title: Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke.
abstract: BACKGROUND
  Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic.
  
  
  METHODS
  A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance.
  
  
  RESULTS
  Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient's goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients' needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient's progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five phases therapists have to go through. The guidance includes criteria and conditions that motivate therapists, and make it possible for them, to actually use technology in their daily clinical practice.
  
  
  CONCLUSIONS
  The reported requirements are important as guidance for people involved in the development of rehabilitation technology for arm-hand therapy of stroke patients. The stepwise guide provides a tool for facilitating successful implementation of technology in clinical practice, thus meeting future therapy demand.
authors.affiliation: Adelante Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC, Hoensbroek, The Netherlands. A.Hochstenbach@adelante-zorggroep.nl
authors.forename: Ananda
authors.initials: A
authors.lastname: Hochstenbach-Waelen
authors.forename: Henk A M
authors.initials: HA
authors.lastname: Seelen
mesh_terms: D001132:Arm / Q000502:physiology; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation; D004059:Diffusion of Innovation; D005081:Exercise Therapy; D006225:Hand / Q000502:physiology; D006801:Humans; D009048:Motor Skills / Q000502:physiology; D010806:Physical Education and Training / Q000379:methods; D020127:Recovery of Function; D012046:Rehabilitation / Q000295:instrumentation*; D012984:Software; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000502:physiology*