P10005: Balance Rehabilitation
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Chat Interview with JJ Mowder-Tinney 21Sep09

Elizabeth DeBartolo:Office Hours 8-9pm

Elizabeth DeBartolo:Hi JJ, how are you doing?

JJ:Pretty good. Classes and clinic are crazy as always.

Elizabeth DeBartolo:I'll bet! Thanks for agreeing to "meet" with the team this late.

JJ:No worries. Did you get my email with some answers to the questions I received today? Oh yea - how are you?? Sorry - I am so bad.

Elizabeth DeBartolo:I got the message. That should help clear some things up. I think the biggest concern is to make sure the team is delivering something that you will actually need and use, while still making sure the project is appropriate for a 5-person senior design team.

JJ:To be honest - I think it will be a hard project. I am just pretty clueless at what is too much.

Elizabeth DeBartolo:Hang on one second - I have to go say good night to my daughter... Hopefully the team will be here soon, too.

JJ:No problem!

Elizabeth DeBartolo:OK, down to just one job now. :) I was looking through your responses to the questions Rochelle sent you, and I'd like to follow up with a couple of them.

JJ:ok -

Elizabeth DeBartolo:In terms of the activity for the patients, are you looking for something displayed on a monitor, or could there be other options? For example, as they lean to different regions, they hear a different tone, or they could grab some sort of "prize"?

Elizabeth DeBartolo:Or are you looking only for video feedback to the patient? I'm talking about separate from information that would be recorded for your purposes.

JJ:I think that some type of display would be optimal. However, audio feedback could be beneficial but that would be much more limited. Not sure I get how they could grab a prize. The reason I say that is because we could do that now - not sure how you could make it different.

Elizabeth DeBartolo:I don't know - just asking - can't hurt to check! Why do you say that audio would be much more limited?

Elizabeth DeBartolo:Hi Rochelle

JJ:I didn't mean that bad - just hard for me to imagine some of the things. Definitely doesn't hurt to ask. I was thinking visual would allow you to move in different directions with different goals. It seems audio would just be increased at their limits of stability. But remember - I am limited in how I am picturing things.

JJ:Also - Rochelle. Hi and forgot to tell you no one came to clinic last wednesday. I thought someone was going to stop by.

Rochelle Perry:hello we were just catching up

Rochelle Perry:I'm sorry I thought I emailed you we were going to come when we had more questions for patients and your therapists

JJ:That is fine - just checking.

Rochelle Perry:I didn't get responses to your questions. Were they in that email you just sent?

Rochelle Perry:oh they are attached. I'm sorry

Elizabeth DeBartolo:OK...I just want to clear up the audio thing a bit more and then I'll keep quiet for a bit and let the team go. I was thinking audio like, lean in a different direction and play a different tone or something. Not necessarily just volume based.

Elizabeth DeBartolo:Or maybe the farther out you lean, the higher or lower the note gets. Play a little song. :)

JJ:Oh - that makes sense. That could work...

Elizabeth DeBartolo:I think the team must be catching up with the file. I'll ask one more question, then.

Rochelle Perry:we are. sorry

Rochelle Perry:thanks Dr. DeBartolo

Elizabeth DeBartolo:As far as putting the device on multiple surfaces, do you specifically want to sit a device on a bed, chair, ball, etc, because they represent items from the home, or are you just looking for varying levels of difficulty? And related to that, are you looking at having the patients try to lean in different directions in a controlled manner, or are you leaning them or making them unstable and asking them to re-center? Or is it some of both?

JJ:I am mostly looking at the varying levels for increased difficulty. Also - a surface like a rocker board would allow them to move and for me to move them. I can't do that on stable objects and that is a great way to facilitate movement. So I guess sometimes it is both.

JJ:good question!

Elizabeth DeBartolo:Sorry...I'm reading and thinking...

Rochelle Perry:we are too sorry.

JJ:I'm ok

Rochelle Perry:So when you use the rocker and balance ball now you accomplish what you are looking to do, but you are looking for feedback?

JJ:Correct! It gets boring rather quickly. But if there is a goal from an activity to accomplish then we could continue doing the activity much longer to accomplish challenge, endurance, and repetition. I was thinking more about Beth's idea of tones - maybe they could try and play a song themselves. If there was a way we could work on the sitting activity longer while making it more motivating that would make a big difference.

Elizabeth DeBartolo:How do you track patient progress when you're using the board or ball? Or is that one of the other things you're looking for?

Rochelle Perry:can you give us access to the whiteboard?

Elizabeth DeBartolo:workign on it...

JJ:Right - We can't track it. We look at how much assist they need but that is pretty objective.

JJ:I meant subjective - sorry.

Elizabeth DeBartolo:OK, you can use the white board now.

Elizabeth DeBartolo:drawing tools are the little icon in the lower right of the board.

JJ:FYI - Not sure how/why to use whiteboard.

Elizabeth DeBartolo:So is an ability to track patient progress something that you are looking for? If so, how would you measure it?

JJ:I was thinking about about the visual piece before but for audio maybe how many notes they are able to do - OR the highest note they could get to (which could be the outer limits of stability). I guess it would depend on how you do it.

Elizabeth DeBartolo:So you don't have a set measure that you would need - just something objective that you could track from session to session?

Rochelle Perry:we are thinking about, maybe having the patients sit in the middle of this stand, and lean to touch the buttons, and maybe the buttons will light up and you hear some noise or play some song or something?

JJ:Correct - as long as we could show some type of progression with that patient.

Rochelle Perry:as you adjust the angle of the sides and the position of the patient the game would change, and perhaps the buttons move

JJ:ahh -- I see what you are saying. THat could definitely be objective if you could measure how far away they would be. All three planes of movement are represented so that is good and a way we could measure improvement (one plane movement versus transverse plane).

Rochelle Perry:cool

JJ:You could also use this in standing - put it on a table. That would make it much more diverse. You could probably put this on top of the parallel bars and use it with people just starting to stand.

JJ:I am assuming it would be portable.

Rochelle Perry:i would say that it should definitly be possible, this is still a very basic idea

JJ:We have a perfect patient right now who is getting better, young guy with a head injury, and just getting his sitting balance back. I think something like this would really keep his interest and allow him to sit much longer.

JJ:the drawing was very helpful

Elizabeth DeBartolo:OK, I'm going to try to get back to basic needs for the project. I know we've been through this before, but I think we're still learning about what problems are being solved, so I'd like to take another crack at it...

Elizabeth DeBartolo:So you're looking for balance training that could be both active and passive (not sure if htat's accurate - you tip them AND you ask them to lean themselves)

JJ:If I tip them they need to maintain themselves - which is very difficult for most of my patients. It is actually easier for them to reach then react to me tipping them so all of the training would be active.

JJ:Did that make sense? Not sure my head is clear enough to describe it well.

Rochelle Perry:yes i think we undrstand

Rochelle Perry:so active from the patients point of view and passive from the PT

Elizabeth DeBartolo:Or are there times when you'd do both - beginning patients lean under their own power and advance patients would have to recover from a position you enforce (or maintain that position)?

JJ:hmm - I would say active from both ends. I don't mean to be word smithing. It is active all around.

JJ:Yes - the Beth...

JJ:Yes - to Beth...

Elizabeth DeBartolo:And you can currently do both of those now, but on different pieces of equipment, with no patient feedback and no objective measur eof progress

Elizabeth DeBartolo:?

JJ:Correct!

Elizabeth DeBartolo:So I'm going to list what I'm seeing as needs below...

Rochelle Perry:so with this you could move it to multiple surfaces

Rochelle Perry:for the second one...are there any specific measurements like speed or distance

JJ:When you say the second one are you talking about the drawing on the right?

Elizabeth DeBartolo:#2 below.

Elizabeth DeBartolo:or are you just looking for any way to measure progress, as long as it's objective?

JJ:Oh - sorry. Anything objective would be great. But yes - speed and distance are great measures.

Rochelle Perry:all right thanks

JJ:Remember - one of the biggest aspects of this is providing the patient with something fun and motivating to do in sitting. Many times these patients have cognitive deficits and those things are very important.

Elizabeth DeBartolo:!

Elizabeth DeBartolo:How about varing levels of difficulty - you said that's why you use the different types of surface, right?

Elizabeth DeBartolo:It's getting late, too - just a heads-up!

JJ:Thanks - I can feel it.

Rochelle Perry:if the machine was protable couldn't we use multiple surfces

JJ:Yes - the different surfaces provide me with options for challenging them. If the equipment was portable I definitely think the person could be sitting on different surfaces.

Elizabeth DeBartolo:Or if the device itself had a way of varying difficulty? I'm just trying to get at the basic need.

Elizabeth DeBartolo:So if you had different levels to challenge them with a single device, you wouldn't necessarily need to use different surfaces?

JJ:You could definitely provide a challenge through the device. The surface change would be a different type of challenge. So - overall I guess I would say it would just be different. I can't say if one would be better then another. I think having both options would be nice but not mandatory.

Elizabeth DeBartolo:Is #5 OK?

JJ:sounds good to me! I also really like #1 - I just noticed it. I must have missed it earlier - sorry.

JJ:Going to have to go soon. Anything else I can get you now?

Rochelle Perry:ok we still think a lot of the needs we already had are the same. Can we send them out to you again for approval?

Elizabeth DeBartolo:Same here.

JJ:Ok with me.

Rochelle Perry:You gve us a lot of goods ideas. Thank you for meeting with us. You've been very helpful.

Elizabeth DeBartolo:Yes, thanks for yoru time!

JJ:Thanks for being patient in explaining everything to me. Talk soon! Bye!

Rochelle Perry:Thank you have a good evening

Elizabeth DeBartolo:Rochelle, I can email you the note below if that's helpful.

Notes:

  1. Provide fun and motivating feedback to patient!
  2. Provide PT with objective measure of progress (anything objective is good. Speed and distance are good)
  3. Allow for patient-controlled leaning
  4. Allow for PT-controlled leaning and recovery
  5. Different ways of challenging the patient - different surfaces and/or different levels of difficulty (i.e., PT tips patient further or patient is asked to reach further)