HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Human-Computer Interaction

Background:

• Huntington disease (HD) is a progressive neurodegenerative disorder causing significant cognitive-executive and motor function decline, primarily linked to basal ganglia (BG) atrophy.
• Current treatments for HD lack specific interventions for executive and motor dysfunction.
• Music-based interventions show potential for enhancing executive abilities by utilizing external rhythmic cues to compensate for impaired BG-dependent timing and rhythm generation.

Purpose of the Study:

• To co-design and develop a tablet-based rhythmic drumming application (HD-DRUM) utilizing an integrated knowledge translation (IKT) framework.
• To ensure the HD-DRUM app is accessible for at-home use by individuals with HD.
• To enable quantification of performance improvements and adherence for future clinical evaluations.

Main Methods:

• An IKT framework guided the iterative design and development of the HD-DRUM app.
• Three phases of knowledge user engagement and co-design were employed: a web survey (n=29) for accessibility needs, usability testing of tablet touchscreens, and usability testing of the app's design (n=12) with HD patients and clinicians.
• The Template for Intervention Description and Replication (TIDieR) checklist was used to ensure comprehensive intervention description.

Main Results:

• Survey data revealed cognitive and motor impairments impact app accessibility, highlighting the need for intuitive interfaces.
• Tablet-based touchscreens were confirmed as a feasible and accessible delivery method for the app.
• Key design features implemented include large, distinct buttons, audio-visual cues, gamification, positive feedback, and drumming to music to enhance motivation and engagement.

Conclusions:

• An IKT-based co-design approach effectively refined the HD-DRUM app, targeting BG-reliant cognitive and motor functions in HD.
• The co-designed HD-DRUM app is suitable for home use, allowing performance and adherence tracking.
• Detailed intervention description using the TIDieR framework facilitated refinement and preparation for clinical evaluation and potential scale-up.