Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study

Abstract

Background As many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a “Planned Nudge” to the odds of affected limb movement during the observation period following “No Nudge.” Results The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07). Conclusions Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true

Clinicians’ perceptions of a potential wearable device for capturing upper limb activity post-stroke: a qualitative focus group study

“…Importantly, these identified potential uses aligned with the common goal of maximizing functional use of the affected upper limb for individuals with some motor return identified by therapists. Moreover, the identified potential uses of self-monitoring and motivating greater use of the affected arm also align with a growing interest among rehabilitation researchers in the use of wearable devices to promote greater upper limb use [17] and some preliminary evidence to suggest that feedback from wearable devices may increase upper limb movement practice [18,19]. If the evidence accumulates regarding wearable devices potential for increasing functional use of the upper limb then findings from these focus groups suggest that therapists' interest in wearable devices that provide quantitative information on arm use and therapists' stated priority of maximizing functional use may help facilitate future knowledge translation efforts.…”

Changes in Upper Limb Capacity and Performance in the Early and Late Subacute Phase After Stroke

“…14 This "translation gap" might be attenuated with the help of prompts delivered by apps and/or bracelets which stimulate the integration of the affected UL. [32][33][34] As one would expect, capacity played a decisive role in using the affected UL and ARAT scores explained most of the use ratio at both 3 (69%) and 6 months (64%). The addition of a range of secondary factors to the regression 3.1 (1.9, 4.0) 3.5 (1.9, 4.4) -0.01 (-0.48, 0.85), P=0.21 Total UL activity, hours, median (IQR) 5.8 (4.9, 7.3) 6.1 (5.1, 7.2) -0.08 (-0.43, 0.79), P=0.78 Use ratio, median (IQR) 0.8 (0.6, 0.9) 0.8 (0.6, 0.9) 0.00 (-0.06, 0.08), P=0.85 Bilateral magnitude, median (IQR) 88.9 (71.7, 106.0) 95.0 (73.1, 113.9) 1.60 (-6.02, 10.41), P=0.096 Magnitude ratio, median (IQR) -1.0 (-3.1, -0.3) -0.9 (-3.0, -0.3) -0.08 (-0.51, 0.46), P=0.56…”

Development and evaluation of an efficient training program to facilitate the adoption of a novel neurorehabilitation device

“… 11 Yet, there are other barriers to implementation of many low-cost, low-profile rehabilitation devices. 6 , 12 – 16 …”

“…11 Yet, there are other barriers to implementation of many low-cost, low-profile rehabilitation devices. 6,[12][13][14][15][16] One such barrier is therapists' access to training. 17,18 Trainings are traditionally in person with non-reimbursable hours, leaving therapists the burden of attending trainings during their free time and using their own money to cover registration and travel costs.…”