Testbed Requirements for Technology Enhanced Stroke

Rehabilitation to Support Independent Living

Awais Ahmad, Peter Mozelius and Karin Ahlin

Department of Computer and System Science, Mid Sweden University, Östersund, Sweden

Keywords: E-Health, Stroke Rehabilitation, Independent Living, Ageing Well, Testbed Requirements.

Abstract: An identified global phenomenon is that, as the percentage of older adults increases, new challenges arise for

medical care and rehabilitation. Several research studies have presented e-health as a promising concept to

support the idea of independent living among patients with chronic diseases. The Mid Sweden region has a

relatively old population and is a region where people live with long distances to the nearest hospital or health

care centres. This study had a focus on defining testbed requirements for a technology enhanced stroke

rehabilitation adapted to the specific region. The focal research question to answer in this study was: What

are the requirements and their associated benefits and barriers of using technology-enhanced systems instead

of traditional techniques for stroke rehabilitation in the Mid Sweden region? With Design Science as the

overall research strategy, data was collected by semi-structured interviews with key stakeholders in the field

of stroke rehabilitation. A deductive thematic analysis was conducted where important themes were grouped

into the four main requirement categories of: Technical, Human-computer-interaction, Clinic and

Sustainability. Beside the more specific requirements, an interesting finding was the division of stroke

rehabilitation into the categories motoric, cognitive and speech rehabilitation; also, how technology enhanced

solutions might be used in these categories. Each category has a potential for a successful use of technology

enhanced services, but as the standard procedure in traditional stroke rehabilitation each patient needs a

personalised treatment.

1 INTRODUCTION

Because the population of older adults is increasing

significantly all over the world, leading to current

and future demographic changes, the world is facing

substantial challenges (Chaaraoui and Florez-

Revuelta, 2016). According to United Nations’ global

ageing indicators, number of people aged more than

60 years was 801 million in 2015 which will become

1.4 billion in 2030 and mover over in 2050, it will

increase to 2.1 billion which means that 20% of the

total papulation will be 60 years or older.

Consequently, the number of people requiring long-

term medical care will also be increased and more

medical and social services will be needed that are

designed to support chronic diseases (Ehn et al., 2015,

Chaaraoui and Florez-Revuelta, 2016). Traditional

rehabilitation systems require a large number of

clinical staff and they are difficult to deploy because

of high running costs (Zhang et al., 2016).

In the last two decades, Technology Enhanced

Systems (TES) has emerged as potential tools for

many treatments in therapy and rehabilitation. Those

technologies are not only cost effective, they are

helpful to develop more usable, useful, and accessible

e-health services that can be helpful for physical,

cognitive and psychological rehabilitation (Zhang et

al., 2016, Rizzo and Kim, 2005, Broeren et al., 2008).

Some other theoretical findings show that there are

some critical requirements, which need to be

addressed in order to adopt those e-health

technologies such as trust, personal integrity,

technology acceptance, e-health literacy and

accessibility of ICT (Fischer et al., 2014, Ahmad and

Mozelius, in press). These findings therefore need to

be meet with requirements from the user perspective.

Thusly, this study had a focus to understand the

requirements of technology enhanced systems (TES)

for independent living and to determine the

challenges for deployment of TES.

Stroke is one of the biggest causes of death around the

world and a main reason of chronic disabilities in

adults (Yamato et al., 2016). It is considered a

primary cause of permanent physical damage in the

174

Ahmad, A., Mozelius, P. and Ahlin, K.

Testbed Requirements for Technology Enhanced Stroke Rehabilitation to Support Independent Living.

DOI: 10.5220/0007658101740182

In Proceedings of the 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2019), pages 174-182

ISBN: 978-989-758-368-1

adult population and, due to those physical

disabilities, the affected people fail to continue a

healthy social life and they must compromise the pure

joy of life; the older adults are the most affected age

group (Broeren et al., 2008).

Although the challenges for stroke rehabilitations

are common all over the world, our main focus was

the Mid Sweden region. According to “Statistics

Sweden”, the population of the Mid Sweden Region

is scattered in the whole region and a large number of

people are living outside the cities (SCB, 2016).

Consequently, providing rehabilitation services in the

remote areas is even more challenging and a large

amount of resources are needed to meet these

challenges. Technology enhanced systems can play a

vital role there.

1.1 Aim

The aim of the study was to define the testbed

requirements for a technology enhanced stroke

rehabilitation to support independent and active

living. The main research question was: What are the

requirements, benefits and barriers of using

technology enhanced systems instead of traditional

techniques for stroke rehabilitation in the Mid

Sweden region?

2 EXTENDED BACKGROUND

2.1 Stroke Rehabilitation

After stroke, rehabilitation has been challenging for

both patients and healthcare providers, as it requires

high motivation and hard work from patients and

extensive resources from health care providers

(Yamato et al., 2016, Broeren et al., 2008). Most

commonly, a stroke patient may suffer from some

serious motor, cognitive and speech impairments

(Langhorne et al., 2011). Various treatments are

available for stroke rehabilitation that involves

physical therapy, cognitive recovery and speech

restoration with language therapy (Seniów et al.,

2009, Langhorne et al., 2011, Veerbeek et al., 2014,

Pollock et al., 2014).

Stroke patients experience motor impairments in

the left or right side of the body that can limit their

physical activity and consequently the patient’s

ability to perform their daily routine tasks decreases

immensely (Langhorne et al., 2009, Palmcrantz et al.,

2017). In order to overcome the aftereffects of stroke,

and to increase the quality of patient's life, intense and

long-term physical training is needed and should be

started as early as possible (Ehn et al., 2015). Many

of the currently used treatments for motor injuries

involve physiotherapy and guided physical exercises;

the perceived benefits of using physical therapy in

stroke rehabilitation are continually increasing

(Veerbeek et al., 2014). In the last two decades,

several technology-enhanced rehabilitation systems

for stroke have been suggested in different studies

with their own benefits, drawbacks and limitations

(Rizzo and Kim, 2005, Broeren et al., 2008,

Palmcrantz et al., 2017). A number of novel therapies

has been developed and tested and, in few of them,

virtual reality and robotics are also involved.

Although the perceived benefits of these

interventions are not well known yet, there are strong

possibilities of progress in these types of therapies

(Langhorne et al., 2009).

2.2 Independent Living and Ageing

Well

Considering the rapid increase of older population,

several research studies have highlighted the

importance of designing new e-health services to

support the ideas of independent living and ageing

well (Bowes and McColgan, 2013, Christophorou et

al., 2016). Recent research studies have found that

most older adults prefer to age in place, and that this

concept is favored by policy makers (Peek et al.,

2016), but also that contextual and psychosocial

factors must be carefully explored if e-health services

should result in a beneficial impact (Bowes and

McColgan, 2013, Axelsson and Wikman, 2016).

The concepts of ageing well and older adults’

possibilities for independent living are related and

intertwined (Billis et al., 2015). Ageing well, or

healthy ageing, has been described as a lifelong

process to optimise the opportunities for improving

and preserving health and physical, social and mental

wellness to obtain independence and quality of life

(Peel et al., 2004). Stroke is one of several acute

health conditions that often results in lost

independence, and a main objective in the

rehabilitation must be to reestablish and facilitate

patients’ independent living to obtain their quality of

life (Gwozdz and Sousa-Poza, 2010).

3 METHOD

The overall research strategy for the study was a

Design Science approach inspired by the fivefold

Testbed Requirements for Technology Enhanced Stroke Rehabilitation to Support Independent Living

175

process outlined by Johannesson and Perjons (2014).

In the general definition, Design Science should

involve a rigorous process where the design of

artefacts should try to solve observed problems and

make research contributions (Hevner et al., 2004,

Peffers et al., 2007; Johannesson and Perjons, 2014).

This study was carried out for the first two phases of

the process that is illustrated below in Figure 1.

Firstly, a problem was identified and formulated, and

in the second phase the testbed design requirements

were defined.

Figure 1: Phases in the Design science process.

Many design science studies do not carry out all the

five phases of the method framework depicted in

Figure 1. This study was conducted as a Requirement-

Focused Design Science project, with a focus on

defining requirements. This type of study starts with

an existing problem and defines requirements in a

combination of a literature study and interaction with

relevant key stakeholders. In Requirement-Focused

Design Science Research, the artefact design is only

outlined and involves neither artefact demonstration,

nor artefact evaluation. (Johannesson and Perjons,

2014).

Defined requirements will be the foundation for

future work, where the remaining phases in Figure 1.

will be carried out. Defined testbed requirements

were divided into the categories of 1) Technical

requirements, 2) HCI requirements, 3) Clinic

requirements, and 4) Sustainability requirements, as

the four fundamental pillars for a successful

implementation of a testbed for stroke rehabilitation

to support independent living.

3.1 Data Collection

Some type of interviews may be the most common

data collection method for defining requirements. A

direct approach to requirement specification is to

interview different stakeholders about which explicit

requirements they would suggest. Interviews can be

highly efficient, but they also risk stifling creativity if

they are too structured. Best practice is often to use

semi-structured or unstructured interviews to

encourage informant initiatives. It is also of

importance to select informants with a competency

and engagement that add value to the requirement

specification process (Johannesson and Perjons,

2014).

Data for defining the requirements in this study

were gathered in a combination of semi-structured

interviews and by a literature study. All interviews

were carried out following a common instrument,

with a basic question schedule that allowed

adaptation to the various interviewees. The basic

question schedule included themes such as work

relation to stroke rehabilitation, current knowledge,

use, and understanding of use of ICT and its

usefulness in relation to stroke rehabilitation, future

wishes for use of ICT in relation to stroke

rehabilitation, and budget for using ICT in relation to

stroke rehabilitation. Keywords for searching

literature were: e-health, stroke rehabilitation,

independent living, and ageing well. Interviews were

also combined with taking handwritten notes, to

provide a backup to the audio recording, but also to

facilitate the analysis process. The analysis process

has been reflexive for the researchers, looking at the

novelty of the requirement area, stroke rehabilitation

(Thomsson, 2002). The impact has been further

knowledge building and reflection following each

interview session and further reading to understand

the area.

Table 1: Informants’ professional roles and years of

experience of Stroke rehabilitation.

Informant

Professional role

Years of

experience

Informant 1

Speech therapist

Informant 2

The region’s medically

responsible doctor

Informant 3

Therapist #1

Informant 4

Physiotherapist #1

Informant 5

Physiotherapist #2

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176

Data were collected from five informants with

different roles in contemporary stroke rehabilitation.

This was a purposive sampling where all informants

have special expertise and deep knowledge in the

investigated area. Purposive sampling is a sampling

technique where researchers rely on their own

judgment when choosing informants to participate in

ta study. Chosen informants’ roles and their years of

experience are described below in Table 1.

Informants 3 - 5 work as part of a mobile team for

stroke rehabilitation located at the region’s hospital.

The mobile team includes one manager and four co-

workers, adding one more therapist. The mobile team

is responsible for rehabilitation after clinical care as

the patients have been relocated to their homes. The

mobile team offers care for patients living 70 km from

the hospital, which covers parts of the region. Patients

living further away are not provided with any support

from the mobile team.

3.2 Data Analysis

A deductive thematic analysis was conducted with

Technology, HCI, Clinics and Sustainability as the

four predefined themes. The analysis was conducted

as content analysis based on audio recordings and the

transcribed recordings. Each researcher conducted an

individual analysis, followed by discussions on the

various findings to conclude the material. The

individual analysis was formed by the steps in

meaning units, condensation, code, category, and

themes (Elo and Kyngäs, 2008, Bengtsson, 2016,

Erlingsson and Brysiewicz, 2017).

As pointed out by Gibbs (2018) there are both pros

and cons with the use of Computer Assisted

Qualitative Data AnalysiS (CAQDAS) tools to assist

the analysis process. CAQDAS, is a term, introduced

in 1991, that refers to the wide range of software now

available that supports data analysis in qualitative

work. At the same time as the software provides a

structured and powerful way to manage the analysis,

CAQDAS has also been criticised for inflexibility,

and for creating distance between the researcher and

the data (Gibbs, 2018). However, the latest versions

of CAQDAS tools have improved the flexibility, and,

when several researchers collaborate, a common

computer assisted structure can be of value. A

CAQDAS tool facilitates the process of storing,

organising, categorising and visualising the gathered

data. The common CAQDAS used in this study was

the NVivo tool (Alfasoft, 2018).

3.3 Ethical Considerations

The ethical considerations relate to the informants

taking part in this study and the consequences of the

actual research (Helgesson, 2015). The informants

were all briefed on and responded to informed

consent, including details such as the right to

withdraw from the interview or interview questions

and personal integrity. Further, the purpose of

collecting the informant material is solely for research

purposes.

This study does not consider the individual third

person, such as patients performing stroke

rehabilitation, but does discuss stroke rehabilitation in

general. Therefore, interview questions related to

individual patients were omitted, as well as specific

training programs or patient names for further

interviews. To protect the informants, their names are

omitted in the transcriptions, while the transcriptions

are stored at the local university’s appointed and

password saved information system for empirical

material.

The consequences of the actual research is

determined by clinical and social aspects, since the

focus is on the usability for stroke rehabilitation and

the patient. The technology requirements are

subordinated, since technology is supposed to support

the patient.

4 FINDINGS

The process of defining testbed requirements for

technology enhanced stroke rehabilitation was

conducted holistically, but with requirements divided

into the categories of Technical, HCI, Clinical and

Sustainability requirements. The categories have

several interrelations, but findings are presented

separately.

4.1 Technical Requirements

Physical damage has large variations between

different persons and stroke recovery is

heterogeneous in its nature (Langhorne et al., 2011).

As highlighted by Informant 1, the rehabilitation has

to be individually adapted with more advanced

technology enhanced solutions for patients that have

the cognitive ability to use a text based and complex

interface. For this target group, the use of virtual

reality and interactive video gaming may be

beneficial for the motoric recovery (Laver et al.,

2015), and that the language relearning can be

facilitated by various standard applications for

Testbed Requirements for Technology Enhanced Stroke Rehabilitation to Support Independent Living

177

language training. Preferably, these applications

should involve features for recording and replaying

the patients’ pronunciation exercises. (Informant 1)

Considering more severely damaged patients,

language skills can be lacking and the

recommendation is to use image based applications,

which can be used to diagnose the damage level

(Dobkin, 2004). An example of an image based tool

are the so-called ‘Talking photographs’, applications

that can be run from a tablet or a smart-phone

(Informant 1). Some patients have a damage level

where the initial training has to be carried out by oral

exercises with repetition and mimicking only, and

many patients have a visual impairment caused by the

stroke. (Informant 1)

For patients with mild-to-moderate upper

extremity motor impairment, low-cost, off-the-shelf

exergames connected to sensors seem an interesting

add-on alternative (Laver et al., 2015, Tsekleves et

al., 2016). Considering patients with more severe

motor impairment, a solution might be to use

technology based on eye-tracking navigation

(Informant 2). Finally, a crucial factor for technology

enhanced services is the quality, or existance, of

internet connections in the patients’ homes. There are

still several blank spots without internet access in

some the region’s remote areas (Informant 3-5).

4.2 HCI Requirements

Human-computer interaction (HCI) is an established

field in computer science where designing, evaluating

and implementing interactive computing systems is

considered from the user’s perspective (Gulliksen,

2017). The requirements should be considered from

the HCI prospective and some important HCI factors

need to be addressed. Several theoretical findings

showed those critical HCI factors are trust in different

forms, personal integrity, technology acceptance and

e-health literacy (Fischer et al., 2014, Veer et al.,

2015, Ahmad and Mozelius, in press).

The approach of older adults towards e-health

applications is different from younger people and

they feel difficulty in adopting those applications

(Fischer et al., 2014). As reported by Informant 1, not

all people accept Technology Enhanced Systems and

few of them are actually set against them. Older

adults especially have difficulty using e-health

applications (Informant 1).

Despite the fact that a large amount of resources

are invested on Technology Enhanced Systems, they

are not easy to adopt for patients and there are some

issues regarding usability and perception of

usefulness which need to be addressed (Haslwanter,

2018). During the interviews, both Informants 1 and

2 emphasized heavily the importance to consider the

aspects and requirements of usability and usefulness

of technology enhanced services (Informant 1;

Informant 2). Informant 1 described that there are

many different kinds of mobile phone or iPad based

applications available for stroke rehabilitation and

they recommend them for the patients’ use. The

usability of those applications depends heavily how

much a patient is affected by stroke and how much

their brain has been damaged (Informant 1).

While designing e-health services, personal

integrity and patient’s privacy should be considered

as a critical issue and Healthcare providers need to

consider it while deploying technology-enhanced

systems such as monitoring cameras (Courtney et al.,

2008, Ahmad and Mozelius, in press). Three

informants mentioned that patients are very much

concerned about their privacy and personal integrity

(Informant 3 - Informant 5).

Several studies highlighted the importance of e-

health literacy to increase the usability of e-health

services for older adults (Ahmad and Mozelius, in

press, Vines et al., 2015). The use of web applications

in stroke rehabilitation depends on the understanding

of these applications and there should be clear

guidelines and instructions to use these applications

(Informant 1, Informant 5). Older adults especially

have more difficulties using mobile applications

because of their lesser understanding of how to use

them (Informant 1).

4.3 Clinic Requirements

This striking disease is caused by interruption of the

blood supply to the brain because an artery to the

brain is either blocked (ischaemic stroke) or bursts

(hemorrhagic stroke) and it damages the brain tissues

(Yamato et al., 2016).

The rehabilitation must be carefully adapted to

each individual, and how stroke has affected a

patient’s abilities show large variations (Informant 1).

Depending on where in the patient’s brain the damage

is located, there can be a wide variety of disabilities

that need rehabilitation (Informant 2). An important

principle is to start the rehabilitation as soon as

possible (Informant 1; Informant 2), and preferably in

two or three days after the stroke has occurred

(Informant 2). How the rehabilitation should be

carried out in detail depends on the patient’s cognitive

and motoric condition, and a technology enhanced

rehabilitation has the best probability to be successful

for patients with milder cognitive and motoric

disabilities (Informant 1; Informant 2).

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Stroke rehabilitation could be divided into three

main categories: cognitive, motoric and speech

rehabilitation (Informant 3-5). According to the

informants, there is a potential for technology

enhancement in all the categories, but probably not

for stroke patients with more severe disabilities

(Informant1; Informant 3). In a rough estimation at

least 25% of the patients could benefit from various

types of technology enhanced support (Informant 1).

Specific to the investigated region is that the

population is evenly spread out with the city of

Östersund as the central hub (Informant 2). The

mobile stroke team visits patients in their homes if

they live inside the 70 kilometre radius that defines

their working range. Patients living outside the radius

are excluded from the services that are carried out by

the mobile stroke team.

4.4 Sustainability Requirements

Sustainability is created by finding the balance

between its three pillars: environmental, social and

economic (Brundtland, 1987), aiming for a wished

end-goal, here the stroke rehabilitation.

Sustainability is usually discussed as a direction for

fulfilling today’s need by not sacrificing the coming

generations’ possibilities to fulfilling their needs.

Detailing the pillars shows that environmental

sustainability, often viewed as the fundamental part,

deals with maintaining long-term human and material

resources. Here the human resources, looked upon as

social sustainability, includes every possible patient

in need of stroke rehabilitation and their specific

needs (Informant 1 - Informant 5).

The economic sustainability derives from the

ability for everyone to afford to take part in stroke

rehabilitation and the efficient use of co-workers’

time (Informant 1 - Informant 5). One primary reason

for economic sustainability equalising efficiency

might be the lack of financial resources in the region.

Equalisation between technological development and

economic growth, and further between economic

growth and sustainable development, is far from

unproblematic. One problem is to understand the

equalisation in itself, and another is defining

development as sustainable.

Social sustainability includes meeting the patient

at their level, supporting them in feeling secure,

performing everyday courses, and performing

exercises related to their physical level (Informant 3 -

Informant 5). There is, therefore, a need for flexibility

related to social sustainability, e.g. while using TES

in a health care context or at home. One such could

be the variation for cognitive rehabilitation, where

some of the patients need everyday instruction and

evaluation. Another social perception is that of joyful

and inspirational rehabilitation. Their view is that

younger patients might view using TES as more

inspiring than physical rehabilitation and thereby be

more likely to use it.

The economic sustainability was discussed

concerning both the patients and the co-workers. For

rehabilitation in the patient’s home, the software

needs to be affordable, both in consideration to the

investment, implementation, and maintenance. The

latter is discussed as the Mid Sweden region does not

offer any maintenance technicians for home support

(Informant 3 - Informant 5). Related to that is the cost

for power supply and other surrounding costs.

Therefore, the informants view the health care

context as more economically sustainable, regarding

implementation and maintenance. The other view on

economic sustainability is that of the co-workers.

Using TES, regardless of context, can make them

more efficient timewise. They view driving far to

meet the patient for half an hour as a waste of time in

comparison to talking to them, e.g., using Skype or

cell phone. The saved time could be used for quality

improvements, not further specified. They did discuss

the office situation, and finding needs for

reconstruction related to privacy concerns.

The environmental sustainability was not

highlighted by the respondents, and was more viewed

as a foundation. Environmental sustainability refers

to the long distances, where the co-workers need to

drive for several hours per workday to meet the

patients in person (Informant 2 - Informant 5).

However, one idea to make the implementation more

environmental in a friendly way was to use

geographically closed health care centres that include

space for self-care situations, such as measuring

blood pressure (Informant 3).

5 DISCUSSION

What is specific for the investigated region is the

heterogenous demographic spread around Östersund

as the central hub for healthcare. The relatively long

distances inside the 70 km work radius for the stroke

team raised thoughts about telecommunication and

technology enhanced services. An ordinary 20

minutes home visit for the mobile stroke team could

involve a 2 hour car drive in both directions

(Informant 3-5). However, all informants agree on the

importance of human-to-human interaction and that

technology should be tested as a complement and not

as a replacement.

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179

There seems to be a potential for using e-services

in all three stroke rehabilitation categories with

obvious benefits in the motoric rehabilitation.

Exergames and other game-based solutions would be

interesting adjunctive alternatives (Karasu and Batur,

2018) but always with the principle of a careful

individual adaptation. As pointed out by Pollock et al.

(2014), the effectiveness of a treatment depends upon

the patient’s physical and mental condition. Therefore

physiotherapists should choose the treatment

according the patient’s medical requirements

(Pollock et al., 2014).

Considering the speech rehabilitation there are

also a wide range of software for articulation

exercises and language relearning (Informant 1). A

speech therapist can prescribe the combination of

hardware and software that has been selected for a

patient. However, not all patients have the computer

skills or the visual ability to use all existing

applications. A custom built, tablet-based stroke

rehabilitation platform with software applications for

speech rehabilitation has been tested with promising

results in Canada (Pugliese et al., 2017).

The cognitive rehabilitation might use both games

and software for telecommunication (Informant 3).

Patients often suffer from memory impairment and a

digital game based approach could be an appreciated

complement to traditional rehabilitation (Withiel et

al., 2018). Finally, the concept of telecommunication

was brought up by the mobile stroke team, and also

the idea of testing a mobile robot based

communication tool in patients’ home environments

(Informant 3-5).

Stroke is one of the most common causes of

physical, cognitive and speech disabilities. Right after

stroke, effective and urgent rehabilitation is needed in

order to overcome or decrease the disabilities.

Technology Enhanced Systems can play a vital role

here (Zhang et al., 2016). However, there are some

critical factors that need to be addressed while

constructing these systems. Things should be seen

from the user perspective and human requirements

should be fulfilled.

Technical requirements have to be carefully

outlined. The willingness to use Technology

Enhanced Systems heavily depends upon the

perceived benefits of using these technologies,

quality of information and training to use them,

degree of joyfulness in these technologies, the

medical condition of the patient after stroke and the

age group of the patient. All the informants agreed

that technology-supported solutions should be

interactive, interesting and joyful to increase the ease

of use and to meet the above mentioned requirements

(Informant 1 - Informant 5). As suggested by many

studies, attitude towards contemporary technologies

depends upon usefulness, usability, education and

training, previous experiences and trust on these

technologies (Broeren et al., 2008, Fischer et al.,

2014, Lee and Coughlin, 2015, Zhang et al., 2016).

An important part of the HCI requirements is to

consider trust and privacy. Patients are in general

concerned about privacy and integrity, and even more

when it comes to the use of monitoring devices

(Informant 3 - Informant 5). Finally, the economic

sustainability needs further investigation, and with

the perspective that efficiency always should be

related to patients’ personal integrity and social

sustainability. Technology must be a complement and

support social interaction and not only a cost-

effective substitute.

6 CONCLUSION

With the help of surprisingly collaborative and open-

minded informants, the study has generated useful

general requirements for further future testing and for

the planned implementation of a testbed. However,

in all of the three found rehabilitation categories,

motoric, cognitive and speech rehabilitation, there is

a need for more specific requirements.

Some important benefits and barriers have also

been discovered in the field of technology enhanced

stroke rehabilitation. Technology enhanced solutions

seem to have a potential to support independent

living, but only if HCI requirements such as trust,

privacy and user-friendliness are met. Stroke patients

often suffer from memory impairment and visual

impairment and therefore the requirements for user-

friendliness need to be stricter than for just any

ordinary technology enhanced solution. Finally,

findings have also contributed to a better

understanding of the specific health care conditions in

the Mid Sweden region.

7 FUTURE WORK

This study defined the more general requirements for

a future testbed implementation for technology

enhanced stroke rehabilitation. The natural next step

would be to define more specific testbed technical

and HCI requirements for each of the three found

rehabilitation categories. From a longer perspective,

the presented requirements should be used as part of

the design and implementation of a future testbed.

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