Background: Few existing interactive rehabilitation systems can effectively communicate multiple aspects of movement performance simultaneously, in a manner that appropriately adapts across various training scenarios. In order to address the need for such systems within stroke rehabilitation training, a unified approach for designing interactive systems for upper limb rehabilitation of stroke survivors has been developed and applied for the implementation of an Adaptive Mixed Reality Rehabilitation (AMRR) System.

Results: The AMRR system provides computational evaluation and multimedia feedback for the upper limb rehabilitation of stroke survivors. A participant's movements are tracked by motion capture technology and evaluated by computational means. The resulting data are used to generate interactive media-based feedback that communicates to the participant detailed, intuitive evaluations of his performance. This article describes how the AMRR system's interactive feedback is designed to address specific movement challenges faced by stroke survivors. Multimedia examples are provided to illustrate each feedback component. Supportive data are provided for three participants of varying impairment levels to demonstrate the system's ability to train both targeted and integrated aspects of movement.

Conclusions: The AMRR system supports training of multiple movement aspects together or in isolation, within adaptable sequences, through cohesive feedback that is based on formalized compositional design principles. From preliminary analysis of the data, we infer that the system's ability to train multiple foci together or in isolation in adaptable sequences, utilizing appropriately designed feedback, can lead to functional improvement. The evaluation and feedback frameworks established within the AMRR system will be applied to the development of a novel home-based system to provide an engaging yet low-cost extension of training for longer periods of time.

Background: Although principles based in motor learning, rehabilitation, and human-computer interfaces can guide the design of effective interactive systems for rehabilitation, a unified approach that connects these key principles into an integrated design, and can form a methodology that can be generalized to interactive stroke rehabilitation, is presently unavailable.

Results: This paper integrates phenomenological approaches to interaction and embodied knowledge with rehabilitation practices and theories to achieve the basis for a methodology that can support effective adaptive, interactive rehabilitation. Our resulting methodology provides guidelines for the development of an action representation, quantification of action, and the design of interactive feedback. As Part I of a two-part series, this paper presents key principles of the unified approach. Part II then describes the application of this approach within the implementation of the Adaptive Mixed Reality Rehabilitation (AMRR) system for stroke rehabilitation.

Conclusions: The accompanying principles for composing novel mixed reality environments for stroke rehabilitation can advance the design and implementation of effective mixed reality systems for the clinical setting, and ultimately be adapted for home-based application. They furthermore can be applied to other rehabilitation needs beyond stroke.

As the application of interactive media systems expands to address broader problems in health, education and creative practice, they fall within a higher dimensional space for which it is inherently more complex to design. In response to this need an emerging area of interactive system design, referred to as experiential media systems, applies hybrid knowledge synthesized across multiple disciplines to address challenges relevant to daily experience. Interactive neurorehabilitation (INR) aims to enhance functional movement therapy by integrating detailed motion capture with interactive feedback in a manner that facilitates engagement and sensorimotor learning for those who have suffered neurologic injury. While INR shows great promise to advance the current state of therapies, a cohesive media design methodology for INR is missing due to the present lack of substantial evidence within the field. Using an experiential media based approach to draw knowledge from external disciplines, this dissertation proposes a compositional framework for authoring visual media for INR systems across contexts and applications within upper extremity stroke rehabilitation. The compositional framework is applied across systems for supervised training, unsupervised training, and assisted reflection, which reflect the collective work of the Adaptive Mixed Reality Rehabilitation (AMRR) Team at Arizona State University, of which the author is a member. Formal structures and a methodology for applying them are described in detail for the visual media environments designed by the author. Data collected from studies conducted by the AMRR team to evaluate these systems in both supervised and unsupervised training contexts is also discussed in terms of the extent to which the application of the compositional framework is supported and which aspects require further investigation. The potential broader implications of the proposed compositional framework and methodology are the dissemination of interdisciplinary information to accelerate the informed development of INR applications and to demonstrate the potential benefit of generalizing integrative approaches, merging arts and science based knowledge, for other complex problems related to embodied learning.