Application of wearable technology in upper limb stroke rehabilitation in the home setting

Abstract

Stroke is a leading cause of disability, significantly affecting surivivors’ quality of life. Research indicates that over 20 hours of task specific training per month is essential for optimal UL recovery post-stroke. Self-directed UL rehabilitation at home provides a viable option for intensive practice especially given the constrained health services. Wearable technology, which provides augmented feedback and enables remote monitoring, holds promise for home-based UL rehabilitation. However, its effectiveness in rehabilitating the hemiparetic UL in home settings remains unclear. This thesis introduces a new telerehabilitation approach using the “Smart Reminder” (SR) wearable device, an evolution of the “Remind to move” device specifically designed for home-based training for stroke individuals, with two additional features. The SR device includes a gyroscope to track the range of motion of the hemiparetic arm and integrates with a smartphone application. The thesis aims to generate knowledge and evidence on the effects of telerehabilitation using the SR device for home-based self-directed UL training in stroke survivors. Five studies were conducted to achieve the thesis's aims. Two literature reviews (Studies 1 and 2) laided the theoretical groundwork. Study 1 (Chapter 2) is a systematic review and meta-analysis that found home-based UL interventions more effective than clinic-based therapies and identified critical factors for implementing technology-based interventions at home. Study 2 (Chapter 3) is a scoping review that identified three key considerations for designing wearable devices: using a smartphone as a visual display, implementing a fading feedback schedule, and ensuring an interactive interface. Building on these reviews, three empirical studies (Studies 3, 4, and 5) were conducted. Study 3 (Chapter 4), a mixed-methods usability study, evaluated user perspectives and factors influencing the use of the SR device. The study confirmed the device's usability [system usability scale: 84.3 (12.3)] and demonstrated a high therapy adherence rate (91%) among local stroke survivors. Qualitative results from Study 3 identified four primary considerations for wearable-based intervention: wearability, user interface, system performance, and exercise content, which were applied in Study 5. Two clinical trials (Studies 4 and 5) investigated the clinical effects of SR in improving the hemiplegic UL outcomes of the stroke survivors. Study 4 (Chapter 5 in the thesis), a feasibility pilot randomized crossover trial (n=12), suggested that a 4-week telerehabilitation program using the SR improved the hemiplegic UL function and demonstrated its feasibility for home use. Study 5 (Chapter 6 in the thesis), a randomized controlled trial (n=40), compared the telerehabilitation training using the SR device with conventional training using a sham device. The SR group showed significant improvements in Fugl Meyer Assessment-Upper Extremity (FMA-UE) scores (p=0.036) and higher adherence rates (97% vs. 82.3%, p=0.038). Subgroup analysis revealed that participants with severe paresis experienced a notable improvement with SR intervention, in the FMA-UE scores (mean difference: 3.38, p=0.008) compared to the sham group. In summary, this thesis advances the understanding of the wearable technology in stroke rehabilitation and confirmed the efficacy of the telerehabilitation using SR wearable in improving the motor outcomes of the hemiplegic UL in persons with stroke.