Designing User-Centered Technologies for Rehabilitation Challenge that Optimize Walking and Balance Performance

The purpose of this chapter is to provide the reader with motivation to design technology solutions that provide effective levels of challenge during walking and balance training activities for people with motor disabilities. When clinicians choose to use certain technologies for training, they are investing time and effort toward an activity that they expect will result in greater abilities and skills as outcomes. During training sessions, there are many factors at play that determine how well a person participates and benefits from the time that is spent relearning skills and increasing abilities. In addition to the usual considered physiological factors such as strength, and skill, a client must overcome psychological barriers during the training session. Our focus is on using rehabilitation robotics and virtual reality to provide safety and assurance, along with motivation and enjoyment, which is necessary to encourage high levels of balance and walking training performance so that clients get the most benefit during the training session. First, we describe some exemplar frameworks of challenge (Regulatory Focus Theory and OPTIMAL Theory) and their relation to high walking and balance training performance, including overcoming psycho-behavioral barriers to achieving high training performance. Second, we explore device considerations when designing for high training performance, including mechanisms to provide safety from falls, allowance for a large variety of ecologically valid walking and balance tasks with graded difficulty, motivational experiences with sustained attention, and added resistance to increase walking workload. We conclude by providing recommendations for future device development with an introductory guide to a design process that is user-centered from the start.