ReWire: Designing for Traumatic Brain Injury

A classmate and I assisted ReWire Inc, a medical start-up whose goal is to create a scalable solution to the high cost of TBI rehabilitation, by reviewing existing literature about the nature of TBI, how it affects cognition, and how to design for people with cognitive delays. We conducted a competitive analysis and created a survey, which was distributed to TBI patients and their providers. Our final deliverables included a literature review and a design checklist focusing on stylistic and functional requirements.

Objectives

To assist the ReWire team with the usability and learnability of their mobile application by doing the following:

• Understanding industry standards for designing for users with limited cognitive abilities
• Gathering data on preferences of TBI patients and their healthcare providers for application functions and features
• Determining methods to encourage continued use of the application

Methods

Survey–We created a survey for TBI patients and their providers to gain insight into our primary users' current approach to treatment and how we can improve it. Some areas explored include the following:

• Reported symptoms and how they affect day-to-day recovery
• Mobile applications and wearable monitoring devices already used by patients to supplement treatment
• Characteristics of TBI that will require extra sensitivity in design/handling

Competitive Analysis–We explored existing mHealth applications, including those that were HIPAA-compliant, to inform our research on best practices for design.

Literature Review–We reviewed medical literature, studies from the VA and the IMS Institute for Healthcare Informatics, and proceedings from various conferences devoted to web accessibility in order to establish the following:

• Best practices for designing interfaces for users suffering from TBI
• Methods to encourage adoption and meaningful, sustained engagement with mHealth applications

Key Findings

Patients desire real-time, tailored feedback–Patients are more likely to utilize wearable devices and mHealth applications if they provide real-time recommendations on improving personal stats and/or progress achievements and allow for personalized reminders/alerts to be set. They may also feel more satisfied with recovery applications if graphical displays of their progress are made available. Careful consideration of patients' needs when designing app functionality will be necessary to ensure that ReWire is widely adopted and incorporated into daily life.

TBI patients have unique needs for UIs–While general guidelines for web accessibility and design (simplicity, consistency, etc..) hold true, interfaces for TBI patients must take into consideration additional limits on cognitive processing. For example, designers should avoid using bright colors, because many TBI patients suffer from chronic migraines, which vibrant interfaces can trigger. As patients often experience memory loss and difficulty concentrating, designs should ease cognitive demand whenever possible.

Challenges

• Unfortunately, we did not have direct access to TBI patients and their providers for our early generative research. We had to rely on connections at the Florida Institute for Human and Machine Cognition to distribute our survey for us. As a result, we only received 15 responses. Regardless, the qualitative data from these responses was helpful in establishing key barriers to treating patients with TBI.
• While much research has been conducted concerning TBI, we found very little research focusing on design for TBI patients. We had to dig deep into articles focusing on accessible design and other mHealth technologies to determine best practices.
• There are relatively few applications that are HIPAA-compliant, which made providing the start-up with guidance based off existing models quite difficult.