Interactive stepping tile for rehabilitation

Diagrams and artwork showing the Interactive Stepping Tile

About 50,000 Australians suffered a new or recurrent stroke last year, and more than half were left with a disability that affects their ability to live independently.

After a stroke, fall, brain or spinal injury, physical rehabilitation is often an arduous process, says Associate Professor Bert Bongers from UTS’s Interactivation Studio.

Overcoming a major injury can be a daunting task. At first your progress might only be measured in a few millimetres or a few grams of pressure.

— Associate Professor Bert Bongers, Interactivation Studio

To enhance this rehabilitation process, Associate Professor Bongers and his team have developed the highly responsive Interactive Stepping Tile that gets patients to perform standing, balancing and stepping exercises, and see even their smallest improvements on screen. “Stepping is a way of training yourself and getting your coordination back – and it also helps with fall prevention,” he says.

These tiles are part of the world’s biggest study of gaming technology, looking at the rehabilitation potential of computer games, iPad apps and interfaces such as the Nintendo Wii.

Professor Cathie Sherrington, from the George Institute for Global Health and the University of Sydney, is leading this three-year study, funded by the National Health and Medical Research Council. The study involves 300 patients and a team of health professionals, engineers, designers and consumers across three states.

Interactive Stepping Tile in use in the Brain Injury unit at Liverpool Hospital (photographer: Shane Lo)

“We know that more exercise is associated with better outcomes, and technology may provide a way to achieve more exercise without extra staff time as the devices offer feedback and encouragement, and can be fun,” Professor Sherrington says.

Making use of a range of open-source hardware and instant-manufacturing techniques (such as 3D printing and laser cutting), the tiles are linked to a computer that allows patients and therapists to receive detailed, real-time graphic feedback on rehabilitation tasks.”

The tiles record and then display a patient’s precise weight distribution between their right and left foot – essential information especially for stroke victims recovering from full or partial paralysis.

“There are four sensors in the central tile, so when you rock your feet back and forth you can see corresponding circles get bigger and smaller on the screens as the weight distribution changes,” says Research Assistant Albert Ong.

Using gaming principles and interactive approaches, the system motivates patients to work independently and meet pre-programed goals, such as the number of steps on a tile.

Undergraduate student Rebecca Hall developed the first prototype of the tile in the Interactivation Studio for her industrial design honours project in 2012.

We need a diverse range of people, with different backgrounds like industrial design, graphic design, sound design, engineering, and to continuously involve people from a medical background. The diversity of the team reflects the complexity of the problem space.

— Associate Professor Bongers

Currently rehabilitation units at Bankstown-Lidcombe Hospital, Liverpool Hospital and Adelaide’s Repatriation General Hospital are using the tiles.

“People learning to use their bodies again require accurate feedback about their attempts to perform a task such as standing and stepping,” explains Senior Physiotherapist at Bankstown-Lidcombe Hospital Karl Schurr. “This technology is important because it gives immediate feedback about a patient’s success in generating force with their legs – no matter how small.”

Associate Professor Bongers and his team are collaborating with technology company Snepo and have reprogrammed the stepping tiles’ software as a smartphone or tablet app. They are also refining the tile design for ease in manufacturing.