Naveen Bagalkot, Tomas Sokoler
Increasingly, researchers engage with design as a means of inquiry to understand and theorize about real-world situations in a nuanced and generative manner. Doing so involves negotiating a tension between two opposing objectives. On the one hand, design is inherently concerned with addressing the problem through shaping a unique and particular solution. On the other, theorizing is increasingly desired as an outcome of a design inquiry. Or, in other words, a design inquiry needs to formulate findings that are transferable across various situations and are generative of new designs. How do design researchers negotiate the dialectic between theorizing and designing in practice?
In this article, we discuss how, through formulating and exploring a design ideal in a design situation, we managed to negotiate the dialectic between theorizing and designing. We reflect on work where we engaged with designing as a way of inquiry to understand and theorize about the possible roles self-monitoring technologies could play in enhancing out-of-clinic physical rehabilitation. In this project we had two objectives. First, as design researchers, we wanted to formulate generative insights across the various specific situations of physical rehabilitation. Second, as designers, we were expected to at least point to possible technological devices as solutions to enhance the particular practices of physical rehabilitation we engaged with. We draw from our experiences of engaging with in-situ collaborative design in a very specific situation—physical rehabilitation—to highlight how the design ideal offered us a handle to manage the negotiation between the two objectives. Elsewhere  we have discussed the notion of design ideal as an intermediate construct between a theoretical concept and a particular design situation. However, in this article we position design ideal rather as an operative handle that enables a design researcher to navigate the theorizing-designing dialectics.
For us, the design ideal was a "frame" we as design researchers formulated in the meeting between our research question and the specific circumstances of a design situation. The design ideal was the articulation of our vision for a desirable outcome of the design activity, both toward answering the research question and toward pointing to unique solutions for the particular design situation. Through a process of in-situ collaborative sketching and making design artifacts we explored the possibilities of operationalizing the vision. Such an exploration was not a linear process; rather, it was in line with what Donald Schön terms as having a reflective conversation with the materials of the design situation . Reflecting on this experience gave us answers for our research question and pointed us toward unique solutions.
Physical rehabilitation happens across clinics and homes. In between visits to the clinic, rehabilitees—people undergoing rehabilitation—are prescribed physical therapy that involves performing physical exercises at home. However, rehabilitees face immense challenges in performing the prescribed exercises at home; lack of adherence is widespread . Pervasive and mobile technologies are increasingly being designed and developed to support rehabilitees engaging with the prescribed exercises when out of the clinic. In most cases, these technologies enable rehabilitees to self-monitor—record their exercises and collect data about their progress—as a key enabler for various strategies of motivation including social scaffolding and gamification, among others.
Informed by embodied interaction , we instead focused on embracing the ways in which the rehabilitees integrated the prescribed therapies with the objects, spaces, and routines of their everyday life. In particular, we focused on exploring the ways in which self-monitoring technologies could be designed to become an integral part of the everyday physical and social settings of rehabilitees' physical rehabilitation.
We explored the answers to the research question by engaging in the process of designing self-monitoring technology in very specific and particular situations of physical rehabilitation (published in ). Here, we extract our reflections on one such situation—ReSwing—highlighting how we managed to negotiate the theorizing-designing dialectics within the situation and how such negotiation led us to uncover partial answers to our research question and to outline possible unique solutions.
ReSwing was inspired by Gita, a 75-year-old woman undergoing therapy for knee replacement. Gita lived with her husband Kumar in a village and had to travel three hours by bus to meet her doctor in the city of Pune. She did most of her exercises without the help or supervision of her physiotherapist. She had been doing so for the past five years and believed she was successful, as she was mobile, performed her activities of daily living without any help, and managed the housework too. Post surgery, Gita was at the hospital for three weeks undergoing at-clinic rehabilitation. Once back home, she configured her exercises to suit her everyday life. She modified one of her exercises so she could perform it on the swing in her garden, rocking back and forth on the swing (Figure 1). A research assistant working in the field recorded a video of Gita performing the swing exercise before we engaged with her in the design exploration.
For Gita, it was not as important to know the time she spent on the swing as it was to share aspects of her rehabilitation life with visitors.
Design ideal at the beginning. A previous exploration had pointed to the possibility of designing self-monitoring technology as a resource that rehabilitees can engage with to turn their everyday physical activities into prescribed exercises. Named ReBrush, the concept scenario was inspired by Anna, a 65-year-old rehabilitee who used the activity of brushing her teeth as a resource to pace her hip-balance exercises.
The scenario of ReBrush is as follows (Figure 2):
Anne is a 65-year-old woman undergoing rehabilitation from hip replacement. Her therapists suggest she perform the standing-on-one-leg exercise at home. For this purpose, she gets the ReBrush and sets the timer for one minute. The next day while she is brushing her teeth, she stands on her left leg; after a minute, the handle of the brush turns green. Anne then shifts her position for another minute. After a course of two weeks, Anne has pushed herself to manage to stand on one leg for three minutes at a stretch, by pacing the timer gradually. ReBrush communicates this data to a database giving Anne and her therapist information about her progress.
Initially we thought that Gita's swing exercise, a good example of a rehabilitee integrating prescribed exercise with an everyday activity, could be a good situation to further explore the possibility illustrated by ReBrush toward designing self-monitoring technology for self-pacing. With such a formulation we began the ReSwing exploration.
However, during our first interview with Gita it became apparent that she paces her exercise in a way that is different from Anne's more quantified version. Gita listens to a 30-minute radio music program while on the swing, which gives her the sense of time. Meanwhile, during our interactions with Gita we encountered other more interesting aspects of her life as a rehabilitee. Gita's doctor considers her to be a successful rehabilitee, and asks some of his patients from places near Gita's village to visit her for advice on living with replaced knees. On another note, we found that Gita was the leader of a bhajan mandal, a group of musicians who perform devotional songs. She used to go around nearby towns and villages to perform, and has collected a fair amount of trophies congratulating her effort. These trophies are displayed centrally in her living room. Gita engaged with these trophies as "props" to recollect her life as a musician.
For Gita, it was not as important to know the time she spent on the swing as it was to share aspects of her rehabilitation life with visitors.
Reframing the design ideal. Encountering these aspects of Gita's life as a rehabilitee, we reframed the design ideal from ReBrush and outlined ReSwing. We speculatively envisioned a new scenario: What if Gita could engage with the recorded self-monitored data in ways similar to how she engages with the music trophies to tell stories about her rehabilitation process to prospective rehabilitees visiting her for advice?
As we immersed ourselves in the design situation of Gita, our theoretical concern about exploring support for self-pacing became a concern about exploring two possibilities for self-monitoring technologies that would support the recollection and sharing of rehabilitation experiences.
Operationalizing the vision. We formed an early version of the vision in the form of a hardware sketch. It consists of two components: a mat with an accelerometer connected to an Arduino and Zigbee module, and a trophy with three LED lights connected to another Arduino and Zigbee module (Figure 3). The trophy is designed to fit the aesthetics of the other trophies she has in her home, with the text congratulating her and her husband for being successful in her rehabilitation program.
When Gita keeps the mat on the swing and does her exercise sitting on it, the LEDs light up. The mat communicates the accelerometer readings to the LEDs in the trophy via Zigbee. When the mat is rolled up and stored after using, the LEDs then fade gradually over time (24 hours) until Gita uses the mat again. The trophy lights up and fades based on how much the mat was used, showing Gita the frequency of her exercise. Gita can display the trophy in her living room, along with her other trophies, and may engage with it as a "prop" in her recollection and retelling of her rehabilitation story to new and would-be patients sent to her by her doctor.
Exploring the sketch. We left the sketch with Gita for two weeks, asking her to engage with it whenever she exercises using the swing. During the follow-up interview we encountered a new aspect concerning the role played by a rehabilitee's life partner in self-monitoring the exercises. Gita and her husband demonstrated how they engaged with the sketch. Gita was on the swing in the garden, pushing her knees back and forth. Meanwhile, Kumar was in the living room looking to see if the LEDs on the trophy were flickering fast enough, and kept asking Gita to either reduce or increase the speed on the swing. However, we had not designed the sketch with this purpose at all! The flickering of the LEDs was rather a result of amateur coding. This surprising discovery led us to consider how closely Kumar was involved in the rehabilitation of his wife. Kumar also recounted the details about his active role in her rehabilitation, telling stories about him staying in the hospital in Pune during Gita's surgery, encouraging Gita to keep exercising every day, and modifying her exercises to suit their home environment.
Toward a new design ideal. Informed by uncovering the role played by partners in rehabilitation, in a subsequent exploration (ReExercise ) we explored how to design self-monitoring technology that embraces the partner's role and that could become an integral part of the social context of a person's rehabilitation.
We began the ReSwing project concerned with exploring the role of self-monitoring technology to support self-pacing. After our first encounter with the design situation, this concern turned into a concern with exploring if and how a self-monitoring technology could support recollection and sharing the rehabilitation experience. This vision was captured by the design ideal and operationalized by the sketch. Experiencing the sketch in the situation led to a new insight about the role of the partner in rehabilitation and the possibility of self-monitoring technology to support or enhance it. Through a back and forth, reflective process we constructed a space of possible roles that self-monitoring technology could play in enhancing out-of-clinic rehabilitation. In other words, through designing—formulating and exploring the design ideal—we could theorize successfully.
At the same time, the situation also brought forward a concrete manifestation of the vision in the form of the ReSwing sketch. Though it is not near a prototype that can be tested and deployed, it does, however, indicate an outline for a device that can enhance rehabilitation practice.
Our underlying process of formulating and exploring the design ideal in a concrete design situation was not different from a traditional designer's process. As Jonas Lowgren and Erik Stolterman  discuss, a designer closely works with a design vision, an operative image, and a specification. However, the difference with our process was that our aim was not so much to produce a well-crafted solution for a design problem, but rather to theorize through design. As outlined here, our experience indicates that formulating the vision, or what we call the design ideal, and exploring it in a designerly manner with the particularities of a design situation, offers design researchers a handle to negotiate the theorizing-designing poles successfully.
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5. Bagalkot, N.L., Sokoler, T., and Shaikh, R. Integrating physiotherapy with everyday life: Exploring the space of possibilities through ReHandles. Proc. of the Sixth International Conference on Tangible, Embedded and Embodied Interaction. ACM, New York, 2012, 91–98.
Naveen Bagalkot is a researcher with Srishti Labs at the Srishti Institute of Art, Design, & Technology, Bangalore, India. His research focuses on employing design as a way of inquiry into the intersection between out-of-clinic healthcare and digital technology, particularly in resource-constrained settings. email@example.com
Tomas Sokoler is associate professor with the People and Computational Things section at the IT University of Copenhagen, Denmark. He has a comprehensive project portfolio demonstrating explorative design and construction-oriented research in the broader intersection of interaction design and ubiquitous computing. firstname.lastname@example.org
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