I conducted secondary and primary research to design and test a singing therapy app for brain injury patients. The final prototype addressed research questions of how to facilitate recovery through mobile technology and how to inspire positive mental health among patients in recovery.
According to the Centers for Disease Control, an estimated 1.7 million people sustain a traumatic brain injury (TBI) every year. While nearly 80% are treated and released from emergency departments, many still feel the impact of injury in their everyday lives, well after the period of intensive care has ended.
Inspired by a friend who suffered a traumatic brain injury, Theratune is a singing therapy application to make recovery brighter, more meditative, and regenerative. It was created over the course of 10 weeks during a part-time evening course in user experience design.
Brain injury patients often find themselves with significantly reduced communication abilities, sometimes even rendered speechless. While the brain has high developmental potential 1 - 3 months after the injury, the amount of physical, occupational, and speech therapy is often limited by the amount that insurance will cover. Struggling to communicate on a daily basis also commonly results in feelings of helplessness and depression. This project thus aimed to address the following primary challenges:
1. How might we facilitate recovery through mobile technology?
2. How might we inspire positive mental health among patients in recovery?
PROCESS: how might we facilitate recovery through mobile technology?
Melodic intonation therapy.
Early concepts included telemedicine (connecting therapists with patients via video chat), file transfer (between therapists and patients), as well as an e-learning app (to allow patients to learn independently with therapist-approved exercises). However, after conducting some competitor research, the last idea of self-guided curriculum seemed the most in need of innovation. In interviews with TBI and stroke patients, caregivers, and clinicians, people reported that the most commonly used technology for therapy exercises was analog cassette tapes!
Focusing on speech exercises involving music seemed particularly promising: language ability is usually located the brain’s left hemisphere, whereas areas for music are located in the right. Researchers have found that activating the brain’s right hemisphere with melodic intonation therapy, or musical speech exercises, can reduce the dominance of the damaged left hemisphere’s language areas.
Low cognitive yield.
Patients, caregivers, and clinicians all reported in interviews that fatigue was the most likely factor to regress symptoms. The brain’s executive function can often be affected in injuries as well, making even simple choices a challenge. One key interview insight was thus to prevent fatigue and choice paralysis by guiding users through a linear lesson plan.
Mobile technology can provide repeatable interactive exercises and feedback at a lower cost than traditional therapies. To put it simply, "more therapy is better", as an app developer at the Moss Rehabilitation Research Institute stated in an interview. Like a fitness program, therapy is never truly “done”: people continue to benefit from doing exercises. The resulting lesson programming was therefore designed to inspire higher levels of practice, making the most of the brain’s post-traumatic developmental potential.
PROCESS: how might we Inspire positive mental health among patients in recovery?
The joy of music.
If you can recall the last time you sang, it probably made you feel good. You’re not alone: people consistently rank music as one of life’s supreme sources of pleasure and emotional power, according to The New Yorker. Finding a large number of research participants within the target population was a bit challenging, considering the timeframe.
However, as a part of researching for Theratune, I also conducted a brief survey via Amazon’s Mechanical Turk to understand sentiments about singing among the general population. When asked, "How does singing make you feel?", happy was the predominant feeling reported among survey respondents.
But this same survey revealed that people lack confidence when it comes to singing. 82% of respondents surveyed wished they could sing better, and all top preferred singing locations reported by free-form response were characterized by being alone (e.g. car, home, shower). Theratune was thus designed to boost confidence by teaching basic musical principles (pitch, tone, rhythm) and providing encouraging feedback.
Singing requires active focus on the breath. Long recognized among practitioners of eastern medicine, deep breathing is proven to decrease stress levels and promote relaxation. Exercises in the application were designed to ease users into singing and to encourage mindful breathing by prompting users to sing one note at a time.
After conducting interviews and a survey, I proceeded to create sketches, wireframes, as well as an InVision prototype – taking cues from the language learning app Duolingo as a particularly well-designed and research-based educational program. A quick round of follow-up usability testing generated insights that were easily accommodated. A few examples:
• "I can't see what that is. These buttons are tiny!" led to larger home screen icons
• "It would be nice if the feedback was tied to the actual content" led to repetition of each exercise’s answer
• "I don't know where to go next" led to clearer instructional button text
• "Can there be a countdown? I wasn't ready to sing" led to a countdown to prepare the user to engage
• "More icons, please" led to additional icons to lower cognitive load
A main realization from this project was how difficult it can be to recruit niche populations, such as brain injury patients. However, I also learned that the challenge of recruiting is worth it: interviews with those niche populations added more credibility when justifying design decisions.
I also learned about the importance of generating empathy as a researcher: during the project’s final presentation, I encouraged everyone in the audience to sing a note together. This effectively worked as firsthand proof of the ideas I was presenting – people have a reluctance to sing in public, yet once they do it, they feel better. Facilitating the experience of seeing via someone else’s perspective – particularly someone from an underrepresented population – was especially rewarding, and something I hope to continue throughout my career.