V A A N I
OVERVIEW
As we grow older our problems grow with us. From having a high functioning body in our prime of life towards a life of peace the journey is beautiful with a few blockages along the way. However, one such blockage is so big to overcome that it often leaves you with irreversible damage without the correct first aid.
Brain Stroke affects 1.8 million of the population of India and 15 million of the world population. The aftermath of the stroke is a burden heavy to bear both by the affected individual and the caregiver.VAANI is a device that will help reduce this burden in the developing nation that India is and aims at providing improvement in the quality of life an individual lives after a brain stroke.
PROBLEM AREA
BRAIN STROKE
A stroke is a medical emergency. It happens when a blood vessel in the brain bursts or, more commonly, when a blockage happens.
Without treatment, cells in the brain quickly begin to die. This can cause serious disability or death.
1.8 million
people suffer from stroke in India
Worldwide Figures
15 million worldwide
66.7%
Permanently disabled
33.33%
Die
There are 2 main types of stroke that affect people commonly -
Ischemic Stroke
This is the most common type of stroke.
It occurs when a blood clot is lodged in an artery and cuts off blood supply to the brain.
It is usually caused by either:
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Embolism
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Thrombosis
Every second counts. Without oxygen, brain cells begin dying within minutes. Once brain tissue has died, the body parts controlled by that area won’t work right. This makes stroke a top cause of long-term disability. There are clot-busting drugs that can curb brain damage, and they must be given in a short time -- usually within 3 hours of when symptoms start
Haemorrhagic Stroke
This occurs when there is a rupture of a blood vessel causing bleeding in the brain.
It is usually caused by:
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High blood pressure
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Defects in the blood vessel wall such as cerebral aneurysms
Time = Brain Damage
Think F.A.S.T.
The FAST test helps spot symptoms. It stands for:
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Face drooping. Ask for a smile. Does one side droop?
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Arm weakness or numbness.
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Speech. Can the person repeat a simple sentence? Do they have trouble or slur words?
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Time to call an ambulance. Don’t delay.
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Loss of Sensation
Problems of Movement
Communication
Problems after Stroke
Inadequate ventilation of lungs
Incontinence
Depression
Social Deprivation
Emotional Problems
Rehabilitation
Psycotherapy
Speech Therapy
Physisians
Educating about Stroke
Orthotics/Prothetics
Occupational Therapy
Physiotherapy
PRIMARY RESEARCH
To understand the shift of life of the patients I conducted deeper research on the patients through personal interviews with the caregivers.
B.P.Uma
Bhimrao Meshram
Raghubir Singh
"She cries all the time."
"He screams all the time."
"He only listens to his eldest son."
"We put on the TV for him"
"The nights are very difficult to deal with"
"He starts throwing away things to get attention"
"We guess most of the time,what they want"
KEY INSIGHTS
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The caregiver is often a spouse who himself is in his or her 50's with his or her own set of medical problems.
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Not everybody is able to bear the cost of recovery and rehabilitation.
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The wheelchair is needed but often not purchased as pertaining to management on their own.
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The nighttime is one of the most difficult to deal with when the patient is alone with his or her thoughts unable to move, unable to speak.
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To grab attention bad behavior such as screaming, throwing of things, cursing, use of bad language is often chosen as a last resort by the patients.
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Most of the patients spend their time watching television.
SECONDARY RESEARCH
BURDEN OF STROKE
Stroke is responsible for 3.5%
of disability-adjusted life year (DALY) in India.
Organized rehabilitation services are available in the country but they are mainly in private hospitals of the cities.
Stroke rehabilitation is not well developed in India due to lack of personnel.
Majority of stroke survivors continue to live with disabilities, and the costs of ongoing rehabilitation and long term-care are largely undertaken by family members, which impoverish their families.
To understand the shift of life of the patients I conducted deeper research on the patients through personal interviews with the caregivers.
POST STROKE
DEPRESSION
WHY ME?
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40-50% of Stroke survivors suffer from depression.
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Saddened by the loss of independence
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Assistance can be at times embarrassing and also demeaning.
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Feeling of a Prisoner in their own home.
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Changed nature of relationships.
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Fatigue after physiotherapy.
SLOW DEGRADATION OF QUALITY OF LIFE
Its not the stroke which kills the person, it's what comes after the stroke. A huge shift in the life that a person was living and the life his family was living is observed. Relationships are severed, emotions overwhelm, and financial burden increases. Often a person is observed to die of loneliness, depression, and other underlying diseases which go excommunicated.
EMPATHY MAPPING
SAYS
Cannot communicate
via
speech
Unable
to communicate
what
they think
Dependent on caregiver
Therapy
Watch Television
Anger
Sadness
Fear
Frustration
Hopelessness
THINKS
DOES
FEELS
IDENTIFYING AREA OF INTERVENTION
Communication is a basic human right. It's how humans function. We are social animals.
Inability to speak is a root cause of a lot of problems and a lot of problems can be solved if dealt with. If only the patients are able to communicate what is wrong, what do they need, what are they feeling,who do they need will remove the frustration building up due to lack of communication.
Hence I decided to work on the area of Speech impairment after stroke which is called
A P H A S I A
Aphasia is a language disorder associated with stroke.
It is a result of damage of the areas of the brain responsible for language production and language processing present in the left hemisphere of the brain.
There is a disconnect between what's in there and what comes out of here.
The ability to connect one dot to another is lost
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The severity of Aphasia is directly related to the Size of brain injury resulting from stroke.
The ability to speak is lost however intelligence remains intact.
Communicating with patients with Aphasia
-
The use of gestures is important
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Yes/No questions help
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Less number of questions
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Use of Prompts
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Repeating a few times
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Giving the individual time to respond
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Summarising what the individual has communicated
USER PERSONA
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Name : Jitendra Verma
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Age : 65
-
Gender : Male
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Type : Hemiplegic
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Assistive Device : None
Jitendra had a stroke 4 years ago.There was a delay in reaching the hospital on time hence several complications developed which affected the treatment and recovery.Following his treatment,unable to go back to work and being the sole breadwinner for the family,his wife and 2 kids suffered from a great financial burden.His inability to speak after stroke and lack of rehabilitation makes it more difficult.
Quotations
I want to be able to control over my care and rehabilitation.
I want to participate in life.
Tasks
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Rehabilitation therapies
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Physiotherapy
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Speech Therapy
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Occupational Therapy
Problems
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One Side is Paralysed
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Speech is affected
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Communication doesn’t happen
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Fatigue
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Pain from Physiotherapy
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Sadness,Loneliness and Depression
Frustrations
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Loss of independence
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Immobility
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Changes in Relationship
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Inability to communicate
Needs
-
Company
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Love
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Encouragement
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Motivation
DESIGN BRIEF
For Stroke patients, who need to communicate, VAANI, is an assistive communication device that is easy and affordable. Unlike devices like alarms/buzzers, it communicates the actual need of the user.
Design an easy-to-use communication system for stroke patients who have aphasia .
DISCOVERING PAIN POINTS
Stroke Patient Communication
Distorted Speech
Screaming
Throwing things
Swearing
Exhibiting bad behavior
Crying
AAC
Augmentative and Alternative Communication
-
Augmentative means to add/enhance.
-
Alternative means a choice/substitute.
-
Communication means sending and receiving messages.
gestures, expressions, writing etc are all modes of communication
Existing techniques of AAC are categorised as follows
Low Tech
includes gestures,
drawings
words
pictures
Mid Tech
maps,
charts,
communication boards
High Tech
speech generating
device accompanied
by an AAC software
Cost of AAC
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The existing techniques that implement AAC are a bunch of devices and applications available mostly on the Apple Store and are too costly for the vast population of India. These applications are designed with the aim of enabling communication in autistic kids and they act as a learning tool for them. However, they have not been able to prove very helpful with aphasia patients.
The cost associated with treatment specific for aphasia using High tech AAC is certainly too high for a developing nation like India. Hence, I decided to redefine my brief as follows.
There are 2 main orientations of treatment of aphasia -
Restorative/linguistic treatment - where the aim is to work on building neuroplasticity of the brain
Substitute/compensatory treatment -where the goal is to establish functional communication to convey messages successfully to the listener
I decided to work on developing a product that will use compensatory strategies and tools to maximize functional for communication social interaction.
REDEFINED BRIEF
To design a mid-tech AAC device to establish functional communication in stroke-affected Aphasia patients.
IDEATION & PROTOTYPING
While ideating for the solution I tried to integrate the Universal Design principles.
The product will be culturally align with the Indian context.
The product will be used by the patient and the caregiver both.
The product will be able to be used by people with different levels of physical limitations that come after a stroke.
The product will respect the affordability and the cost considerations
CULTURAL
EQUITABLE
USABLE
ECONOMY
AESTHETICS
The design will employ aesthetics so as to promote social integration
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creating a shared communication space.
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improving the quality of interactions with unfamiliar partners
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increases no. of conversational turns.
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increases ease of sharing information and understanding information.
Design considerations
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Mid-Tech
-
Affordable
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Lightweight
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Portable
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Ergonomic design
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Bluetooth / Wired Speaker Connectivity
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Battery/USB Cable operated
A book that will have symbols in form of a grid denoting different phrases and needs such as below :
CONCEPT
The Touch to Speech feature of this simple device will enable communication between the aphasia individual and the person he or she is trying to communicate with.
To make it MID-TECH the use of Capacitive touch keypads will be done.
The book will have different pages having these symbols which will help establish functional communication.
Click to hear
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FINAL CONCEPT
While pondering upon the research and the interviews conducted for this project I came across another fascinating discovery that patients were not able to speak but humm a sound throughout the day. They unknowingly remember their favorite song and are able to sing it completely with all the correct lyrics. This led me to discover a term called Music Intonation Therapy.
Melodic Intonation Therapy (MIT) is an evidence-based treatment method that uses intoning (singing) to improve expressive language in people with aphasia. The approach takes advantage of the undamaged right hemisphere by engaging areas that are capable of language.
MIT + LAMP
Use of MIT(Melodic Intonation Therapy) in combination with LAMP (Language Acquisition through Motor Planning)
If the output of these symbols which is simple speech right now could be in a more melodic form,it will help associate the words on the book with a rhythm, a melody, and repeating after what was just pressed can help engage multisensory and motor networks, inducing changes within these networks to foster links between distant, but functionally related brain regions with continued and lifelong musical practice.
Starting by establishing a sense of rhythm in the patient -
Sa
Re
Ga
Ma
Pa
Dha
Ni
Sa
By teaching the patient the basics of rhythm i.e Sa re ga ma pa, we can establish a sense of rhythm that the patient will remember and will then try to incorporate it in every conversation.
How will it work?
Intonation and Left-Hand Tapping
Stimulates the Right hemisphere of the brain
Inner Rehearsal
By silently intoning what they are trying to speak
Auditory-Motor Feedback Training
Listening to the recordings.
WHATS NEXT ?
Prototyping with MIT.
User Testing
Enhancement in Aesthetics.