Posts Tagged home
[ARTICLE] Development of a Novel Home Based Multiscene Upper Limb Rehabilitation Training and Evaluation System for Post-stroke Patients – Full Text PDF
Upper limb rehabilitation requires long-term, repetitive rehabilitation training and assessment, and many patients cannot pay for expensive medical fees in the hospital for so long time. It is necessary to design an effective, low cost, and reasonable home rehabilitation and evaluation system. In this paper, we developed a novel home based multi-scene upper limb rehabilitation training and evaluation system (HomeRehabMaster) for post-stroke patients. Based on the Kinect sensor and posture sensor, multi-sensors fusion method was used to track the motion of the patients. Multiple virtual scenes were designed to encourage rehabilitation training of upper limbs and trunk. A rehabilitation evaluation method integrating Fugl-meyer assessment (FMA) scale and upper limb reachable workspace relative surface area (RSA) was
proposed, and a FMA-RSA assessment model was established to assess upper limb motor function.
Correlation based dynamic time warping (CBDTW) was used to solve the problem of inconsistent upper limb movement path in different patients. Two clinical trials were conducted. The experimental results show that the system is very friendly to the subjects, the rehabilitation assessment results by this system are highly correlated with the therapist’s (the highest forecast accuracy was 92.7% in the 13th item), and longterm rehabilitation training can improve the upper limb motor function of the patients statistically significant (p=0.02<0.05). The system has the potential to become an effective home rehabilitation training and evaluation system.[…]
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U of A researcher developing personalized program that brings the appeal of electronic gaming to physical therapy for older adults.
By BEV BETKOWSKI
A high-tech University of Alberta research project is letting seniors hit a computerized gym especially designed for their needs.
VirtualGym, an electronic game that combines the entertainment of gaming with prescribed exercises, is being put through its paces in a Calgary seniors’ residence to test its user-friendliness and appeal.
Once perfected, it will deliver at-home therapeutic exercises for seniors with chronic health issues, mobility problems or dementia, at the click of a button.
“It’s a concept of bringing rehabilitation home,” said PhD candidate Noelannah Neubauer, who helped design the program. “We already have telehealth being used by doctors, why not rehabilitation too?”
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The joint research project is teaming computing scientist Eleni Stroulia and other researchers from the faculties of science and rehabilitation medicine, with support from AGE-WELL, Canada’s Technology and Aging Network.
Designed to work through Kinect, a motion sensor system originally designed for Xbox video game consoles, VirtualGym works by giving users personalized feedback as they exercise along with an onscreen avatar using a “Simon Says” theme.
“It’s designed so the exercises are completely customizable from a personal trainer or physical therapist and their progress can be monitored,” Neubauer said. By recording users’ movements through VirtualGym, therapists can remotely watch for progressions and adjust exercises accordingly.
Stroulia and her team thought their original version of VirtualGym, developed in 2015, would be a good fit for seniors, but it was a flop with their test group, who found the game too busy.
“They didn’t like it at all,” said Victor Fernandez-Cervantes, a post-doctoral researcher in computing science, who took it back to the drawing board.
Using feedback from Edmonton senior Stuart Embleton and other volunteers from the Cardiac Athletic Society of Edmonton who tried the system, Fernandez-Cervantes made VirtualGym more user-friendly.
“We wanted to design it from their point of view.”
He dialled down the noise with a less distracting and cartoonish version of the game. The screen scenery evolved from its original version—an instructional avatar exercising on snowy ground in front of a brick building—to a soothing blank-walled room with a potted plant at either side. The avatar’s build was also adjusted to reflect a more typical body shape for older adults. As well, he programmed its movements with simple but specific instructions on how to do an exercise properly, complete with correctional tools like arrows and colours that pop up if needed.
Fernandez-Cervantes is continuing to tweak VirtualGym to create a 3-D version. Right now the exercises are only partially viewable, which is a problem for seniors, Embleton believes. “If the program wants you to lift your leg and kick your foot up, you should be able to see that action from a suitable perspective,” he explained.
Other planned improvements include adding simple games to measure cognitive awareness for users. “Over time, perhaps changes in scores could reflect varying levels of cognitive impairment,” Neubauer said.
The eventual plan is to market VirtualGym widely through a spinoff company, Stroulia said.
Embleton, 77, believes seniors would use VirtualGym if it were available to them.
“Most seniors nowadays have computers and TV sets, and that, plus an optical input, is all you need to use the system. It’s going to be more and more useful as it’s further developed. It’s called a game, but it’s really a useful therapeutic process. If I had a broken hip or was frail or couldn’t drive, and needed some physical therapy, I could use a virtual gym at home,” he said.
That’s especially valuable for rural or shut-in seniors who can’t go to real-life gym classes or make regular visits to physiotherapy clinics, said Neubauer.
“We want seniors to be able to exercise more, and this provides another option for them.”
Their work on VirtualGym also offers insight and a set of guidelines for other game designers wanting to develop exercise technology for seniors, said Fernandez-Cervantes.
“When designing products, seniors need to be involved. Soon enough, everyone will be a senior.”
[ARTICLE] Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial – Full Text
Introduction Effective interventions to promote upper-limb recovery poststroke are characterised by intensive and repetitive movements. However, the repetitive nature of practice may adversely impact on adherence. Therefore, the development of rehabilitation devices that can be used safely and easily at home, and are motivating, enjoyable and affordable is essential to the health and well-being of stroke survivors.
The Neurofenix platform is a non-immersive virtual reality device for poststroke upper-limb rehabilitation. The platform uses a hand controller (a NeuroBall) or arm bands (NeuroBands) that facilitate upper-limb exercise via games displayed on a tablet. The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial aims to determine the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper-limb poststroke.
Methods and analysis Thirty people poststroke will be provided with a Neurofenix platform, consisting of a NeuroBall or NeuroBands (dependent on impairment level), seven specially designed games, a tablet and handbook to independently exercise their upper limb for 7 weeks. Training commences with a home visit from a research therapist to teach the participant how to safely use the device. Outcomes assessed at baseline and 8 weeks and 12 weeks are gross level of disability, pain, objectively measured arm function and impairment, self-reported arm function, passive range of movement, spasticity, fatigue, participation, quality of life (QOL) and health service use. A parallel process evaluation will assess feasibility, acceptability and safety of the intervention through assessment of fidelity to the intervention measured objectively through the Neurofenix platform, a postintervention questionnaire and semistructured interviews exploring participants’ experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on QOL and resource use.
Strengths and limitations of this study
The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial will investigate the feasibility, acceptability and safety of a novel gaming platform (the Neurofenix platform) at home for upper-limb exercise after stroke.
Upper-limb activity data will be objectively measured by the device. Assessment outcome measures include objective (assessed blind to timepoint) and self-reported measures.
To be maximally inclusive, stroke survivors with moderate to severe arm impairment will be included in the study.
The feasibility of conducting an economic evaluation will be determined by collected data on quality of life and resource use.
This is a home-based intervention study; thus, participants and researchers collecting the data will not be blinded.
Stroke is the leading cause of severe disability worldwide with approximately 17 million new strokes each year.1 2 The UK has 1.2 million stroke survivors with 110 000 first-time strokes occurring each year resulting in an estimated societal cost of £26 billion per year.1 2 Following stroke, 85% of people initially experience upper-limb weakness, and of those with minimal movement on hospital admission, only 11%–14% regain full function of their arm.2–4 This loss in upper-limb function results in increased dependence and decreased quality of life (QOL).5 Reduced upper-limb function has been identified as a strong predictor of lowered psychological well-being poststroke.5 6 Innovation and investigation of effective treatments for arm recovery has been identified as a priority for stroke research.7
Evidence indicates the most effective interventions to improve upper-limb function are characterised by high intensity and repetitive practice.8 A higher intensity and frequency of upper-limb stroke rehabilitation is associated with improved QOL,9 motor function and ability to perform activities of daily life10 and is cost-effective.11 The UK quality standard for stroke advises 45 min of each relevant therapy for a minimum of 5 days a week.11 However, a 2015 UK national stroke audit showed on average most hospitals are unable to meet this quality standard.12 Specifically, time spent retraining the upper limb is very low, with an average of 32 repetitions per rehabilitation session.13 14 As such, there is a growing emphasis on the stroke survivor exercising independently without the presence of a therapist. However, adherence to home exercise is known to be poor.15 16 A perceived lack of support and feedback along with boredom with exercises are the most frequently cited factors associated with poor compliance.17 18
Virtual reality (VR)-based activities have been suggested as an intervention to improve upper-limb recovery by providing motivating environments or gameplay to facilitate rehabilitation.19 This digital health solution helps address boredom and compliance problems, can facilitate increased time in therapy and may not be reliant on therapist contact time.19 20 In addition, the ability of VR activities to provide feedback may enhance motor learning.21 22 Visual feedback via an on-screen character (avatar) can activate mirror neurones, which may aid recovery from stroke.23 24
VR can be considered in terms of the level of immersion provided, that is, the degree the user feels present in the virtual world due to the technical aspects of the VR environment. Immersive systems can generate life-scaled, three-dimensional images, with surround sound auditory and sensory feedback such as vibration, and pressure,25 whereas non-immersive systems involve two-dimensional images typically viewed on a screen with interaction being via controller-based systems (such as computer keyboards, joysticks, balance boards and handheld devices) or via camera-based tracking systems.26 Non-immersive systems are more commonly used for rehabilitation as they have smaller space requirements, cost less and have fewer side effects (eg, motion sickness).27
The Neurofenix platform is a non-immersive device designed to enable and encourage stroke survivors to independently exercise their upper limb with minimal therapist input. The platform was developed by Neurofenix, a bioengineering enterprise (www.neurofenix.com), along with stroke survivors and neurological physiotherapists. The platform consists of a hand controller or armbands, seven specially designed games, a tablet and an instruction handbook.[…]
[Abstract + References] Evaluation of an Upper-Limb Rehabilitation Robotic Device for Home Use from Patient Perspective
This paper presents a user study to evaluate the system’s performance by measuring objective indicators and subjective perception between the two versions of a planar rehabilitation robotic device: (i) PupArm system, called RoboTherapist 2D system for commercial purpose, designed and developed for clinical settings; and (ii) Homerehab system, developed for home use. Homerehab system is a home rehabilitation robotic platform developed inside the EU HOMEREHAB-Echord++ project framework. Nine patients with different neurological disorders participate in the study. Based on the analysis of subjective assessments of usability and the data acquired objectively by the robotic devices, we can conclude that the performance and user experience with both systems are very similar. This finding will be the base of more extensively studies to demonstrate that home-therapy with HomeRehab could be as efficient as therapy in clinical settings assisted by PupArm robot.
This work has been supported by the European Commission through the project HOMEREHAB: “Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – Echord++” (Grant agreement: 601116); by the AURORA project (DPI2015-70415-C2-2-R), which is funded by the Spanish Ministry of Economy and Competitiveness and by the European Union through the European Regional Development Fund (ERDF), “A way to build Europe” and by Conselleria d’Educació, Cultura i Esport of Generalitat Valenciana through the grant APOTIP/2017/001.
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Langhorne, P., Coupar, F., Pollock, A.: Motor recovery after stroke: a systematic review. Lancet Neurol. 8(8), 741–754 (2009)
Richards, L., Hanson, C., Wellborn, M., Sethi, A.: Driving motor recovery after stroke. Top. Stroke Rehabil. 15(5), 397–411 (2008)
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Badesa, F.J., Llinares, A., Morales, R., Garcia-Aracil, N., Sabater, J.M., Perez-Vidal, C.: Pneumatic planar rehabilitation robot for post-stroke patients. Biomed. Eng. Appl. Basis Commun. 26(2), 1450025 (2014)
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LLinares, A., Badesa, F.J., Morales, R., Garcia-Aracil, N., Sabater, J., Fernandez, E.: Robotic assessment of the influence of age on upper-limb sensorimotor function. Clin. Interv. Aging 8, 879 (2013). https://doi.org/10.2147/CIA.S45900
[ARTICLE] Automatic Control of Wrist Rehabilitation Therapy (WRist-T) device for Post-Ischemic Stroke Patient – Full Text PDF
Full Text: PDF
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There’s no place like home for engaging in the levels of physical activity (PA) that can aid in recovery poststroke—at least compared with the current hospital setting—according to a small study from Australia.
For the study, researchers used accelerometers and self-reports to track the PA and sitting time of 32 participants (mean age of 68, 53% male) who had experienced a stroke, comparing data gathered during their last week in the hospital with data gathered during their first week home. Participants were also assessed in a number of areas during their final week in the hospital, including physical function, functional independence, pain, anxiety, and depression.
The researchers were interested in finding out if an individual’s environment plays a role in PA poststroke—something they describe as “pivotal” to recovery—and whether other factors, such as depression, have an effect on any changes in PA levels. Results were e-published ahead of print in theArchives of Physical Medicine and Rehabilitation (abstract only available for free).
They found that environment does seem to make a difference—and a fairly big one at that. While the amount of time spent awake didn’t change much from hospital to home (13.1 hours a day in the hospital vs 13.5 hours per day at home), the amount of PA achieved—and time spent in sedentary behaviors—varied significantly. Participants sat for an average of 45 fewer minutes a day at home than they did in their last week in the hospital, were upright for 45 more minutes a day, spent 12 more minutes a day walking, and completed an average of 724 additional daily steps.
The results were similar when adjusted for demographic variables and didn’t seem to be significantly affected by any of the secondary factors assessed in the hospital, save one—depression, which when present was associated with no gains in PA at home.
The researchers don’t pin the improvement to any single factor but speculate that “the home environment may provide greater opportunity for activities of daily living such as cooking, cleaning, social and community activities, and there may be fewer external restrictions such as hospital routines and safety concerns around mobilization.”
Authors of the study also believe the gap between home and hospital PA poststroke could be closed if hospitals were to take more cues from the home environment.
“Physically, cognitively, and socially enriched stroke rehabilitation environments appear to increase activity by 20%,” they write. “Wards [that] include communal areas to promote more time spent upright, and the need to transport patients further for personal care may create opportunities for activity. The low activity levels in [the] hospital and at home found in our study, and in prior reports…indicate that there is clearly more work to be done in promoting activity after stroke.”
[ARTICLE] A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial – Full Text
Stroke patients usually suffer primary cognitive impairment related to attention, memory, and executive functions. This impairment causes a negative impact on the quality of life of patients and their families, and may be long term. Cognitive rehabilitation has been shown to be an effective way to treat cognitive impairment and should be continued after hospital discharge. Computerized cognitive rehabilitation can be performed at home using exercise programs that advance with predetermined course content, interval, and pace. We hypothesize that computerized rehabilitation might be improved if a program could customize course content and pace in response to patient-specific progress. The present pilot study is a randomized controlled double-blind crossover clinical trial aiming to study if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform (“Guttmann, NeuroPersonalTrainer”®, GNPT®).
Individuals with chronic-stage stroke will be recruited. Participants will be randomized to receive experimental intervention (customized tele-rehabilitation platform, GNPT®) or sham intervention (ictus.online), both with the same frequency and duration (five sessions per week over 6 weeks). After a washout period of 3 months, crossover will occur and participants from the GNPT® condition will receive sham intervention, while participants originally from the sham intervention will receive GNPT®. Patients will be assessed before and after receiving each treatment regimen with an exhaustive neuropsychological battery. Primary outcomes will include rating measures that assess attention difficulties, memory failures, and executive dysfunction for daily activities, as well as performance-based measures of attention, memory, and executive functions.
Customized cognitive training could lead to better cognitive function in patients with chronic-stage stroke and improve their quality of life.
Stroke, the most common cerebrovascular disease, is a focal neurological disorder of abrupt development due to a pathological process in blood vessels . There are three main types of stroke, namely transient ischemic attack, characterized by a loss of blood flow in the brain and which reverts in less than 24 h without associated acute infarction ; ischemic stroke, characterized by a lack of blood reaching part of the brain due to the obstruction of blood vessels and causing tissue damage (infarction), wherein cells die in the immediate area and those surrounding the infarction area are at risk; and a hemorrhagic stroke, where either a brain aneurysm bursts or a weakened blood vessel leaks, resulting in blood spillage into or around the brain, creating swelling and pressure, and damaging cells and tissue in the brain .
In 2013, according to the World Health Organization (WHO) and the Global Burden of Disease study, worldwide, there were 11–15 million people affected by stroke and almost 1.5 million deaths from this cerebrovascular disease [4, 5]. Moreover, in 2013, the total Disability-Adjusted Life Years (years of healthy life lost while living with a poor health condition) from all strokes was 51,429,440. In Spain, in 2011, the National Institute of Statistics reported 116,017 cases of stroke, corresponding to an incidence of 252 episodes per 100,000 inhabitants . Although stroke incidence increases with advancing age, adults aged 20–64 years comprise 31% of the total global incidence.
Stroke often results in cognitive dysfunction, and medical treatment may cause great expense on a personal, family, economic, and social level. Depending on the area of the brain affected and the severity of lesions, stroke patients may suffer cognitive impairment, and alteration in emotional and behavioral regulation . Generally, cognitive impairment derived from stroke includes alterations in attention, memory, and executive function .
Recent reports have begun to show positive results from the use of computerized cognitive rehabilitation systems (CCRS) for stroke patients to improve attention, memory, and executive functions. Nevertheless, more research is needed to better control variables and improve training designs in order to reduce heterogeneity and increase control of the intensity and level of performance during treatments [9, 10, 11, 12].
CCRS allow adjustment of the type of exercises administered to the specific cognitive impairment profile of each patient, but within a fixed set of possible exercises such that heterogeneity of therapy choice is minimized. This can improve studies by allowing better categorization of patient groups that execute similar training sessions in a similar range of responses . Further, CCRS offers the possibility of applying cognitive rehabilitation at home, while patient adherence and performance can be monitored online, so that patients do not need to live near, lodge near, or travel to a rehabilitation center to receive therapy. Because CCRS therapy is entirely digitized, it generates objective data that can be analyzed to determine the relative effectiveness of these interventions. We hypothesize that by allowing a trained professional to oversee an automated customization program that stratifies the level of difficulty, duration, and stimulus speed of presentation, we will reduce the heterogeneity of traditional cognitive training and improve the efficacy of intervention in chronic stroke patients.
The first objective of this pilot study is to assess if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform (“Guttmann, NeuroPersonalTrainer”®, GNPT ® )  intended to increase the control of experimental variables (cognitive impairment profile, adherence, and performance) traditionally identified as a source of experimental heterogeneity. The study aims to assess if this benefit could translate into an improvement of the trained cognitive domains (attention, memory, and executive functions).
The second objective is focused on generalization, namely the ability to use what has been learned in rehabilitation contexts and apply it in different environments . Transfer of learning is included within the concept of generalization when specifically referring to the ability to apply specific strategies to related tasks . Two types of transfer have been proposed – near transfer and far transfer . By near transfer we mean that, through the training of a task within a given cognitive domain, improved function in other similar, untrained tasks may be observed in the same cognitive domain. For instance, a patient who performs selective attention exercises and improves execution through the training might improve their performance in other selective attention exercises too. By far transfer we mean that training in a given cognitive domain may improve performance of tasks in other cognitive domains. Such improvement will be observable in tasks that are structurally dissimilar from the ones used in the training. For instance, if a patient performs selective attention exercises, they may also improve their performance in memory tasks.
It has been demonstrated that computerized cognitive training can lead to the phenomenon of transfer, as previously studied in stroke patients . Thus, our research aims to note whether the application of patient-customized tele-rehabilitation can give rise to an improvement in other functions that are based on cognitive domains related to those that have been trained (near transfer) as well as in different ones (far transfer).
Finally, the third objective is to assess the variables of demography (age, sex, years of education) and etiology (ischemic stroke or hemorrhage) and their impact on rehabilitation outcome, given the need to understand the patient characteristics that may influence treatment effectiveness .[…]
[Abstract] Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned
Objective: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy.
Materials and Methods: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists’ weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators.
Results: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology’s use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed.
Conclusion: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.
The functional connectivity and structural proximity of elements of the language and motor systems result in frequent co-morbidity post brain injury. Although rehabilitation services are becoming increasingly multidisciplinary and “integrated”, treatment for language and motor functions often occurs in isolation. Thus, behavioural therapies which promote neural reorganisation do not reflect the high intersystem connectivity of the neurologically intact brain. As such, there is a pressing need for rehabilitation tools which better reflect and target the impaired cognitive networks.
The objective of this research is to develop a combined high dosage therapy tool for language and motor rehabilitation. The rehabilitation therapy tool developed, MaLT (Motor and Language Therapy), comprises a suite of computer games targeting both language and motor therapy that use the Kinect sensor as an interaction device. The games developed are intended for use in the home environment over prolonged periods of time. In order to track patients’ engagement with the games and their rehabilitation progress, the game records patient performance data for the therapist to interrogate.
MaLT incorporates Kinect-based games, a database of objects and language parameters, and a reporting tool for therapists. Games have been developed that target four major language therapy tasks involving single word comprehension, initial phoneme identification, rhyme identification and a naming task. These tasks have 8 levels each increasing in difficulty. A database of 750 objects is used to programmatically generate appropriate questions for the game, providing both targeted therapy and unique gameplay every time. The design of the games has been informed by therapists and by discussions with a Public Patient Involvement (PPI) group.
Pilot MaLT trials have been conducted with three stroke survivors for the duration of 6 to 8 weeks. Patients’ performance is monitored through MaLT’s reporting facility presented as graphs plotted from patient game data. Performance indicators include reaction time, accuracy, number of incorrect responses and hand use. The resultant games have also been tested by the PPI with a positive response and further suggestions for future modifications made.
MaLT provides a tool that innovatively combines motor and language therapy for high dosage rehabilitation in the home. It has demonstrated that motion sensor technology can be successfully combined with a language therapy task to target both upper limb and linguistic impairment in patients following brain injury. The initial studies on stroke survivors have demonstrated that the combined therapy approach is viable and the outputs of this study will inform planned larger scale future trials.
[Abstract] Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home.
This research explores the impact of receiving feedback through a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation on the users’ self-efficacy; more specifically, mastery experiences and the interpretation of biomechanical data. Embedded within a realistic evaluation methodological approach, exploring the promotion of self-efficacy from the utilisation of computer-based technology to facilitate post-stroke upper-limb rehabilitation in the home included; semi-structured interviews, quantitative user data (activity and usage), observations and field notes. Data revealed that self-efficacy was linked with obtaining positive knowledge of results feedback. Encouragingly, this also transferred to functional activities such as, confidence to carry out kitchen tasks and bathroom personal activities. Findings suggest the PSMrS was able to provide key sources of self-efficacy by providing feedback which translated key biomechanical data to the users. Users could interpret and understand their performance, gain a sense of mastery and build their confidence which in some instances led to increased confidence to carry out functional activities. However, outcome expectations and socio-structural factors impacted on the self-efficacy associated with the use of the system. Increasing the understanding of how these factors promote or inhibit self-management and self-efficacy is therefore crucial to the successful adoption of technology solutions and promotion of self-efficacy.