HExo

Hand Exoskeleton

A mobile application that operates a hand exoskeleton device, to help patients rehabilitate independently at home.

Health Tech UX Design & Research

@ Cre-AID LABS, a MedTech startup

MY ROLE + RESPONSIBILITIES

I worked closely with Engineers, Healthcare Professionals (HCPs) and Patients. I drove the user research, created wireframes and prototypes, ensured successful testing and implementation.

TEAM

1 UX designer and researcher (me)

4 R&D Engineers - engineered the HExo device

1 Developer - developed the accompanying application

TOOLS

Figma

Adobe Photoshop + illustrator

Procreate

01 INTRODUCTION

Context

What are Exoskeletons?

'Exo' or 'external' skeletons aid patients recovering from neuromuscular disorders such as strokes or injuries. These devices support the recovery process by assisting with movement and exercises that help patients gradually regain their lost Range Of Motion (R.O.M).

Process overview

02 RESEARCH

Market solutions

What are the current approaches to physiotherapy + rehabilitation?

Therapist-driven rehabilitation

(most common)

An entirely human intervention, with therapists assisting patients through their recovery.

Effective, but expensive and HCP time- intensive.

High-tech exoskeletons

Advanced devices exist but are prohibitively expensive, limiting access to only a few.

Bulky, stationary exoskeletons

Large devices are typically owned by hospitals and used exclusively in physiotherapy centers, making them inaccessible for at-home use.

Where HExo Comes in

A lightweight, portable, and affordable exoskeleton. An equitable solution designed to be accessible across all scales of hospitals, clinics, and home environments.

Functionality A

Exercise therapy (CPM)

To maintain and improve range of motion (R.O.M).

Functionality B

Daily activity assistance
Enabling patients to regain independence in everyday tasks.

The device is operated with controlled speeds and Range of Motion (ROM)

a. Full ROM (120 degrees); b. Speed changed; c. Partial ROM

The problem

Rehabilitation can feel overwhelming and intimidating for patients, especially when adapting to new technologies. The challenge lies in ensuring the application is simple yet effective, offering patients a seamless experience that builds trust in the device while enabling HCPs to deliver effective care.

How can we design an application for HExo that is motivating and empowering for patients and aids healthcare professionals deliver treatment effectively?

This application serves as the cornerstone of a broader vision: a comprehensive patient care and rehabilitation platform. By bridging the gap between diagnosis, treatment plans, and full recovery, HExo aims to streamline the rehabilitation process with HCP guidance.

This case study explores the HExo application's patient interface

Who are our users?

Interviews and contextual inquiries

Through a number of 1:1 interviews and contextual inquires with our two user groups of healthcare professionals (HCPs) and patients, I gathered valuable data that informed the design process. These interactions also enabled me to create detailed user profiles, incorporating actionable insights and key takeaways.

Interview takeaways

Interviews with patients highlighted their fluctuating emotional states right from diagnosis, to the various stages of recovery and adapting to the disorders which are sometimes temporary and otherwise longterm.

Interviews with HCPs underscored that unlike certain medical procedures, physiotherapy is a relatively long term process that needs a high level of monitoring for effective results. Therapists often lend patients motivation and assurance in their recovery. Often times, there are gaps in communication when patients are transferred between departments or centers that can create problems.

Contextual inquiry takeaways

I observed patients' recovery journeys across different stages and touchpoints, focusing on their interactions with HCPs during consultations and therapy sessions, as well as their use of the HExo device for rehabilitation exercises.

Contextual inquires reflected patients' motivation levels that translated into their consistency and adherence to therapy. It was important for patients to see progress themselves, but also be reassured by their HCPs.

User profiles

Illustrations sourced from pinterest

Use case scenarios

Home-Based Rehabilitation for Patients

Patients recovering from neuromuscular disorders use HExo at home to perform exercises (Continuous Passive Motion - CPM) without frequent visits to the hospital.

Supporting Daily Activities with Active Assistance (Future Use Case)

Patients use the HExo device’s active-assisted mode (via EMG signals) to perform essential daily activities, such as eating, writing, or lifting objects.

Assisted Therapy in Hospital Settings

Physiotherapists or occupational therapists, use HExo during therapy sessions to deliver consistent and repetitive exercises (CPM) tailored to each patient’s needs.

Caregiver-Assisted Therapy at Home

Caregivers assist patients in operating the HExo device at home, particularly for elderly patients or those with limited dexterity.

03 DESIGN SOLUTION

Design goals

Patient Comfort and Confidence: Design a user experience that reduces the intimidation with rehabilitation devices and medical technology.

Ensure Patient Safety: Incorporate safeguards to prevent accidental changes to critical settings, or tampering with the device functionality.

Foster Motivation: Provide clear feedback on recovery milestones and motivational messaging to encourage adherence to recovery plans and empower users.

Enable HCPs: Technology aided therapy to help HCPs deliver patient care effectively, offload cognitive load and ease decision making and monitoring processes.

Design Question

How might we help patients have a smooth recovery journey right from diagnoses to complete recovery in a way that they are independent and comfortable?

Features by priority

Through our interviews and analysis, we identified the priority of different features, guiding the creation of our information architecture. Since customizing each patient’s R.O.M is essential to the device’s functionality, it is incorporated into the setup process, which leads to the CPM or therapy mode.

Information architecture

With great consideration of our design goals and research insights, the Information architecture has been put together to cater to a wide range of users, easy to navigate and understand

3.1 PROTOTYPING + ITERATING

Finding an intuitive structure

Finding a clear and intuitive way to organize the app's core functionalities—calibration, manual mode, and therapy mode.

initial concept

The initial approach used collapsible cards to organize the functions within a single screen. While this method grouped all information compactly, it resulted in a cluttered interface that users found challenging to navigate.

final design

I restructured the app by dividing the modes into dedicated pages, each accessible via a conventional navigation bar, leveraging users’ familiarity with this structure. It created a cleaner, more intuitive interface, allowing users to toggle seamlessly between sections. The bottom navigation bar is also more thumb friendly.

Ease of operating HExo

Operating the flexion, extension and speed of HExo

The HExo device features three primary controls. The goal was to design a system that ensures safe operation, leaving no room for error. Any incorrect flexion or extension beyond the patient’s prescribed Range of Motion (R.O.M) could result in adverse injuries, making precision and reliability essential in the control mechanism.

Contextual inquiries revealed that patients were already familiar with basic terms like flexion, extension and R.O.M due to their interactions with HCPs and medical reports.

initial concept

The initial concept used pre-defined increments and decrements for flexion and extension, but this added complexity with more buttons and increased the risk of exceeding the patient’s R.O.M, potentially causing injury, since it was unsuitable for precise operation.

The slider control for speed proved unsuitable due to the complexity of programming precise minute variations.

final approach

I redesigned the controls to use press-and-hold buttons for flexion and extension, offering a more intuitive user experience. This approach also enhanced safety, as the device would stop moving immediately when the button was released.

Instead, we implemented a simple scale from 1 to 5, which was intuitive for users during testing, with 1 representing the slowest speed and 5 the fastest.

Measuring movement - flexion and extension

We found that using degrees was the most intuitive metric for users, offering a universal and straightforward way to track and communicate progress. Additionally, degrees served as the standard metric for the R&D team to configure the HExo device effectively.

To enhance this further, we introduced the HExo Buddy—an interactive visual aid that mirrors the patient’s movements, visually representing degrees of flexion and extension in real-time.

This combination of numerical metrics and visual feedback improved usability, enabling patients and HCPs to monitor and adjust movements easily

3.2 HI-FI PROTOTYPES UPON USABILITY TESTING

Usability testing with patients highlighted several actionable insights that were implemented to create a more intuitive and user-friendly design that minimized assistance on physiotherapy.

Simplifying device setup + calibration

To use the device, it must first be configured to the patient’s Range of Motion (R.O.M) during the setup process, which involves multiple steps.

Before usability testing

Usability testing revealed that the initial design lacked clarity, leaving users unsure of the sequence and required actions.

Final design

In the final design, each step was displayed individually on separate screens with clear instructions. Additionally, users were alerted at the appropriate stage to wear the device, minimizing the risk of injury.

Motivating patients through rehab

Therapy is a key component to the application, and patients often require motivation and support to endure the discomfort associated with the process.

Progress tracker

The progress card displays progress toward each phase, helping patients understand their goals and motivating improvement. The therapy home screen shows days completed in each phase, and expanding the card reveals milestones and achievements.

Encouraging patients during therapy sessions

Observing in-person physiotherapy sessions revealed that therapists often motivate patients with encouraging words. The app replicates this with prompts at the start, mid-point, and end of sessions. A cheerful Cre-AID mascot adds a personal and positive touch to the experience

Collecting patient feedback for HCP insights

Usability testing with physiotherapists highlighted the importance of gathering patient insights post-session, similar to in-person therapy. This feedback, including reports of pain or difficulties faced, is compiled into a report for HCPs to inform and adjust treatment plans effectively.

Designing for patient safety

Once the device is calibrated, the patient's R.O.M is automatically applied across all modes, including manual and therapy. This ensures ease of use while enhancing safety by preventing the device from exceeding the calibrated R.O.M under any circumstances.

An emergency stop button was added to all screens as a kill switch for enhanced safety. While the flex and extend controls already function as press-and-hold buttons, this additional measure ensures immediate halting of device movement if needed.

Restricting access to calibration settings

Our interviews with physiotherapists highlighted that often patients take spontaneous decisions to increase their R.O.M or level up their exercise premature to their HCP's advice. This could lead to complications and injuries.

Access to edit calibration and therapy (CPM) settings is restricted through an access code known only to HCPs. This measure safeguards patients from mishaps and prevents tampering with the device.

Outcomes

Developed an integrated application that simplifies operating the HExo exoskeleton, empowering patients to rehabilitate independently at home, while also meeting the professional needs of HCPs.

Achieved an 93% success rate in pilot testing:

4 patients successfully used HExo independently at home.

12 patients tested the device in hospital settings under HCP supervision.

Takeaways

Designing for the healthcare industry came with its unique challenges. It emphasized the need for deep empathy with patients, understanding their pain points, and focusing on helping them achieve their goals with minimal friction. Patient emotions and challenges were pivotal in shaping the application's design and functionality.

This project also underscored the importance of simplifying complex interactions, making the application intuitive for users. It was particularly distinctive because it didn’t fit into standard categories of commonly used applications with pre-established structures, requiring an entirely original approach to design and problem-solving.