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In response to the high incidence of falls for stroke survivors, the Board of Directors of the Jewish Rehabilitation Hospital has requested the development of a Yoga-Balance Rehabilitation solution to help hemiparesis patients, (people who have weakness on one side of their body). A performance needs assessment was conducted and indicated the following competencies that need to be developed by patients (primary performers): Competency 1: Identify benefits of the yoga technique for stroke survivors Competency 2: Perform breathing technique Competency 3: Perform ankle balance exercise This report will present the high-level design, by summarizing the interventions that will address gaps in motivation, resources, knowledge and skills in the fall prevention campaign. I will first present the road map, an overview of the campaign and its interrelated components. Secondly I will summarize each component.
Note: The interventions are limited in scope in order to meet the requirements of the class project. Performers include physicians and patients. Ideally caregivers should also be targeting in a more comprehensive solution campaign. Repeated selected elements (i.e. planned repetition) will be used heavily due to patients cognitive limitations that impair their ability to retain information.
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C= Competency F= Format 2 Competency 1: Identify benefits of the yoga technique for stroke survivors Competency 2: Perform breathing technique Competency 3: Perform ankle balance exercise
Humble Performer
Indifferent Performer
Conventions Why you chose this intervention A poster was chosen because it could be displayed in the hospital wing where stroke victims receive therapy. A poster with a strong image can be an effective way to catch peoples attention.
Type of information available Advertisements provide short, positive messages with a call to action such as Join us for a free demo class at lunch and rely heavily on graphics. They will also include a reference number for more information. Structure or format of the information A large poster with point form information and a picture. Writing style Formal language Claims are supported by a credible authority Conversational and inviting tone Encouraging tone
Performers dont have to think too much to decode the message. The performers should get the message at first glance. Message is attractive with a call to action Message is clear and concise Message is persuasive Powerful and creative image Resource reference listed on the poster
Communication medium Print Why you chose this medium Print advertisements are visually accessible. The impact of this medium comes from repetitive messaging that they will experience throughout the hospital. Advantages of the medium, especially in this context One time production cost is moderate Low-Moderate development time Effortless medium for users to read Consistent message Easiest read Far reach with minimal effort
Limitations of the medium, especially in this context Costly to print Linear medium Limited by space on the poster No one likely to read in-depth
Structure or format of the information The pamphlet would catch the readers attention with a relatable image, catching attention, then provide some information, and close with a call to action or receive more information Writing style Minimal text The visual layout of the document should be attractive Visuals play a prominent role in communicating the message Formal and professional Inspirational Conveys information clearly; bullet points, lists, appropriate images
Communication medium Print pamphlet, with PDF version also available on the website under complementary services Why you chose this medium The rationale for having a pamphlet is to make use of waiting time. The pamphlets will be in physician consultation rooms for a period of 8 months. Patients end up asking physicians about the yoga fall prevention program during their consultation. At that point the doctor can easily recommend the program to them. Advantages of the medium, especially in this context One time production cost is low (relative to 40-hours) Low-to-moderate development time Effortless medium for users to use Consistent message Easy to read For users, access to playback equipment
Limitations of the medium, especially in this context Changes and updates cannot easily be made Lack interactivity Can only have key information
These information sessions will be held periodically as new groups of people that experience stroke need to learn about the benefits. A yoga therapist, a doctor, caregivers and patients present a lecture on the benefits of a Yoga-Balance Training program to clinicians in the feeling arrogant phase. The performance need it addresses is skills and knowledge at the unit level. The purpose will be to discuss the benefits of yoga to reduce the incidence of falls for stroke survivors. The aim is to discuss the implications of yoga on the incidence of falls for stroke survivors in order to provide doctors with evidence of the programs efficacy. Format of the intervention Lecture Competency it addresses Identify benefits of the yoga technique for stroke survivors
Conventions Why you chose this intervention I chose this intervention because many doctors know about the general benefits of yoga, but may not know about its capacity in treating stroke patients. The Q& A is important for addressing skeptical attitudes and addresses doctors informational gaps or concerns about the training program. Type of information available An overview of the upcoming campaign Speakers present evidence-based research on yoga and the prevention of falls Patients share personal stories that express the value of the intervention Patients, caregivers and yoga therapists answer questions A call to action to how doctors can contribute to the initiative
Structure or format of the information 1. Doctors would be notified by e-mail 2. Lunch or breakfast is served 3. When doctors are seated, panelists (yoga therapist, doctor, patient) present information
Expectations that performers have Research will be presented by a credible source There will be a round of brief introductions People can ask questions and the respondents will answer honestly
Communication medium Live Why you chose this medium Meeting patients and experts in person and learning about their perspective, helps establish a sense of connection, which can help doctors learn and motivate them to support the initiative. Advantages of the medium, especially in this context Cost of production is moderate For producers, cost of playback equipment is very low. Development time is moderate Doctors are familiar with the medium Non-verbal communication can be captured live Meeting people in person can establish a sense of connection
Limitations of the medium, especially in this context Doctors are busy and will have to schedule time for the session Information communicated in person can be difficult to recall, when time passes Bringing patients, caregivers, and doctors to the hospital poses some moderate scheduling challenges.
The learning program addresses the skills and knowledge component at the individual level. This intervention is essential to the campaign because it teaches patients the benefits of yoga as well as practical techniques. It provides novice performers with basic knowledge and skills to reduce the incidence of falling. Format of the intervention Lecture Competency it addresses Identify benefits of the yoga technique for stroke survivors Perform breathing technique Perform ankle balance exercise
Conventions Why I chose this intervention This intervention was chosen because patients do not have knowledge about the benefits of yoga. Knowledge and skills are necessary precursors to successful performance. Type of information available Expository content Objectives Activities Practice Evaluation
Procedural and informational knowledge Extra resources FAQ addressing frequent issues
Structure or format of the information The training program will be presented in three units, which are based on the main objectives and will be presented orally by the instructor. Writing style
Expectations that learners have: There will be physical resources to support the class, including a room, desks and learning material To listen to an instructor in a clean classroom environment To learn how yoga can be a tool for fall prevention To learn how and when they can do yoga To practice exercises To be given handouts or job aids To be able to ask questions about the subject To receive answers To receive feedback To learn from an expert To apply what they have learned in everyday life
Communication medium The learning program will be instructor led in a classroom in the hospital. There will be printed material for students and instructors. Why I chose this medium Patients often experience feeling of isolation after the dramatic change in lifestyle after stroke. A classroom-based course is most effective to address the performers needs. In class, the facilitator can modify content on the fly to better address the performers needs. It is also an ideal setting to meet other patients that are undergoing the rehabilitation process. Advantages of the medium, especially in this context Costeffective Convenient location, in the hospital
This intervention is a resource video, to help patients recall the exercise. The performance phase that is targeted is those in the arrogant phase, by viewing the video and following along individuals get instant feedback by listening to the instructors cues. Stroke patients have cognitive limitations, so reducing the cognitive load by providing easy to follow instructions after the training is essential to program adherence. Format of the intervention Tutorial Competency it addresses Identify benefits of the yoga technique for stroke survivors Perform ankle balance exercise
Conventions Why I chose this intervention This intervention was selected because it provides easy instructions that performers can visually follow. Some patients experience cognitive limitations, watching a video tutorial will help refresh knowledge and skills learned at the training. A refresher tutorial can help patients remember instructions for performing exercise. Type of information available Title Describe benefits of preforming the ankle exercise Duration of exercise Step-by-step instructions
Structure or format of the information The tutorial will be uploaded onto YouTube and linked to the Hospitals website under complimentary services. Before starting the tutorial, learners will be asked not to eat to 30 minutes before they practice the exercises
Expectations that learners have Performers expect to be able to learn the benefits of the exercise Follow-step by step instructions Performers expect the instructions to be at a pace they can follow That the instructor will communicate clearly
Communication medium Asynchronous (Ideally viewed on a tablet or phablet) Why you chose this medium Tablets are suitable for stroke patients because they have speech generating devices, text to speech, and virtual keyboards Advantages of the medium, especially in this context Moderate production cost Tablets are very intuitive and easy to use Overcome barriers of distance and time Ease of use Remote access 24/7 Interactive Easily distributed
Limitations of the medium, especially in this context Moderate development time Social isolation Some users may not be comfortable with medium Up-front costs (computer and internet) Some devices require plug-ins to run YouTube Users may not have access to a tablet
Conventions Why I chose this intervention It is hard for patients (because they rely on family member to drive to the hospital for follow-ups in a regular basis). With the feedback system, the clinical unit can detect issues patients are facing with performance metrics remotely. Type of information available The clinician or therapist and individual will receive feedback on whether or not the patient is performing exercises correctly and how to correct their performance if need be. Individual performers gain points, badges and social media recognition to keep them motivated throughout their therapy. Clinicians gain access to a range of valid performance metrics and multiple means of displaying improvement - Tables, pictures and/or videos.
Communication medium Online asynchronous Why you chose this medium The feedback system is a software platform designed for physical therapy. It is comprised of two parts: the wave and the portal. The Wave is an application that may be downloaded and installed on a personal computer (PC). It contains all the activities a patient would engage in to participate in physical therapy. The Portal is a web application which clinicians can log into, and monitor their clients who are using the Wave. They are also able to prescribe new activities and customize them based on their individual patients feedback and needs. Advantages of the medium, especially in this context Clinical Unit Standardized assessment Highly interactive relationship with patient Cost effective, the system costs less than having a physiotherapist monitor patients Individual In the at home model, patients can use it in between clinical visits or after being discharged Provides instant feedback on their progress
Limitations of the medium, especially in this context Clinical Unit: The system requires that a clinician be monitoring the users, and prescribing the activities. May not be able to fit task in day-today tasks May not be comfortable using technology
Individual The patients must purchase the Microsoft Kinect for Windows, directly from Microsoft or Amazon. Impersonal Patient may not be comfortable using technology Out of pocket cost to purchase Kinect device
Structure or format of the information Coordinator sets up meeting time for several pairs of buddies Shuttle bus picks up patients and drops them off at hospital cafeteria Buddy pairs meet over afternoon tea, which is provided free of charge Shuttle bus drops off patients at their homes
Writing style
Expectations that learners have Icebreakers to learn about their buddy To talk to several people in the yoga rehabilitation program To build relationships To try different teas and to relax
Communication medium Live (Face-to-face) Why I chose this medium I chose this medium because patients feel isolated due to their limitations. A face-to-face meeting over tea is a relaxed way to get to know each other. Advantages of the medium, especially in this context For producers, low cost for production Relative ease to support event using existing facilities For users, moderate to high comfort level with medium
Limitations of the medium, especially in this context For producers, it requires a low-to moderate amount of time to organize the event Patients require transportation
E-coaching aims to engage, motivate and help arrogant phase patients continue practicing their fall prevention exercises. This intervention addresses the unit and the individual. The software records and shares progress information with the yoga therapist, they can then provide feedback by sending notes to the patient and updating their program routine remotely. Format of the intervention E-coach Competency it addresses Perform breathing technique Perform ankle balance exercise
Conventions Why I chose this intervention E-coaches have an implied level of authority and can insist on compliance. The software records and shares progress information with the clinician and the clinician can send notes to the patient and update their program routine. Type of information available Establish and set personal performance goals Clearly specify goals Use diagnostic and assessment tools to gather performance metrics towards goal Maintain current behavior (confirming feedback) and change behavior (corrective feedback) Observe, monitor and verify performance Provide clear and timely feedback
Structure or format of the information Online Simulation Writing style Supportive Create succinct statements of expectation Avoid vague and ambiguous language
Communication medium Online Asynchronous Why I chose this medium This medium was chosen because the feedback system (intervention 8) includes an e-coaching. Up to 65% of patients are non adherent or partially adherent to their at home rehabilitation programs, e-coaching helps the engagement factor by providing personalized feedback based on progress metrics. Advantages of the medium, especially in this context Unit: Data captured by feedback is easily exportable for quick and efficient record keeping. Simulation system fills out documentation for the therapist Easy accessibility for therapist, its easy for them to participate in the relationship E-coach is available 24/7 Cost are low Reduces the need to coordinate schedules Easy for patient to access Overcomes geographical distance Reduce cost to travel and logistics
Limitations of the medium, especially in this context Unit Impersonal, lack of face-to- face component The system requires that a clinician be monitoring the users, and prescribing the activities. May not be able to fit task in day-today tasks May not be comfortable using technology
The patients must purchase the Microsoft Kinect for Windows, directly from Microsoft or Amazon. Impersonal, lack of face-to- face component Patient may not be comfortable using technology Out of pocket cost to purchase Kinect device