A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

Demers, Marika; Winstein, Carolee J.

doi:10.1080/10749357.2020.1856557

Cited by 17 publications

(9 citation statements)

References 77 publications

(106 reference statements)

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“…Knowledge of spontaneous bimanual arm/hand use in the daily environment may provide a foundation for neurorehabilitation clinicians to 1) assess the transfer of skills gained in therapy to real-life situations, 2) guide personalized interventions and 3) evaluate progress. 46,55 Participants' perception of the usefulness of wearable sensors to encourage movement behavior supports the potential of wearable technology, not just as an assessment tool, but as a mean to deliver real-time interventions outside the clinical setting. Future work should aim to develop theoretically driven and evidence-based interventions that leverage wearable technology to promote recovery-enabling behaviors.…”

Section: Discussionmentioning

confidence: 99%

Wearable technology to capture arm use of stroke survivors in home and community settings: feasibility and early insights on motor performance

Demers

Bishop

Cain

et al. 2023

Preprint

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Objective: To establish short-term feasibility and usability of wrist-worn wearable sensors to capture arm/hand activity of stroke survivors and to explore factors related to use of the paretic arm/hand. Methods: 30 chronic stroke survivors were monitored with wrist-worn wearable sensors during 12h/day for a 7-day period. Participants also completed standardized assessments to capture stroke severity, arm motor impairments, self-perceived arm use and self-efficacy. Usability of the wearable sensors was assessed using the adapted System Usability Scale and an exit interview. Associations between motor performance and capacity (arm/hand impairments and activity limitations) were assessed using Spearman's correlations. Results: Minimal technical issues or lack of adherence to the wearing schedule occurred, with 87.6% of days procuring valid data from both sensors. Average sensors wear time was 12.6 (standard deviation: 0.2) h/day. Three participants experienced discomfort with one of the wristbands and three other participants had unrelated adverse events. There were positive self-reported usability scores (mean: 85.4/100) and high user satisfaction. Significant correlations were observed for measures of motor capacity and self-efficacy with paretic arm use in the home and the community (Spearman's correlation rhos: 0.44-0.71). Conclusions: This work demonstrates the feasibility of using low-cost wearable sensor technology to capture paretic arm activity outside the laboratory. It also provides insight into factors related to everyday arm use, such as motor capacity and self-efficacy. Impact: The integration of wearable technologies into clinical practice offers new possibilities to complement in-person clinical assessments and better understand how each person is moving outside of therapy and throughout the recovery and reintegration phase. Insights gained from monitoring stroke survivors in the home and community will inform future efforts to effect durable gains in paretic arm/hand use in the lived environment.

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Section: Discussionmentioning

confidence: 99%

Wearable technology to capture arm use of stroke survivors in home and community settings: feasibility and early insights on motor performance

Demers

Bishop

Cain

et al. 2023

Preprint

Self Cite

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“…We found that the simple act of probing about arm use produced a small but significant increase (~10 min) in paretic arm use over 5 days ( Figure 2E ). In the same study, an analysis of EMA responses along with the quantitative accelerometer data revealed that social context (i.e., not alone) and self-efficacy for paretic arm/hand use complement an individual's motor capability (i.e., FM score) and play essential roles in paretic arm/hand use behavior in the natural environment ( 45 , 48 ). Previous work from one of us showed that including social interaction in stroke VR-based motor rehabilitation enhances performance ( 49 ).…”

Section: Toward a Paradigm Shift: Embedding Rehabilitation In Activit...mentioning

confidence: 92%

“…However, a difficulty is to monitor (via the sensors) and promote (via EMA) daily tasks that are at the “just right challenge” to maximize plastic processes involved in motor recovery. One solution is to use EMA + sensors ( 27 ) in conjunction with EMI (ecological momentary intervention) to design the optimal intervention strategy ( 48 ). As clearly shown by an early monkey study ( 50 ), not all repetitions yield plastic changes in the motor system: only the precision grasps, which had to be learned, and not the power grasps, were associated with motor cortical map plasticity.…”

Section: Toward a Paradigm Shift: Embedding Rehabilitation In Activit...mentioning

confidence: 99%

Virtuous and Vicious Cycles of Arm Use and Function Post-stroke

2022

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Large doses of movement practice have been shown to restore upper extremities' motor function in a significant subset of individuals post-stroke. However, such large doses are both difficult to implement in the clinic and highly inefficient. In addition, an important reduction in upper extremity function and use is commonly seen following rehabilitation-induced gains, resulting in “rehabilitation in vain”. For those with mild to moderate sensorimotor impairment, the limited spontaneous use of the more affected limb during activities of daily living has been previously proposed to cause a decline of motor function, initiating a vicious cycle of recovery, in which non-use and poor performance reinforce each other. Here, we review computational, experimental, and clinical studies that support the view that if arm use is raised above an effective threshold, one enters a virtuous cycle in which arm use and function can reinforce each other via self-practice in the wild. If not, one enters a vicious cycle of declining arm use and function. In turn, and in line with best practice therapy recommendations, this virtuous/vicious cycle model advocates for a paradigm shift in neurorehabilitation whereby rehabilitation be embedded in activities of daily living such that self-practice with the aid of wearable technology that reminds and motivates can enhance paretic limb use of those who possess adequate residual sensorimotor capacity. Altogether, this model points to a user-centered approach to recovery post-stroke that is tailored to the participant's level of arm use and designed to motivate and engage in self-practice through progressive success in accomplishing meaningful activities in the wild.

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“…79 Similarly, Ecological Momentary Assessment combined with ecological momentary intervention may provide contextually relevant interventions delivered at the point of performing the walking activity in the real world to support persons with stroke to better translate walking capacity to walking performance. 25…”

Section: Promising Research Directions Targeting Walking Performancementioning

confidence: 99%

Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice

Moore

Boyne

Fulk

et al. 2022

Stroke

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Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.

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A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

Cited by 17 publications

References 77 publications

Wearable technology to capture arm use of stroke survivors in home and community settings: feasibility and early insights on motor performance

Wearable technology to capture arm use of stroke survivors in home and community settings: feasibility and early insights on motor performance

Virtuous and Vicious Cycles of Arm Use and Function Post-stroke

Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice

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