilitation; 5 sub-acute stroke survivors (> 3 months post-stroke); 3 neuro-rehabilitation experts (1 movement scientist, 1 physiotherapist, 1 occupational therapist); 3 technology experts (1 biomechanical engineer, 1 medical devices developer, 1 prosthetics orthoptist)	To identify the users’ requirements for a hand rehabilitation device	Functionality requirement: promote hand function; provide active power support for hand and upper limb movements within the safe range of speed and movement for each patient; only provide the required assistance for each individual; train cylinder grasp Usability requirement: easy to don and doff so patients can do it independently; be comfortable and protect the users’ skin; be lightweight; promote smooth movement; be wireless; be low-cost. Safety: avoid any sharp parts; have a back driveable mechanism; easy and quick to stop and move in an emergency situation;
Shirzad et.al, 2015^Citation27	Observation; focus group	11 rehabilitation professionals (detailed information of therapists was not provided)	To develop a bimanual upper limb rehabilitation platform through User Centered Design	Functionality requirement: promote hand movement in both horizontal and vertical planes Usability requirement: To be simple to use; low cost Software requirement: provide enough introduction; be simple and easy to use; provide sufficient feedback for users; include a set up menu;
Popescu et.al, 2017^Citation28	Observation; interview; questionnaires	Therapists (the number of participants was not specified)	To identify the clinical and technology requirements for upper limb rehabilitation robot	Functionality requirement: promote upper limb movement close to ADL; allow users to move in three-dimensional space; keep the trunk stable; be usable in a seated position; promote task-oriented training; maintain joint alignment Usability requirement: be adjustable to individuals’ size and abilities; easy to transport; easy to use; stable Software requirement: provide feedback to therapists and patients; include customizable game settings (duration time); include a redefined menu; involve a modular system Safety: be safe for both patients and therapists to operate
Van et.al, 2018^Citation25	Systematic review of users’ needs of assistive technologies for upper limb rehabilitation after stroke	9 studies (published from inception to August 2017; related to users’ perspective for assistive technologies of rehabilitation; with the involvement of stroke survivors or professionals)	To identify the users’, need for upper limb assistive technology after stroke	Functionality requirement: provide task-oriented, repetitive and intensive exercise; provide active support; promote upper limb function Usability requirement: should be easy to don and doff; be lightweight; adjustable for users; easy to use; low cost; easy to set up and maintain; comfortable to use; stable; portable Software requirement: motivate users; provide feedback; include introductions; include adaptable system settings and programmes; save individual user’s data; provide individualized levels of support and game difficulty; involve a modular system Safety: meet safety regulations Barriers: Users may be unfamiliar with technology; need financial support if the device is incompatible with existing furniture; data privacy needs to be maintained
Wentink et.al, 2018^Citation33	Questionnaire	125 stroke survivors (average 30.6 months after stroke, 81% with cognitive impairments, 84% with physical impairments, 48% with aphasia); 43 informal care givers (mean age = 58 years); 105 health professionals (41%physiotherapists, 15% psychologist, 47% physician); 75% worked in rehabilitation center, 34% worked in general hospital and 10% worked in health center in primary care; 79% had more than 10 years’ work experience)	To identify users’ requirements for e-rehabilitation after stroke	Functionality requirement: Provide functional exercises; Usability requirement: Provide tailored system; usable in most common home environments; Software requirement: require no internet connection; quick to log in; record data on users’ performance and health status; provide a customizable system interface including adjustable background and font; provide (audio) feedback; require no other webpage; avoid complicated options; provide video introduction of device/system usage to patients and therapists; provide frequently asked question menu and system helpdesk; monitor users’ performance (duration time, use frequency); provide online agenda option; provide communication function with other stroke survivors; provide general information of stroke and stroke rehabilitation Barriers: Technology adaptability (users may be unfamiliar with technology or find the system too complicated to use); compatibility with space; cost

Table 2. Design requirements for home-based upper limb rehabilitation robots

Requirements	Source
Functionality requirements
(1)Provide repetitive exercise	^Citation25,Citation26,Citation31,Citation33
(2)Provide intensive exercise	^Citation25,Citation31,Citation33
(3)Provide goal-oriented exercise	^Citation25,Citation28,Citation31,Citation33
(4)Movements produced to relate to ADL	^Citation26,Citation28,Citation29,Citation31
(5)Apply assistive forces to aid practice of therapeutic movements	^Citation25,Citation29
(6)Can be used in a seated position	^Citation26,Citation28,Citation32
(7)Suitable functional workspace to ensure users’ safety	^Citation30
(8)Suitable and safe movement speed of each joint	^Citation28,Citation29
(9)Provide arm weight support and arm stability	^Citation32
(10)Keep trunk stability/Ensure compensation stability	^Citation28,Citation32
(11)Enables arm movement in all planes (three-dimensional movement)	^Citation27,Citation28,Citation32
Usability requirements
(12)Intuitive to use	^Citation25,Citation27,Citation28,Citation30,Citation31
(13)Quick and simple to set up	^Citation25,Citation26,Citation31,Citation32
(14)Quick and easy to install	^Citation31,Citation32
(15)Easy to maintain	^Citation25
(16)Provide different handholds for different users’ needs	^Citation26,Citation29,Citation32
(17)Easy to store	^Citation32
(18)Easy to transport/portable	^Citation25,Citation28,Citation29,Citation31,Citation32
(19)Adjustable to patient’s arm size	^Citation25,Citation28,Citation31,Citation33
(20)Comfortable	^Citation25,Citation29
(21)Easy to don and doff	^Citation25,Citation26
(22)Suitable for the home environment	^Citation26,Citation33
(23)Stability of device base	^Citation25,Citation28,Citation31
(24)Reliability	^Citation25
(25)Compact size	^Citation28,Citation32
(26)Lightweight	^Citation25,Citation29
(27)Low-cost	^Citation25,Citation27,Citation29
Software requirements
(28)User friendly interface	^Citation26,Citation30
(29)Simple operation system	^Citation31,Citation33
(30)Provide visual or audio feedback on handle movement and performance for patients	^Citation25–28,Citation30,Citation33
(31)Provide feedback on users’ performance to therapists	^Citation25,Citation28,Citation30–33
(32)Monitor usage	^Citation25,Citation31
(33)Customizable system, adjustable initial settings	^Citation25,Citation28,Citation31,Citation33
(34)No internet connection requirements	^Citation33
(35)Multiple levels for assistance to accommodate differing patients’ needs	^Citation25,Citation30,Citation32
(36)Simple and clear instructions for use	^Citation25,Citation27,Citation28,Citation30,Citation31,Citation33
(37)Multiple games with differing levels of difficulty to accommodate patients’ needs	^Citation25,Citation30–32
(38)Have menu with frequently asked questions	^Citation27,Citation28,Citation33
(39)Provide online agenda option for patients and therapists to arrange the appointment	^Citation33
(40)Save individual users’ data	^Citation25,Citation33
(41)Modular the rehabilitation exercise (split the exercise into several small tasks)	^Citation25,Citation28,Citation31
Safety requirements
(42)Meet all safety requirements	^Citation25,Citation28,Citation29

Table 3. Result of ranking the identified requirements

Requirements (n = 42)	Ranking result
	Importance level	Importance value
Functionality requirements (n = 11)
(1) Provide repetitive exercise	Essential	4
(2) Apply assistive forces to aid practice of therapeutic movements	Essential	4
(3) Can be used in a seated position	Essential	4
(4) Suitable functional workspace to ensure users’ safety	Essential	4
(5) Suitable and safe movement speed of each joint	Essential	4
(6) Provide arm weight support and arm stability	Essential	4
(7) Provide intensive exercise	Important – Essential	3.5
(8) Movements produced to relate to ADL	Important – Essential	3.5
(9) Provide goal-oriented exercise	Important	3
(10) Keep trunk stability/Ensure compensation stability	Desirable – Important	2.5
(11) Enables arm movement in all planes (three-dimensional movement)	Desirable	2
Usability requirements (n = 16)
(1) Suitable for the home environment	Essential	4
(2) Stability of device base	Essential	4
(3) Intuitive to use	Important – Essential	3.5
(4) Provide different handholds for different users’ needs	Important – Essential	3.5
(5) Adjustable to patient’s arm size	Important – Essential	3.5
(6) Easy to don and doff	Important – Essential	3.5
(7) Reliability	Important – Essential	3.5
(8) Compact size	Important – Essential	3.5
(9) Easy to transport/portable	Important	3
(10) Quick and simple to set up	Desirable – Important	2.5
(11) Quick and easy to install	Desirable – Important	2.5
(12) Easy to maintain	Desirable – Important	2.5
(13) Easy to store	Desirable – Important	2.5
(14) Comfortable	Desirable – Important	2.5
(15) Lightweight	Desirable – Important	2.5
(16) Low-cost	Desirable – Important	2.5
Software requirements (n = 14)
(1) User friendly interface	Important – Essential	3.5
(2) Provide feedback on users’ performance to therapists	Important – Essential	3.5
(3) Customizable system, adjustable initial settings	Important – Essential	3.5
(4) Multiple levels for assistance to accommodate differing patients’ needs	Important – Essential	3.5
(5) Simple and clear instructions for use	Important – Essential	3.5
(6) Simple operation system	Important	3
(7) Provide visual or audio feedback on handle movement and performance for patients	Important	3
(8) Monitor usage	Important	3
(9) Multiple games with differing levels of difficulty to accommodate patients’ needs	Important	3
(10) No internet connection requirements	Desirable – Important	2.5
(11) Save individual users’ data	Desirable – Important	2.5
(12) Modular the rehabilitation exercise (split the exercise into several small tasks)	Desirable – Important	2.5
(13) Have menu with frequently asked questions	Desirable	2
(14) Provide online agenda option for patients and therapists to arrange the appointment	Unnecessary – Desirable	1.5
Safety requirements (n = 1)
(1) Meet all safety requirements	Essential	4

Notification: The importance value is the average value of two responses.

Table 4. Implementation barriers of home-based upper limb rehabilitation robots

Implementation barriers	Derivation and supplement
Operation
Lack of technology knowledge	Stroke survivors are often elderly and may not be familiar with using a computer and other technology.^Citation25,Citation33
Need assistance	Many stroke survivors with severe upper limb weakness need help to set up and don and off a rehabilitation robot at home.^Citation39
System operation	Some systems (games) may be too complicated to stroke survivors to operation.^Citation25,Citation33
Device installation and system set up	A cumbersome installation and setup procedure will be difficult for stroke survivors or their families, resulting less motivation to use the robot.^Citation26
Adherence and monitoring
Lack of motivation	Stroke survivors may not persist with regular exercises.^Citation26
Lack of therapists’ guidance	Rehabilitation at home involves less direct contact with therapists which may lead to the patients performing exercises less effectively than if they were directly supervised.^Citation26
Data privacy	Personal data privacy needs to be maintained.^Citation25
Space
Storage space for device	Many stroke survivors do not have spare space in their homes for a large rehabilitation robot.^Citation25,Citation33
Suitable table or chairs	Home-based rehabilitation may not compatible with users’ furniture, such as the height of a table or chairs.^Citation25
Cost
Cost of device	Some stroke survivors may need financial support to buy or rent a home-based rehabilitation robot.^Citation25,Citation33

Table

Table

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