According to the CDC, 795,000 people in the United States have a stroke each year. Strokes occur when blood supply to the brain is interrupted which causes brain cells to die within the span of minutes. The damage that strokes cause can vary within a multitude of impairments of varying intensities. Stroke rehabilitation then becomes crucial in the recovery process; however, that process is a long and difficult one. Only 10% of stroke survivors are able to recover almost completely post-stroke, and 66% of stroke survivors are currently disabled.
With such a massive medical condition affecting so many, Battelle has developed an innovative technology which uses a combination of electromyography (EMG) and functional electrical stimulation (FES) to read muscle activity to decipher intentions to move and stimulate muscles to act accordingly. One key aspect that this technology aims to address in its current form (a sleeve) is an individual’s impairment in their upper extremity (hand and arm). Through wearing and using the sleeve not only can users engage in therapy, they can also recover their hand and arm functionality through a means of neuroplasticity, a phenomenon in the brain that allows it to grow and alter synaptic structures in a way to function in a new way compared to how it functioned previously.
With a prominent problem to address and the means to do so, the question then becomes how to address the process of stroke rehabilitation and recovery in a way that fosters the most benefit and performs the most good for everyone involved in it.
Stroke Recovery Process
To address stroke recovery and find a point of intervention for this technology to do the most good, the process of how stroke rehabilitation and recovery works must first be examined.
The timeline of stroke recovery tends to segment itself into three major stages: the first few weeks after a stroke, 1-3 months post-stroke, and 6-months and beyond. The process will start off with patients receiving much needed medical care from an entire team of professionals at a hospital. Rehabilitation can be jump-started here with therapy sessions going up to six times per day focusing on the activities of daily living (ADL) such as bathing and preparing food. Goals will be discussed and the patient’s condition will be evaluated here to determine which program or facility they need to be sent to in order to recover as needed.
In the next stage of 1-3 months, most patients will see the most significant gains in recovery in this stage as they continue to engage in rehab with a therapist or professional within a program or facility.
In the final stage of rehab and recovery, 6 months and beyond, improvements will be slower with individuals reaching a steady state with this process taking place in a nursing home facility (depending on the individual) or at home.
There’s a positive correlation to the amount of professional treatment and oversight and the amount of time that passes since having a stroke in the process of rehab and recovery. While the oversight and intervention of medical professionals are focused on the earlier stages of time for a stroke survivor, factors such as cost and the extent of an individual’s damage are primary reasons why responsibility of self-advocacy and initiative to find professional help are on the stroke survivors themselves if they are able to attain it.
However, this does not nessesarily mean that individuals will forgo efforts in rehabilitation. In a survey with stroke survivors (n=6) having a stroke +2 years ago and are not actively enrolled in a program, participants stated that they continue to aim for partial or functional recovery (75%) with their perception of care being rated at “I care very much” (100%) and large amount of effort being put into rehab in general (75%).
With efforts in rehabilitation and hopes of recovery persisting beyond this post-program mark, it’s important to acknowledge the diminished frequency of rehabilitation and oversight and communication with medical professionals to see what is the cause of this diminishment and see what effects are produced as a result.
The Medical Perspective
Our team was able to come across the opportunity to interview Annie Stankivicz, a second-year graduate student studying occupational therapy at The Ohio State University. With experience in conducting observations and fieldwork with stroke patients in an in-patient rehabilitation facility, we were able to host an interview to garner insights into the medical perspective of stroke rehab.
The goal of stroke rehabilitation is patient independence. “In general, our biggest thing is independence… getting the patient back to be as independent as possible… that’s usually the goal.” That benchmark is the patient being able to do daily activities on their own such that they can live in their home independently. With all patients, after they do get home, therapy is something that they will have to do for the rest of their life. However, medical professionals are only able to help so much as their professional oversight and intervention for a patient’s rehabilitation process is contingent upon one thing: health insurance.
“Unfortunately, because of health insurance, patients don’t get a lot of time in acute settings and other programs… Like twenty years ago… the average stay was a month in an in-patient rehab setting, now it’s ten days.”
This identifies the major reason as to why professional oversight and care decreases over time with the frequency of rehab being somewhat correlated to professional oversight. The question then becomes how does the presence, or lack of, professional oversight impact an individual’s recovery and rehabilitation.
Correlating Professional Guidance to Improvements in Rehabilitation and Recovery
Patient improvement with the oversight and assistance of a professional tremendously helps an individual recover post-stroke. Stankivicz in her interview says from her experience that there’s a significant amount of growth that a patient undergoes in an inpatient rehab facility with changes being seen in 5 days or a week period.
While efforts in rehabilitation are solely contingent upon the patient themselves, oversight and feedback in correcting one’s process in rehabilitation exercises is important in any rehab effort. Oftentimes, strokes can lead to cognitive impairments and patients may have a difficult time remembering the specifics of hours-long rehabilitation sessions and the homework that they have to do. Factors such as not remembering all the steps of the process, or not engaging with the exercise fully can hinder the effectiveness and efficiency of recovery, and with lack of oversight in the latter stages where insurance cuts off the means to engage with a professional, stroke survivors can find themselves at a stagnation point where they can recover very little if at all.
Other factors such as mental and physical state also impact recovery and rehab efforts. Not having help or guidance is a factor to consider in this process. Lonely, a response given in the survey results, describes the perception and attitude of the process without the intervention of a caregiver, friend, or professional there to be with them. Fatigue and weakness, common effects from age or the stroke itself can deter engagement of rehabilitation efforts especially without someone there incentivizing the individual to engage. Stankivicz states that even in her inpatient rehabilitation facility, there are some patients who are not as cooperative and some of the hardest parts is convincing patients to do therapy.
Though rehabilitation efforts are not solely contingent upon the presence of a caregiver, the oversight and the point of them being there and able to help can aid an individual in engaging with rehabilitation to recover in a more effective and efficient manner.
Intervention in this point of the recovery process will then promote the most good as it is the stage that is overlooked for stroke survivors. The question then becomes how to intervene in this stage?
Adaptive Equipment for Stroke Rehab and Recovery
As mentioned previously, the aim of rehabilitation is to promote patient independence and enable them to live at home. When at home, the rehabilitation process tends to involve various tools to aid in the activities of daily living post-stroke and in some sense act as an indirect professional intervention for patients going through the process of rehabilitation and recovery. These tools tend to assist an individual with various tasks such as putting on shoes, helping them stand up from the bathtub, etc. and learning how to use these tools are a part of therapy for patients. Direct professional intervention on this end is done to assist the patient as needed. Oftentimes, home visits by an occupational therapist, physical therapist, or home health professional would assist in seeing an individual’s home and help them adapt to their post-stroke life. These tools are generally simple in form and uncomplicated to use, and professionals are careful in educating patients in how to use and install them as needed for their adaptation for home recovery.
Adaptive equipment, tools, and medical devices can then come to function in this last stage of recovery for stroke survivors, and they can look out and care for individuals without the direct oversight of professionals when used appropriately. These items as an indirect intervention can provide professional guidance and care to compensate somewhat for the lack of direct professional intervention in this last general stage of stroke rehabilitation and recovery in order to promote greater effectiveness and efficiency.
As discussed in this op-ed, factors such as health insurance prevent the direct intervention of medical professionals in the latter rehabilitation and recovery process despite an individual’s continued care and drive to recover. The intervention of professional help generally lends towards greater effectiveness and efficiency for stroke survivors engaging in rehabilitation and recovery processes, and adaptive equipment can act as indirect means of professional intervention to provide help and ease in these latter stages when taught, issued, and used appropriately by patients.
Now how does this relate to the Battelle Neurolife sleeve introduced at the beginning?
The Battelle Neurolife sleeve is a type of adaptive equipment (though specifially a Class II medical device) with a lot more nuance and complicated workings than something such as a guardrail in the bathroom. This sleeve would require a lot more direct professional intervention initially and continued intervention throughout its use cycle as well as greater education for a patient to learn how to use it properly. While in its current form it acts as an indirect intervention for the rehab process, the complications and need for direct professional intervention opens up opportunities to facilitate various intervention points for a stroke survivor to receive help as needed– direct and indirect.
So the design question then becomes this: How can the Battelle Neurolife Sleeve Facilitate Professional Intervention Points for the Process of Stroke Recovery and Rehabilitation?