SINGAPORE-CAMBRIDGE GENERAL CERTIFICATE OF EDUCATION (H1) EXAMINATION

PROJECT WORK

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Group Index Number: VJ133

Chan Jia Yi (1608)

Lucas Chan (1609)

Kevin Lie (1618)

Nicole Ang (1623)

Yan Zai Ya (1627)

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Table of Contents

1. Introduction ............................................................................................................................ 6

1.1 Current Situation of Post-Stroke Rehabilitation ............................................................................... 6

1.2 TeleRehab and the problem it seeks to resolve ................................................................................ 7

1.3 Evaluation of T-Rehab ..................................................................................................................... 8

1.4 Choice of Target Group ................................................................................................................... 9

1.5 Project Objectives ......................................................................................................................... 10

2. Stroke Awareness Video Education (SAVE) ............................................................................. 11

2.1 Rationale for SAVE ........................................................................................................................ 11

2.2 Proposal of SAVE .......................................................................................................................... 12

2.3 Strengths of SAVE ......................................................................................................................... 20

2.4 Limitations and Modifications of SAVE .......................................................................................... 21

3. Assistive Chair for Therapy (ACT) ........................................................................................... 23

3.1 Rationale for ACT .......................................................................................................................... 23

3.2 Proposal for ACT ........................................................................................................................... 24

3.3 Strengths of ACT ........................................................................................................................... 31

3.4 Limitations and Modifications of ACT ............................................................................................ 32

4. Fun Rehabilitation ExperiencE (FREE) ..................................................................................... 33

4.1 Rationale for FREE ........................................................................................................................ 33

4.2 Proposal for FREE.......................................................................................................................... 34

4.3 Strengths of FREE .......................................................................................................................... 39

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 4.4 Limitations and Modifications of FREE ........................................................................................... 40

5. Conclusion ............................................................................................................................. 41

6. Bibliography .......................................................................................................................... 42

7. Annex.................................................................................................................................... 47

7.1 Interview Transcript with Associate Professor Gerald Koh, NUS Saw Swee Hock School of Public

Health ................................................................................................................................................ 47

7.2 Interview Transcript with Senior Occupational Therapist Ernest Thia, Tan Tock Seng Rehabilitation

Hospital ............................................................................................................................................. 49

7.3 Interview Transcript with Mr Chye ................................................................................................ 51

7.4 Interview Transcript with Mrs Ann ................................................................................................ 53

7.5 Interview Transcript With Mr Toh ................................................................................................. 55

7.6 Survey Results .............................................................................................................................. 57

7.7 Synopsis Of SAVE .......................................................................................................................... 59

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1. Introduction

1.1 Current Situation of Post-Stroke Rehabilitation

The number of stroke patients is increasing annually, from 5,578 episodes in 2005 to 7,413

episodes in 2016 (Health Promotion Board, 2016). While stroke rehabilitation plays a crucial

role in helping patients regain their pre-stroke functioning abilities (Tan, I.O., 2019), only 1 in

5 stroke patients in Singapore continued their prescribed rehabilitation programme (Khalik,

S., 2014).

Studies have found that patients’ physical disabilities, rehabilitation costs and inconveniences

such as time spent to travel to the rehabilitation centres were some reasons why patients are

unwilling or unable to complete their rehabilitation programme (Chen, A., et al., 2014). As

such, measures need to be taken to encourage patients to complete rehabilitation and

promote recovery from their stroke condition.

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1.2 TeleRehab and the problem it seeks to resolve

The Smart Health TeleRehab (T-Rehab) (Figure 1) was launched in Singapore in 2017 as a

platform to make post-stroke rehabilitation more convenient and accessible for stroke

patients. It enables patients to undergo their rehabilitation exercises at a time and location of

their choice, through the use of wearable sensors and remote monitoring by therapists.

Patients put wearable sensors on their neck and limbs and use resistance bands to carry out

prescribed exercises with video demonstrations, instructions and indicators on an iPad. They

will be able to receive immediate feedback from the detection system as to whether the

exercises are correctly performed, and can consult their therapists through the use of the

video conferencing function (IHIS, n.d). The patients are taught on how to use the T-Rehab

system in training sessions during their hospital stay.

Figure 1: The T-Rehab system design

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1.3 Evaluation of T-Rehab

Strengths of T-Rehab

Encouraging elements motivate patients

T-Rehab includes elements that encourage patients to complete their exercises (IHIS, n.d.).

These features include encouraging messages that are read out while the patient does his

exercises (Tan, A., 2017). These encouraging elements give patients the self-belief that they

can succeed in doing the exercises correctly, hence motivating them to continue their

rehabilitation (Bright, J., 2018). This is a strength that has the potential for further

enhancement.

Limitations of T-Rehab

Does not target lack of awareness of importance of rehabilitation

T-Rehab focuses solely on the physiological aspects of stroke rehabilitation. However, it does

not target the issue of lack of awareness of the importance of rehabilitation, which is the

reason why many patients discontinue their rehabilitation programme (Lui, S.K. & Nguyen,

M.H., 2018). As such, the patients may not see the need to attend follow-up rehabilitation

sessions, leading to a low recovery rate.

Inconvenient to Set Up

Frequent need to set up and adjust the T-rehab device is cumbersome and a hassle. This is

exacerbated by the fact that patients have limited mobility, and hence require external

assistance (Tyagi, S., et al., 2017). This disincentives patients to continue rehabilitation as

poor user experience is highly detrimental to continued usage of a product (Cousins, C.,

2019).

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1.4 Choice of Target Group

The percentage of stroke patients in Singapore that are above 60 years old constitutes an

alarming 60.9% of the entire stroke population within Singapore (Health Promotion Board,

2016). As such, we have decided to target the elderly (aged 60 and above) stroke patients

who are eligible to partake in remote rehabilitation. Since elderly stroke patients are more

restricted in mobility, energy and stamina compared to the other age groups (Zoran, M., et

al., 2013), they are more severely limited in their ability to travel to rehabilitation centers

frequently and would therefore be more likely to use this device that allows them to

rehabilitate from home.

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1.5 Project Objectives

Our project aims to enhance the elements currently present in T-Rehab, as well as minimise

its limitations through a three-pronged approach. Our framework of solutions is shown in

Figure 2 below.

Figure 2: Framework of Solutions

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2. Stroke Awareness Video Education (SAVE)

2.1 Rationale for SAVE

Currently, some elderly patients disregard rehabilitation as they are not aware of its

importance. According to a survey of 73 elderly respondents (Annex 7.6), an alarming 52.1%

were completely unaware of the consequences of not rehabilitating (Figure 3), which include

increased treatment costs, slowed recovery and medical complications such as muscle

shortening (Tan, S.C., 2019).

Figure 3: Awareness of Consequences of not doing Rehabilitation

Our video, SAVE, serves to address these issues as videos have been found to be a powerful

way of appealing to viewers and their emotions (Ford, D., 2016). Reminding patients of the

precious moments they might miss out on and the negative consequences of not completing

their therapy would encourage them to complete their rehabilitation.

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2.2 Proposal of SAVE

Since the organisation, Stroke Support Station (S3) shares similar goals to our motives for

creating SAVE which is to provide support for stroke patients and their recovery, we could

work with them to film the video. Before they first commence on their T-rehab training session,

the video will be played for the patients. This video recounts the rehabilitation process of an

elderly patient, Mr Goh (Annex 7.7).

Scene 1: Post-Stroke

This scene (Figure 4) highlights the mindset patients might have after a stroke. Many of them

are reluctant to carry out their post-stroke rehabilitation exercises due to a sense of

helplessness and believe that there is no escape from their condition (Tan, S.C., 2019). This

serves to pre-empt patients that this is something they will likely experience and that it is

something they can overcome.

Figure 4: Son tries to convince his father to undergo rehabilitation, father refuses and asks
his son to go away

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Scene 2: Realisation

This scene serves to educate patients on the key consequences of the lack of rehabilitation

(Figure 5) by using “fear appeal” to change their attitudes and behaviours (Albarracin, D., et

al., 2015).

Figure 5: A consultation with the therapist, who highlights medical complications (muscle
shortening, additional surgery etc.) due to lack of rehabilitation

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There will be a flashback showing the patient’s past active lifestyle (Figure 6).

Figure 6: Flashback on the experiences he is missing out on (left: playing soccer, right:
playing chess)

It will also show the things the patient is currently unable to do (Figure 7).

Figure 7: Patient’s inability to perform basic daily activities (left: patient unable to reach the
light switch, right: patient unable to reach the door)

This helps patients realise what they are missing out on, thus motivating them to rehabilitate

so that they can enjoy life again.

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Scene 3: Family

This scene (Figure 8) aims to remind the patients how important they are to their families. This

motivates the patients to complete their rehabilitation as human attachment is known to

reduce negative emotions (Zeki, S. et al., 2007) that may inhibit their willingness to do their

rehabilitation. This makes them more inclined to undergo rehabilitation.

Figure 8: Dialogue between father and son, where son reminds him how much he means to
the family

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Scene 4: Recovery

This scene (Figures 9, 10, 11) enables patients to realise that rehabilitation is integral in

improving their post-stroke condition, helping them to regain an active lifestyle and participate

in experiences and activities with their friends and family. Inspiring music will accompany this

scene, as it is shown that music can help to elevate people’s moods (Mental Health, 2017),

further rousing the patients into beginning their rehabilitation process.

Figure 9: Upon reflection on all that has happened, patient is now determined to recover

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 Figure 10: Patient’s road to recovery using T-Rehab over the next few months

Figure 11: Family surrounding the patient, who has substantially restored his basic
functions, and going out of the house with him for the first time since rehabilitation

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Scene 5: Information

Educating patients about the adverse consequences of not following up on rehabilitation is

another way to raise awareness of the importance of rehabilitation. Information about these

consequences can help the patients assess risks and make informed decisions (Oxman, A.D.,

et al., 2019). Hence, this scene (Figure 12) encourages them to follow up on their

rehabilitation to avoid said consequences.

Figure 12: Information is presented to show consequences and complications a patient may
suffer if he does not follow up on regular rehabilitation

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Scene 6: Testimonies

Including insights and real-life success stories of people of similar age profile to the patients

who have gone through the same situation as them (Figures 13 and 14), will inspire and give

them hope that they too can succeed in recovery (Markman, A., 2017). It also ends the video

on a positive note, promoting an optimistic mindset on their condition.

Figure 13: Testimonies from recovered ex T-Rehab users about their journey to recovery

Figure 14: Words of encouragement to the patients watching

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2.3 Strengths of SAVE

To test the feasibility of our solution, we shared the storyboard of SAVE with people of the

same age group as our target audience. In a survey we conducted (Annex 7.6), 65.8% of 73

elderly respondents found the SAVE video motivational and inspiring (Figure 15).

Figure 15: Feedback from respondents on SAVE

Mr Chye, 66, the brother of an ex-stroke patient, who found the video motivating and inspiring,

commended the idea of ex-stroke patient testimonials, as seeing other patients recover will

motivate them further to embark on their journey to recovery (Annex 7.3).

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2.4 Limitations and Modifications of SAVE

Patients may not remember the message and information conveyed by the video after some

time given the limited capacity of the human mind to retain information long-term. Only less

than 30% of the information is retained one day after it is first acquired (Ebbinghaus, H.,

1885). To overcome this, patients will be given a poster after their T-Rehab training (Figure

16), which would serve as a consistent reminder of the importance of rehabilitation. We used

bright colours in the poster’s background as it is shown that bright colours evoke feelings of

optimism (Gremillion, A.S., 2019), which would further motivate patients to complete the

rehabilitation programme.

Figure 16: The poster containing key information about stroke rehabilitation

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Secondly, patients might also lose motivation to continue rehabilitation after some time.

Therefore, we propose for the patients to make a commitment pledge (Figure 17) to set a

goal and commit themselves to doing their rehabilitation. Having a goal in mind for what one

is working towards has been shown to increase motivation (Wade, D.T., 2009). This pledge

can be pasted to the poster mentioned earlier.

Figure 17: The Commitment Pledge

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3. Assistive Chair for Therapy (ACT)

3.1 Rationale for ACT

Many elderly patients find it difficult to set up the numerous parts of the equipment for T-

rehab at home (Tyagi, S., et al., 2017). The difficulty is exacerbated by the decrease in

dexterity in their fingers as they age. There is a rapid decline in hand-grip strength by as

much as 20 – 25% after 60 years of age (Carmeli, E., et.al., 2003), that is further aggravated

by their stroke condition (Platz, T., et al., 2018). This thus reduces the desire to carry out

rehabilitation due to the hassle it brings. As such, ACT is a product that seeks to enhance

the overall user experience by making it easier for the elderly to set up the equipment for

rehabilitation.

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3.2 Proposal for ACT

ACT is a specially designed chair (Figure 18) that targets the key difficulties faced by elderly

users in using T-Rehab to enhance their user experience through 3 key developments which

will be elaborated on below.

Figure 18: Prototype of ACT

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Buckle-and-latch system

Currently, the set-up requires one to tightly tie a resistance band to the legs of the chair for

their exercise (Figure 19) which requires considerable finger agility.

Figure 19: Original method of attaching the resistance band to the chair

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To ease this process, we propose a buckle-and-latch system (Figure 20). This enables easy

and secure attachment and removal of the resistance band to the chair. Patients will need

not tie nor remove any dead knots to the chair, easing the difficulty for users in setting up T-

Rehab.

Figure 20: Buckle-and-latch system

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Automated Adjustment System (AAS)

AAS consists of a rod attached along the leg of the chair, with the buckle attached to a

platform that can move up and down the rod with the push of a switch (Figure 21).

Figure 21: AAS on the leg of the chair

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The leg of the chair will have coloured sections to clearly indicate the possible positions of

the band to vary its tension (Figure 22).

Figure 22: Green, Grey, Blue and Yellow sections to indicate different levels for the band to
have different tensions

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Patients have to push the switch either forwards or backwards to move the buckle to the

position as instructed by the physiotherapist via the app (Figure 23).

Figure 23: Instructions on AAS set-up asking user to move platform to blue segment

According to Hooke’s Law, a physics theory, the lower the position of the resistance band on

the leg of the chair, the more force required to stretch it to a set length. Hence, as the patient

increases in strength with rehabilitation, his physiotherapist can advise him to increase the

tension of the band by adjusting it to a lower level via AAS. This obviates the need for four

bands to accommodate the different levels of tension required, as only one band is needed

for AAS, removing the need to change between different bands.

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Built-in Drawer

With many separate parts present in T-Rehab, set-up may become messy and parts may be

misplaced. Hence, we have added a drawer under the chair seat (Figure 24), enabling the

user to organise and keep the parts which include the resistance bands, motion sensors, and

the charging equipment all in one place.

Figure 24: Sketch of how the components of the device will look like in the drawer under the
chair seat, with labels in each compartment

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3.3 Strengths of ACT

After interviewing several elderly about ACT, the general consensus was that the buckle-and-

latch system and AAS made the set-up of T-Rehab much easier. Mrs Ann commented that

the buckle-and-latch system together with AAS was easier to use than tying the resistance

band on the chair as one “need(s) strength to tie a knot with the band.” She also mentioned

that the buckle-and-latch system was much more secure because the knot tied might become

loose (Annex 7.4). This enables patients to avoid troublesome or potentially incorrect

equipment set-up, and focus on the rehabilitation itself.

Secondly, the built-in drawer successfully achieves its aim of allowing ease of organisation

of items such that the patients will be able to easily find the various parts for the set-up. Mr

Toh mentioned that he “will be able to know where (he) keep(s) various parts (of T-Rehab)”.

He exclaimed that “If the chair is there, everything else will be there” (Annex 7.5).

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3.4 Limitations and Modifications of ACT

While the number of the resistance bands has been reduced to one, potential tangling of the

band can still be frustrating for some users. To solve this, we suggest storing the resistance

bands in a retractable reel, akin to a measuring tape. This makes setting up and keeping the

resistance bands much easier (Figure 25).

Figure 25: Reel for resistance bands to be stored

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4. Fun Rehabilitation ExperiencE (FREE)

4.1 Rationale for FREE

Currently, T-Rehab contains encouraging messages and symbols during rehabilitation that

help to motivate the patients to continue rehabilitation. However, these have a limited ability

to counteract the mundaneness and repetitiveness of the exercises (Tyagi, S., et al., 2017),

affecting the extent to which users follow up with rehabilitation.

Moreover, experts have also noted that patients might lack mental strength and not follow

instructions in an uncontrolled environment (i.e. at home) (Tan, A., 2017). It was also shown

in a separate study that only 1 in 3 stroke patients perform the recommended exercises at

home (Hung, Y.X., et al., 2016).

Since games have been shown to greatly boost intrinsic motivation (Mekler, E.D., 2015), we

decided to implement FREE, an in-app system that aims to engage the elderly by gamifying

the rehabilitative exercises in T-Rehab with games that appeal to their interests and attention

to further motivate the elderly to perform their prescribed therapy.

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4.2 Proposal for FREE

We compiled a list of activities which may appeal to the elderly in Singapore based on various

sources such as PlayHuaHee, a social enterprise catering to the well-being of the elderly

(Rasoulzadeh, M., et al., 2015 & Hua Hee, 2019 & Mineo, L., 2019). We then used it to

conduct a survey (Annex 7.6), and found that the elderly generally enjoyed Tai Chi, mahjong,

and soccer (Figure 26). These are thus the activities we will use as themes when gamifying

the exercises in FREE.

Figure 26: Activities that the elderly enjoy doing

Each game will incorporate a multitude of exercises to accommodate the different types of

exercises that patients could be assigned to, whilst still allowing the patients to play their

preferred game of choice.

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Process

The physiotherapist will first select a list of exercises for the specific patient (Figure 27).

Figure 27: Physiotherapist selecting the exercises for the specific patient

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Games suitable for that patient will appear as game choices for the patient to choose from

(Figure 28). We decided to let patients choose their desired game, as it is shown that

providing choices improves intrinsic motivation (Patall, E.A., et al., 2008).

Figure 28: Example of games that targets different segments of the body

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Elaboration of built in game: Tai Chi Shifu

As the most popular game preference according to our survey, we decided to elaborate on

how the Tai Chi Shifu game works. The game involves a Tai Chi Shifu teaching a class

(Figure 29) but he constantly falls asleep. Patients have to wake the Shifu up to keep the

lesson running smoothly by striking a gong, which makes a noise to wake him up.

Figure 29: Screenshot of Tai Chi Shifu gameplay

When the Shifu falls asleep, an indicator will appear to prompt the patient to wake him up by

sounding a gong using a gong stick. Patients will be prompted to follow the instructions in the

video to sound the gong. As they follow the instructions, the motion sensor will track their

movements, causing the gong stick on the screen to shift to hit the gong. Patients will then

repeat the process as specified by the therapist.

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The screen will also feature a pause button should the patient need a break, and an

information button to recall the video demonstration of the exercise should the patient forget

(Figure 30).

Figure 30: Instructions and video demonstration of exercises to play the game

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4.3 Strengths of FREE

Mr Ernest Thia, a Senior Occupational Therapist, was supportive of this solution, saying that

FREE would help to divert the patient’s focus away from their exercises and make them feel

that they are playing a game rather than doing their exercises (Annex 7.2). Thus, their

exercises would feel less mundane, and they will be more willing to do so on a regular basis.

Game-based rehabilitation has been proven to engage more brain activity as compared to

conventional rehabilitation exercises, promoting recovery rates as it allows the brain to adapt

and recover after a stroke, an occurrence termed as neuroplasticity (FlintRehab, 2018).

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4.4 Limitations and Modifications of FREE

Some patients may get bored playing the game by themselves, even with different themes

available, which may cause them to not use T-Rehab at regular intervals. Hence, we propose

implementing online group rehabilitation which has been proven as a means of effectively

sustaining motivation through providing one another with moral support (GoodTherapy, 2015).

T-Rehab users can arrange a time to meet up online via a meet-up button on the screen and

do their rehabilitation together through T-Rehab.

Patients may over-exert themselves from excitement due to the game’s immersiveness, by

doing exercises at a frequency above their prescribed regimen. This could cause adverse

symptoms like fatigue, spasms and irritability (FlintRehab, 2019). To reduce this risk, the

therapist could set a daily maximum safe limit on rounds of exercise. Upon reaching this limit,

the application will be locked. A safety video can be shown before patients begin exercising,

reminding them about their safety during rehabilitation.

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5. Conclusion

Our solutions SAVE, ACT and FREE work hand-in-hand to target the problem at its root

source to accommodate the needs of elderly stroke patients better. With our solutions, the

home-based stroke rehabilitation experience will be more hassle-free and pleasant for the

patients. It is also more entertaining, thus drawing patients to use the device consistently.

Thus, these solutions mitigate the serious problems that might arise when the elderly fail to

complete their stroke rehabilitation.

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Carmeli, E., et.al. (2003) The Aging Hand

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Chen A., et al. (2014) Post Community Hospital Discharge Rehabilitation Attendance: Self-
Perceived Barriers and Participation Over Time
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Cousins C. (2019) Why Does User Experience Matter

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Ebbinghaus, H. (1885) Hermann Ebbinghaus Forgetting Curve

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FlintRehab. (2018) Video Games for Stroke Patients that Boost Recovery
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Ford, D. (2016) Video Marketing – How It’s Influencing Your Business

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Gremillion, A.S. (2019) Colors And Emotions: How Colors Make You Feel
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IHIS. (N.D) Smart Health TeleRehab
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Platz, T., et al. (2018) Arm Ability Training (AAT) Promotes Dexterity Recovery After a
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Tan, S.C. (2019)The Importance Of Continuing Rehabilitation At Home
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7. Annex

7.1 Interview Transcript with Associate Professor Gerald Koh,

NUS Saw Swee Hock School of Public Health

Lucas: So from what we understand currently about T-Rehab, is it a digital manifestation of

what the stroke patient normally goes through for rehabilitation, instead of going to an area

for like rehab?

Mr Koh: The general idea is actually to guide the users through a set of exercises which the

therapist would normally prescribe at the rehab centre with the patient doing it at home. There

can also be home rehab where the therapist goes to the patient’s home and does it, but of

course that can be very expensive and it's about $150 per visit. But if you do it through tele,

then you save the cost of the therapist to come and visit, but there is a cost to the system -

the system is maybe $70 per week, but if the patient needs to go for rehabilitation for about

three times a week, then the cost for the home rehab would be $450 per week so then the

cost for telerehab would definitely be cheaper as compared to home rehab.

Lucas: So far, how has T-rehab been - do you see any potential shortfalls in your

development of your app. From the data you have collected over trials, what kind of feedback

has there been on T-rehab?

Mr Koh: The preliminary results of our randomised controlled trial showed that there was no

difference between the group with telerehab as with the usual care group, there was no

difference in functional outcome. We assumed that telerehab increases the amount of rehab

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done by the patients hence they will have better functional recovery, but we found the

telerehab system did not do more. So in retrospect we were wrong to surmise that tele rehab

will increase the amount of exercise that the patient does. Other things we were worried about

is that tele rehab could have worse outcomes than usual care. Because in usual care the

therapist is physically there encouraging the patient, there’s a lot of “sayang” and human

interaction. Whereas in tele rehab, there is no one there. You’re just doing it by following a

video, the videos are recorded, and the therapist only reviews it once a week, then if they

decide that you’re not doing it right they will video conference you and tell you that you are

not doing it right and they will teach you how to do it right.

Lucas: Oh I see. So one of our proposed enhancement for T-Rehab is to incorporate games

into the system, will this help to encourage them? Through the use of fun elements in the

system?

Mr Koh: Yes absolutely. So fun elements are shown to improve adherence, very much like

PokemonGo. So you make it fun, gamify it, put an element of game in it, then yes, adherence

does go up.

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7.2 Interview Transcript with Senior Occupational Therapist

Ernest Thia, Tan Tock Seng Rehabilitation Centre

Lucas: Our first solution is to try and incorporate games into their rehabilitation programme,

and the theme of these games will come from the interests of the elderly. Basically just have

what they might like to do in the past, like maybe sports, or music; we try to incorporate it into

a game where they can train their physically affected areas, so that they are able to rehab

themselves while getting immersed into the game itself. So, err, we did a survey on some

elderly in Singapore and a majority of them expressed Tai Chi as their interest, so we like

elaborated on it and came up with a game that revolves around Tai Chi.

Zaiya: Yea they still do the regular exercises, but there will be animations and images to

engage them. The movements of the character in the game will match with the exercise.

Mr Thia: Ok, fine, but the movements must be a controller, so that the patient can play. So

patient is the controller. Then, you can train the movement. The movement does not need to

be very complicated. The movement can just be a up and down, and the thing will move.

Don’t think complicated, just think some simple games that you play.

Lucas: Oh ok, can we also say that if it’s related to the movement inside the game itself, in a

way they will be more engaged and motivated?

Mr Thia: Yes definitely. If the game encourages the movement that you want to train, then

you have more repetitions of the movement. Get it? So they won’t realise that they are

actually doing the movement, and that they are playing the game. That’s how you engage

the patient. Then you can increase the number of movements, versus just doing the exercises

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themselves. So in games, you will usually see an increased number of repetitions. And I think

that’s the main purpose why you want to increase the number of repetitions. So this is how

to distract the patients from their exercises. Yea, I think this solution works fine.

Lucas: We also have another limitation that we thought of. It is mentioned in Mr Koh’s report

that there are patients saying that the tying of the bands to the chair is quite difficult. So what

we were thinking of is having some adjustable locking mechanism along the leg of the chair.

Mr Thia: Oh interesting. But it goes back to the stroke patients that you’re targeting on. The

task you want this patient to do, is it bilateral, or a single-hand activity? The reason why they

say they struggle is because one side of their hand is affected, but it is actually a bilateral

task to tie. So that’s why the patients say they struggle. So the mechanism y’all are

suggesting, y’all have to think carefully about whether or not it can become a single-hand

thing. Once you have that sorted, I think this solution will be quite meaningful. Yup.

Kevin: In addition to the system we are attaching to the chair, we are thinking of fastening the

resistance bands to the chair using a buckle-and-latch mechanism. Like the ones you see in

the car, a seat belt. So basically the resistance bands are integrated to the latch mechanism.

And then the latch is just fastened to the buckle, just like in a car. So the patient technically

only needs to use 1 hand, because he just needs to push the latch into the buckle.

Mr Thia: Nothing wrong. You can go ahead with that.

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7.3 Interview Transcript with Mr Chye

Interviewer: Hi Mr Chye, first of all, thank you for agreeing to do this short interview!

Mr Chye: No problem.

Interviewer: So basically we will be showing you a storyboard of a video that we will show to

elderly stroke patients, and this video aims to increase awareness of the importance of stroke

rehabilitation because some studies show that patients may not be aware of this, hence they

do not continue their rehabilitation. The video will also try to motivate the patients to complete

their rehabilitation programme.

Mr Chye: Okok, go ahead.

(after showing the storyboard)

Interviewer: How do you feel after seeing the plot of the video?

Mr Chye: Very nice, I like the plot a lot. Ya the video sounds like it will be very interesting and

motivating I feel.

Interviewer: What was interesting and motivating about the video?

Mr Chye: Hmm… I like the support the family members showed to the patients. It would make

a very touching aspect of the video.

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Interviewer: Thank you for the feedback! How about the testimonials at the end?

Mr Chye: Oh ya the testimonial! Wah, that part I like a lot. I think including the stories of ex-

stroke patients as motivation for the current stroke patients is a good move. Makes the patient

want to recover.

Interviewer: Oh! Why do you think the testimonials will encourage the patient to want to

recover?

Mr Chye: Ummm...you all students right? I think it’s like if you see your friend get A for a test,

you will be inspired to study hard and get A also right? (us nodding) So same concept lor,

when the patients see other patients recover, they will also want to recover.

Interviewer: Do you feel that the video can be improved in any way?

Mr Chye: Improve ah...hmmm...err...you all showing the video before the training begin right?

I feel the patients ah...they may not remember the stuff in the video leh. You see ah, the video

only 2, 3 minutes long...in a few weeks and months, I think the patients all might forget

everything one.

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7.4 Interview Transcript with Mrs Ann

Lucas: We just need you to see...because we are doing a project on these kinds of resistance

bands. So we just want to get you to try and tie a knot to the chair.

Mrs Ann: Use this to tie a knot on the chair? Who tie? I tie?

Us: Yes.

Mrs Ann: Wow this is very thick man! How to tie? On the chair ah?

Us: Yes.

(she tries to tie it) (she finishes tying in 11.06 seconds)

Kevin: Not bad, congrats!

Lucas: So what do you think when you tied this? Did you find any difficulties? Because maybe

it is very thick or something…

Mrs Ann: You definitely need strength to tie a knot with the band.

Lucas: But if you have a buckle instead; you can buckle this resistance band to the

chair…(shows her the picture)

Mrs Ann: Of course this is definitely more easier!

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Kevin: So there is a buckle on a chair, and there’s a latch on this resistance band, then you

can just fasten it here.

Mrs Ann: That’s good what? I think that’s a good idea. To release (untie) the resistance band

(on the original system), it’s a bit difficult. Because rubber has grip.

Kevin: Can we know what you find so good about using a buckle instead of this tying?

Mrs Ann: It’s definitely secure! Buckle is definitely secure! This (tying) can be opened, a few

times, so it will eventually get loose and (inaudible). Buckle is definitely secured.

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7.5 Interview Transcript with Mr Toh

Lucas: So basically, we will be showing you a special chair that is supposed to make

exercising more convenient for the elderly. The original chair involves tying this resistance

band to the chair leg (demonstrates). So our first question is...for the elderly, do you find it

rather difficult to tie this thing?

Mr Toh: Hmm...ya it does look a bit tough.

Kevin: Can we know what you find tough?

Mr Toh: For the elderly, it will be a bit hard lah. They need to bend down, hold the thing, then

wrap around the chair then tie tie. I don’t think some of them will be strong enough to do all

that. Some elderly are very frail, they might get hurt while tying this thing.

Lucas: So to solve this, right, we came up with this thing where the buckle can be attached

to a latch, which has the resistance bands attached to it.

Kevin: So, no need to tie at all, just fasten, and everything will be secure.

Mr Toh: Hmm...ya...this one fine lah...even with one hand they can fasten. Also no need to

squat down so much...they can just push in the thing.

Zaiya: We also have this drawer where you can put everything inside, so that it is easier for

you to carry out rehabilitative exercises. (shows drawer)

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Mr Toh: Ahhh…so where is the drawer? Under the chair?

Kevin: It is integrated to the bottom of the seat where the person sits.

Mr Toh: I see. Hmm, I think it’s quite creative lah. So...where do they keep the parts in the

present system?

Lucas: I don’t think there is a specific place to keep them, from what we know.

Mr Toh: Ya, then I think this drawer is a good step forward! Because currently, they have no

place to keep it, but now, they have somewhere to keep it, right? Also, how they do the

exercise with the parts all over the place? I think I will lose everything! (laughs) That’s why I

say, the drawer is good! Because then they know if the chair is there, everything else will be

there! Very easy to find all of the parts; it’s organised very well. I think it’s a good plus point

lah.

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7.6 Survey Results

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58
7.7 Synopsis Of SAVE

SCENE 1 (POST-STROKE):

SYNOPSIS: Mr Goh, aged 65, had just suffered a stroke, and is recovering at home. The

stroke had paralysed the left half of his body, hence he requires rehabilitation to train his body

to function normally again. His son tries to convince him to do his rehabilitative exercises.

Son: “Pa, can you start doing your exercises soon? If not you won’t get better!!”

Patient: “Aiya...do, don’t do...doesn’t matter lah! Not like I will recover. This rehab won’t do

anything for me. Just leave me alone can or not?” (Mr Goh gestures son to leave the room)

Son leaves the room.

SCENE 2 (REALISATION):

SYNOPSIS: The patient is in the middle of a consultation with his therapist. The therapist

reviews the patient’s rehabilitation progress. He is stunned that the patient hasn’t completed

a single exercise.

Therapist: Mr Goh, my record says you have not done any exercises since last month. Can I

find out why?

Patient: Aiya...why you ask me that? You know there is no point doing rehab. I exercise here,

exercise there...won’t help one! You see, I can’t even move my finger, how to do rehab even?

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Therapist: Mr Goh, you need to understand this. Your condition will get worse if you don’t

even try to rehab. Look at this diagram here. Look! You see, over time, your muscle starts

shortening and contracting if left untreated. It can contract as much as this. (shows picture)

Once it reaches this level, that’s when you really cannot do anything. The only way to help

you is surgery, which means more medical costs. You may recover slowly with rehabilitation.

But truth is, there is no fast way. This is the best way you have to recover. Mr Goh, I think it’s

best that you do something about your stroke condition now, while you can still move. While

you can still do something about it. Don’t wait till later, when your condition gets worse and

you really can’t do anything about it.

(Scene changes to patient’s home)

The patient, lying in his bed, reaches for his reading light switch located on a table on his

bedside. However, he cannot reach for it. He then tries to open his room door, but to no avail.

He slumps back into his bed, with a look of frustration and defeat.

A flashback plays in his mind, recalling the things he once did in his active, healthy life. The

flashback features him doing his hobbies, which include playing soccer, chess and the guitar

with his friends and family. These are some activities that he used to be able to do in his

active, healthy life, but is unable to do now due to his stroke condition.

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SCENE 3 (FAMILY):

SYNOPSIS: A month after the stroke, the patient’s son approaches him and talks to him

again.

Son: Pa, how are you feeling today?

Grandfather: Okok lah...

Boy: Sure anot? You still haven’t done any of your exercises yet..

Grandfather: Aiya...I already told you it’s useless! You see all the other patients, pull here pull

there, what’s the purpose? Think one day they will suddenly regenerate then walk again ah?

Cannot lah! You see me, I can’t even move my arm. Last month, when I saw the therapist ah,

he told me I will get what...muscle shortening...slower recovery...additional surgery ...fine la!

Not like I can exercise anyway right?

Son: Pa, that’s not how it works...you see a lot of other stroke patients, they do recover! It’s

just that they need a lot of time. They don’t just magically recover one day, you know. It’s a

very slow, gradual recovery. It takes time. You can’t give up so soon, Pa. Just take it easy,

one step at a time. You don’t have to exercise all the time; just 2 or 3 times a week can do

for a start.

Grandfather: Aiya...but recover for what? Papa already 65 years old leh. All my life has been

lived already. What’s the point of recovering? Not like I’ll be able to do a lot more what.

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Son: Pa...don’t say that...you know you have us. You have Mummy. You have me. You have

the entire family. We all want to spend time with you, you know? You’re a big part of us and

always will be. We want to go out on nice lunches at the beach, playing sports...all of these

things don’t feel the same without you, Pa. The rest of your life may not mean much to you,

but it means everything to us. So please Pa, can you… (starts crying)

Grandfather: Ok...sorry. All of you mean a lot to me. I also want to spend time outside with

all of you. I promise I will soon, okay?

Son: Yes, Pa...we are all here for you. You can get through this, okay? Take it one step at a

time. When do you want to start? Tomorrow?

Grandfather: Ok lah...can...

Grandfather is now motivated to recover from stroke, and has a determined look on his

face.

This part of the video serves as a turning point to motivate the patient to recover. It also

intrinsically motivates users watching the video to keep up with their stroke rehabilitation, so

that they can recover their healthy and active state and spend quality time with their families

again, as the patients mean a lot to their families.

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SCENE 4 (RECOVERY):

MUSIC: Motivational and positive

SYNOPSIS: The video will show a timeline of progress in the patients’ recovery over the next

few months, showing short clips that highlight his progress of recovery in the following weeks

and months. It will feature scenes of him using T-Rehab over the months, and his gradual

improvement in mobility over this time period. There are clips of him walking over the months,

with him requiring less and less assistance from family members over time. After a few

months, the patient is mostly recovered with some form of autonomous mobility. He could be

seen going out of his house with his friends for the first time since his recovery , detailing that

he has returned to his healthy, active lifestyle.

SCENE 5 (INFORMATION):

SYNOPSIS: A few pieces of information, detailing the negative consequences of not following

up on their rehabilitation regularly are presented, such as increased treatment costs, slowed

recovery and other medical complications like muscle shortening and more.

SCENE 6 (TESTIMONIES):

SYNOPSIS: After this story ends, past stroke patients/ex-users of T-Rehab will share their

testimonies on their journeys to recovery, as well as give their insights as to why rehabilitation

is important. This further motivates patients watching to keep up with rehabilitation, as it is

more likely that the patients will believe advice that comes from fellow stroke patients that

can relate to them and have gone through the same thing. The ex-users will then share words

of encouragement to the patients watching, after which the video ends.

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