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ETEC-651/551 High Level Design Thanda, Haidee

Brief description of the project

In response to the high incidence of falls for stroke survivors, the Board of Directors of the Jewish Rehabilitation Hospital has requested the development of a Yoga-Balance Rehabilitation solution to help hemiparesis patients, (people who have weakness on one side of their body). A performance needs assessment was conducted and indicated the following competencies that need to be developed by patients (primary performers): Competency 1: Identify benefits of the yoga technique for stroke survivors Competency 2: Perform breathing technique Competency 3: Perform ankle balance exercise This report will present the high-level design, by summarizing the interventions that will address gaps in motivation, resources, knowledge and skills in the fall prevention campaign. I will first present the road map, an overview of the campaign and its interrelated components. Secondly I will summarize each component.

Note: The interventions are limited in scope in order to meet the requirements of the class project. Performers include physicians and patients. Ideally caregivers should also be targeting in a more comprehensive solution campaign. Repeated selected elements (i.e. planned repetition) will be used heavily due to patients cognitive limitations that impair their ability to retain information.

Legend

ETEC-651/551 High Level Design Thanda, Haidee

C= Competency F= Format 2 Competency 1: Identify benefits of the yoga technique for stroke survivors Competency 2: Perform breathing technique Competency 3: Perform ankle balance exercise

Note: Refer to this page for major components of intervention

Fall Prevention Campaign Roadmap

Humble Performer

Indifferent Performer

ETEC-651/551 High Level Design Thanda, Haidee

Major Components of Fall Prevention Campaign:


1. The success of the fall prevention program relies on promotion and integration within the existing hospital environment. This intervention focuses on advertising the benefits of the program on a unit level in order to increase program engagement. 2. The aim of the Q & A is for experts and patients to discuss the implications of yoga on the incidence of falls for stroke survivors in order to provide doctors with the evidence of the programs efficacy. 3. Patient Pamphlets reduce cognitive load. Stroke victims can take the pamphlet home and do not need to rely on their memory, which may be impaired. 4. This learning program develops skills and knowledge that stroke patients need to reduce the incidence of falls. It provides newbie performers with basic knowledge and techniques to reduce the incidence of falling. 5. The aim of this intervention is to provide the individual performer with instructions on how to perform ankle exercises. The performers will follow step-by-step instructions to perform the exercise by following video guidance. 6. This feedback system addresses motivation by combining evidencebased games and motion tracking sensors to offer a fun tool for rehabilitation and instant performance feedback for arrogant performers. This system is intended for home-use and will address performance at a unit and individual level. 7. This intervention addresses a motivational need at the individual level. It helps patients make meaningful connections over a cup of tea with people who are going through a similar experience. 8. E-coaching aims to engage and motivate patients via e-coaching. The ecoach (yoga therapist) provides remote feedback by sending notes to the patient and updating their program routine. Note: In ideal conditions, an advertisement should circulate, in the most suitable medium to promote each individual intervention.

ETEC-651/551 High Level Design Thanda, Haidee


Intervention 1: Fall Prevention Awareness campaign Summary description The success of the Post-Stroke Fall Prevention program relies on promotion and integration (with existing initiatives in the hospital environment). This intervention focuses on advertising the benefits of the program on a unit level in order to increase engagement among caregivers and patients. It will address motivation for performers in the indifferent phase both at the unit and individual level. Format of the intervention Advertisement Competency it addresses: Identify benefits of the yoga technique for stroke survivors

Conventions Why you chose this intervention A poster was chosen because it could be displayed in the hospital wing where stroke victims receive therapy. A poster with a strong image can be an effective way to catch peoples attention.

Type of information available Advertisements provide short, positive messages with a call to action such as Join us for a free demo class at lunch and rely heavily on graphics. They will also include a reference number for more information. Structure or format of the information A large poster with point form information and a picture. Writing style Formal language Claims are supported by a credible authority Conversational and inviting tone Encouraging tone

ETEC-651/551 High Level Design Thanda, Haidee


Expectations that performers have

Performers dont have to think too much to decode the message. The performers should get the message at first glance. Message is attractive with a call to action Message is clear and concise Message is persuasive Powerful and creative image Resource reference listed on the poster

Communication medium Print Why you chose this medium Print advertisements are visually accessible. The impact of this medium comes from repetitive messaging that they will experience throughout the hospital. Advantages of the medium, especially in this context One time production cost is moderate Low-Moderate development time Effortless medium for users to read Consistent message Easiest read Far reach with minimal effort

Limitations of the medium, especially in this context Costly to print Linear medium Limited by space on the poster No one likely to read in-depth

ETEC-651/551 High Level Design Thanda, Haidee


Intervention 2: Patient pamphlet on the Benefits of Yoga Summary description of the component From the perspective of the hospital, the pamphlet is a tool to convey essential information about the benefit of yoga for stroke patients at a unit level. This intervention will address a resource gap for patients in the indifferent phase. The rational for having a pamphlet for patients is that it reduces cognitive load. Stroke victims can take the pamphlet home and do not need to rely on their memory, which may be impaired. Format of the intervention Pamphlet Competency it addresses Identify benefits of the yoga technique for stroke survivors Conventions Why you chose this intervention A pamphlet was selected to inform and motivate patients and caregivers to take part in the program. Type of information available People expect to learn about a service How it benefits them How to learn more about the service or engage it

Structure or format of the information The pamphlet would catch the readers attention with a relatable image, catching attention, then provide some information, and close with a call to action or receive more information Writing style Minimal text The visual layout of the document should be attractive Visuals play a prominent role in communicating the message Formal and professional Inspirational Conveys information clearly; bullet points, lists, appropriate images

ETEC-651/551 High Level Design Thanda, Haidee


Expectations that performers have It provides the core information about the organization or service How to get more information and enroll Visually and graphically appealing The information should be accurate

Communication medium Print pamphlet, with PDF version also available on the website under complementary services Why you chose this medium The rationale for having a pamphlet is to make use of waiting time. The pamphlets will be in physician consultation rooms for a period of 8 months. Patients end up asking physicians about the yoga fall prevention program during their consultation. At that point the doctor can easily recommend the program to them. Advantages of the medium, especially in this context One time production cost is low (relative to 40-hours) Low-to-moderate development time Effortless medium for users to use Consistent message Easy to read For users, access to playback equipment

Limitations of the medium, especially in this context Changes and updates cannot easily be made Lack interactivity Can only have key information

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Intervention 3: Where evidence meets experience Q & A Session Summary description of the component

These information sessions will be held periodically as new groups of people that experience stroke need to learn about the benefits. A yoga therapist, a doctor, caregivers and patients present a lecture on the benefits of a Yoga-Balance Training program to clinicians in the feeling arrogant phase. The performance need it addresses is skills and knowledge at the unit level. The purpose will be to discuss the benefits of yoga to reduce the incidence of falls for stroke survivors. The aim is to discuss the implications of yoga on the incidence of falls for stroke survivors in order to provide doctors with evidence of the programs efficacy. Format of the intervention Lecture Competency it addresses Identify benefits of the yoga technique for stroke survivors

Conventions Why you chose this intervention I chose this intervention because many doctors know about the general benefits of yoga, but may not know about its capacity in treating stroke patients. The Q& A is important for addressing skeptical attitudes and addresses doctors informational gaps or concerns about the training program. Type of information available An overview of the upcoming campaign Speakers present evidence-based research on yoga and the prevention of falls Patients share personal stories that express the value of the intervention Patients, caregivers and yoga therapists answer questions A call to action to how doctors can contribute to the initiative

Structure or format of the information 1. Doctors would be notified by e-mail 2. Lunch or breakfast is served 3. When doctors are seated, panelists (yoga therapist, doctor, patient) present information

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4. Doctors ask questions 5. Panelists provide answers Writing style Formal and personal The delivery should be enthusiastic and motivating

Expectations that performers have Research will be presented by a credible source There will be a round of brief introductions People can ask questions and the respondents will answer honestly

Communication medium Live Why you chose this medium Meeting patients and experts in person and learning about their perspective, helps establish a sense of connection, which can help doctors learn and motivate them to support the initiative. Advantages of the medium, especially in this context Cost of production is moderate For producers, cost of playback equipment is very low. Development time is moderate Doctors are familiar with the medium Non-verbal communication can be captured live Meeting people in person can establish a sense of connection

Limitations of the medium, especially in this context Doctors are busy and will have to schedule time for the session Information communicated in person can be difficult to recall, when time passes Bringing patients, caregivers, and doctors to the hospital poses some moderate scheduling challenges.

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Intervention 4: Staying on your Feet Yoga- Based Balance Training Summary description of the component

The learning program addresses the skills and knowledge component at the individual level. This intervention is essential to the campaign because it teaches patients the benefits of yoga as well as practical techniques. It provides novice performers with basic knowledge and skills to reduce the incidence of falling. Format of the intervention Lecture Competency it addresses Identify benefits of the yoga technique for stroke survivors Perform breathing technique Perform ankle balance exercise

Conventions Why I chose this intervention This intervention was chosen because patients do not have knowledge about the benefits of yoga. Knowledge and skills are necessary precursors to successful performance. Type of information available Expository content Objectives Activities Practice Evaluation

Procedural and informational knowledge Extra resources FAQ addressing frequent issues

Structure or format of the information The training program will be presented in three units, which are based on the main objectives and will be presented orally by the instructor. Writing style

ETEC-651/551 High Level Design Thanda, Haidee


Since stroke patients may suffer from cognitive limitations (due to the impact of stroke) the language will be very simple and the reading grade level 5. Simple and concise language Instructional Many images

Expectations that learners have: There will be physical resources to support the class, including a room, desks and learning material To listen to an instructor in a clean classroom environment To learn how yoga can be a tool for fall prevention To learn how and when they can do yoga To practice exercises To be given handouts or job aids To be able to ask questions about the subject To receive answers To receive feedback To learn from an expert To apply what they have learned in everyday life

Communication medium The learning program will be instructor led in a classroom in the hospital. There will be printed material for students and instructors. Why I chose this medium Patients often experience feeling of isolation after the dramatic change in lifestyle after stroke. A classroom-based course is most effective to address the performers needs. In class, the facilitator can modify content on the fly to better address the performers needs. It is also an ideal setting to meet other patients that are undergoing the rehabilitation process. Advantages of the medium, especially in this context Costeffective Convenient location, in the hospital

ETEC-651/551 High Level Design Thanda, Haidee


Instructors presence will be beneficial for the learners limitations Meeting other performers can promote a social support network and foster a shared experience Learners can get immediate feedback on performance from the instructor, especially in the case of doing physical exercises Material can be covered in an interactive manner and personalized to the audience Spontaneous changes can be made to enhance the learners experience Limitations of the medium, especially in this context Materials must be prepared in advance There is a capacity limit depending on the size of the room Coordinating schedules can be challenging The patients will need transportation to the hospital Some patients may feel shy to ask questions in a classroom setting

ETEC-651/551 High Level Design Thanda, Haidee


Intervention 5: Getting to know your movement Tutorial Summary description of the component The aim of this intervention is to provide the individual performers with instruction on how to perform ankle exercises. The performers will follow step-by-step instructions to perform the exercise by following video guidance.

This intervention is a resource video, to help patients recall the exercise. The performance phase that is targeted is those in the arrogant phase, by viewing the video and following along individuals get instant feedback by listening to the instructors cues. Stroke patients have cognitive limitations, so reducing the cognitive load by providing easy to follow instructions after the training is essential to program adherence. Format of the intervention Tutorial Competency it addresses Identify benefits of the yoga technique for stroke survivors Perform ankle balance exercise

Conventions Why I chose this intervention This intervention was selected because it provides easy instructions that performers can visually follow. Some patients experience cognitive limitations, watching a video tutorial will help refresh knowledge and skills learned at the training. A refresher tutorial can help patients remember instructions for performing exercise. Type of information available Title Describe benefits of preforming the ankle exercise Duration of exercise Step-by-step instructions

Structure or format of the information The tutorial will be uploaded onto YouTube and linked to the Hospitals website under complimentary services. Before starting the tutorial, learners will be asked not to eat to 30 minutes before they practice the exercises

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Writing style Second person Supportive language Motivating Define unfamiliar terms Clear and concise instructions

Expectations that learners have Performers expect to be able to learn the benefits of the exercise Follow-step by step instructions Performers expect the instructions to be at a pace they can follow That the instructor will communicate clearly

Communication medium Asynchronous (Ideally viewed on a tablet or phablet) Why you chose this medium Tablets are suitable for stroke patients because they have speech generating devices, text to speech, and virtual keyboards Advantages of the medium, especially in this context Moderate production cost Tablets are very intuitive and easy to use Overcome barriers of distance and time Ease of use Remote access 24/7 Interactive Easily distributed

Limitations of the medium, especially in this context Moderate development time Social isolation Some users may not be comfortable with medium Up-front costs (computer and internet) Some devices require plug-ins to run YouTube Users may not have access to a tablet

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Intervention 6: Home-based Feedback System Summary description of the component A simulation that addresses motivation by combining evidence-based games and motion tracking sensors to offer a fun tool for rehabilitation and instant performance feedback. This feedback system addresses motivation by combining evidence-based games and motion tracking sensors to offer a fun tool for rehabilitation and instant performance feedback for arrogant performers. This system is bound for home-use and will address performance at a unit and individual level. Rationale for including this intervention Once a patient leaves the hospital, it can be hard to tell if a patient is correctly practicing the exercises prescribed by the yoga therapist. Format of the intervention Simulation Competency it addresses Perform breathing technique Perform ankle balance exercise

Conventions Why I chose this intervention It is hard for patients (because they rely on family member to drive to the hospital for follow-ups in a regular basis). With the feedback system, the clinical unit can detect issues patients are facing with performance metrics remotely. Type of information available The clinician or therapist and individual will receive feedback on whether or not the patient is performing exercises correctly and how to correct their performance if need be. Individual performers gain points, badges and social media recognition to keep them motivated throughout their therapy. Clinicians gain access to a range of valid performance metrics and multiple means of displaying improvement - Tables, pictures and/or videos.

ETEC-651/551 High Level Design Thanda, Haidee


Structure or format of the information You require an Internet connection to use the Portal, and one of the following web browsers to support the application (Internet Explorer 8 or more recent, Firefox18 or more recent , Chrome24 or more recent) Interactive and gamified Writing style Simple and concise Engaging plot Graphics

Communication medium Online asynchronous Why you chose this medium The feedback system is a software platform designed for physical therapy. It is comprised of two parts: the wave and the portal. The Wave is an application that may be downloaded and installed on a personal computer (PC). It contains all the activities a patient would engage in to participate in physical therapy. The Portal is a web application which clinicians can log into, and monitor their clients who are using the Wave. They are also able to prescribe new activities and customize them based on their individual patients feedback and needs. Advantages of the medium, especially in this context Clinical Unit Standardized assessment Highly interactive relationship with patient Cost effective, the system costs less than having a physiotherapist monitor patients Individual In the at home model, patients can use it in between clinical visits or after being discharged Provides instant feedback on their progress

ETEC-651/551 High Level Design Thanda, Haidee


Interactive, fun and context based Portable and available widely geographically Cost effective

Limitations of the medium, especially in this context Clinical Unit: The system requires that a clinician be monitoring the users, and prescribing the activities. May not be able to fit task in day-today tasks May not be comfortable using technology

Individual The patients must purchase the Microsoft Kinect for Windows, directly from Microsoft or Amazon. Impersonal Patient may not be comfortable using technology Out of pocket cost to purchase Kinect device

ETEC-651/551 High Level Design Thanda, Haidee


Intervention 7: Tea For Two Summary description of the component The aim of Tea For Two is to pair patients with one another (based on interests) for a cup of tea at the hospital cafe. This practice brings patients together to provide emotional support and motivation. The aim is to help patients build at least one deep tie and to make several acquaintances by scheduling several pairs of buddies to have tea at the same time and place. This service will be offered to all patients, but targeted towards arrogant performers, patients that have weak social support networks. This intervention addresses a motivational need at the individual level. It helps patients make meaningful connections over a cup of tea with people who are also going through a similar experience. It offers individuals an opportunity to learn, share and express difficulties and best practices for fall prevention. Format of the intervention Buddy system (pairing) Competency it addresses Identify benefits of the yoga technique for stroke survivors Conventions Why I chose this intervention Tea For Two gives patients an opportunity to meet other patients that are also going through the rehabilitation process and share advice. The individuals offer hope, tips, support and strengthen other patients commitment to recovering. Type of information available Tips Informational clarification about fall prevention and rehabilitation outcomes Personal insights from coaches and their own experience

Structure or format of the information Coordinator sets up meeting time for several pairs of buddies Shuttle bus picks up patients and drops them off at hospital cafeteria Buddy pairs meet over afternoon tea, which is provided free of charge Shuttle bus drops off patients at their homes

Writing style

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Conversational Personal Authentic Plain language, informal

Expectations that learners have Icebreakers to learn about their buddy To talk to several people in the yoga rehabilitation program To build relationships To try different teas and to relax

Communication medium Live (Face-to-face) Why I chose this medium I chose this medium because patients feel isolated due to their limitations. A face-to-face meeting over tea is a relaxed way to get to know each other. Advantages of the medium, especially in this context For producers, low cost for production Relative ease to support event using existing facilities For users, moderate to high comfort level with medium

Limitations of the medium, especially in this context For producers, it requires a low-to moderate amount of time to organize the event Patients require transportation

ETEC-651/551 High Level Design Thanda, Haidee


Intervention 8: E-Coaching with a Yoga Therapist Summary description of the component

E-coaching aims to engage, motivate and help arrogant phase patients continue practicing their fall prevention exercises. This intervention addresses the unit and the individual. The software records and shares progress information with the yoga therapist, they can then provide feedback by sending notes to the patient and updating their program routine remotely. Format of the intervention E-coach Competency it addresses Perform breathing technique Perform ankle balance exercise

Conventions Why I chose this intervention E-coaches have an implied level of authority and can insist on compliance. The software records and shares progress information with the clinician and the clinician can send notes to the patient and update their program routine. Type of information available Establish and set personal performance goals Clearly specify goals Use diagnostic and assessment tools to gather performance metrics towards goal Maintain current behavior (confirming feedback) and change behavior (corrective feedback) Observe, monitor and verify performance Provide clear and timely feedback

Structure or format of the information Online Simulation Writing style Supportive Create succinct statements of expectation Avoid vague and ambiguous language

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Expectations that learners have E-coach rewards patient with praise when they achieve performance E-coach helps patients improve performance goals E-coach is available 24/7 Communication is happening via messaging E-coach provides challenges and feedback

Communication medium Online Asynchronous Why I chose this medium This medium was chosen because the feedback system (intervention 8) includes an e-coaching. Up to 65% of patients are non adherent or partially adherent to their at home rehabilitation programs, e-coaching helps the engagement factor by providing personalized feedback based on progress metrics. Advantages of the medium, especially in this context Unit: Data captured by feedback is easily exportable for quick and efficient record keeping. Simulation system fills out documentation for the therapist Easy accessibility for therapist, its easy for them to participate in the relationship E-coach is available 24/7 Cost are low Reduces the need to coordinate schedules Easy for patient to access Overcomes geographical distance Reduce cost to travel and logistics

Limitations of the medium, especially in this context Unit Impersonal, lack of face-to- face component The system requires that a clinician be monitoring the users, and prescribing the activities. May not be able to fit task in day-today tasks May not be comfortable using technology

ETEC-651/551 High Level Design Thanda, Haidee


Individual

The patients must purchase the Microsoft Kinect for Windows, directly from Microsoft or Amazon. Impersonal, lack of face-to- face component Patient may not be comfortable using technology Out of pocket cost to purchase Kinect device