Participant C Co-design Process
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This section details an overview of video documentation from the co-design process. For detailed explanations of the exercises created please click on the exercise titles within each section. All thesis videos can also be found here:
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The movement highlighted in these examples involve some elbow flexion, but not actively, as the participant’s paretic arm remains in a fixed flexed position due to spasticity.
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Primary compensation occurs through trunk flexion (leaning forward) and lateral displacement (shifting sideways) to generate the necessary momentum to activate the switch.
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The arm movement can be seen to be slightly controlled when the movement sequence has finished, and the arm returns back to the lap.
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As the co-design process developed for this exercise - the participant developed a compensatory movement strategy featuring a rapid trunk flexion or ‘jolt’ which was used to generate momentum to activate the switch. This pattern appeared over time in response to the participant anticipating the game's arrow pacing, as the participant prioritised task completion within the given time window,, rather than the careful execution of the exercise.
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To address this compensatory behaviour and promote more efficient neuromuscular recruitment, future games were designed to feature either slower arrows to reduce the urgency to connect the hand with the switch, in game cueing (verbal or visual), musical guidance with musical cueing. Whilst this particular exercise was not developed further, the elbow flexion exercise can be used within game featuring an end of movement switch and 1 arrow press per bar. Musical cueing and movement synchrony was explored further in the 'Shoulder Shrug' exercise.
During the Shoulder Shrug game development the participant developed a compensatory movement pattern involving a shoulder hike or 'jolt' from a lower limb and trunk extension in order to activate the switch above his shoulder. The video demonstrates the participant exhibiting impaired selective motor control which is the inability to contract individual muscles in the pattern required to carry out a voluntary posture or movement (Mohammed et al., 2023). This means that the participant is relying on whole body momentum rather than an isolated activation of the upper trapezius ('the traps') to activate the switch. As seen in the half arm raise, this compensatory strategy emerged in response to both the anticipating when to hit the switch in alignment with the on screen arrow alongside difficulty in executing the movement.
To execute the exercise and reduce compensatory motor patterns, a game (see below) was created that was tailored to the participant. The timing of the shoulder shrug execution matches the BPM of the music and the game includes an anticipatory window - a 4 note pattern in which the last note was the cue to hit the target.. This helped by removing the participant's feeling of urgency to rush to complete the 'shoulder to arrow' press within the game and thus helped to promote movement quality. On screen instructions and in game verbal cueing assisted in this active awareness of motor planning, as well as detailed in person practise and instruction and 'off game' exercises (manual shoulder shrugs).
Un/Assisted Forward reach
Reach arm forward to hit the switch in front of the participant