Posts Tagged Wearable sensors

[Abstract] Gait Performance in People with Symptomatic, Chronic Mild Traumatic Brain Injury


There is a dearth of knowledge about how symptom severity affects gait in the chronic (>3 months) mild traumatic brain injury (mTBI) population despite up to 53% of people reporting persisting symptoms after mTBI. The aim of this investigation was to determine whether gait is affected in a symptomatic, chronic mTBI group and to assess the relationship between gait performance and symptom severity on the Neurobehavioral Symptom Inventory (NSI). Gait was assessed under single- and dual-task conditions using five inertial sensors in 57 control subjects and 65 persons with chronic mTBI (1.0 year from mTBI). The single- and dual-task gait domains of Pace, Rhythm, Variability, and Turning were calculated from individual gait characteristics. Dual-task cost (DTC) was calculated for each domain. The mTBI group walked (domain z-score mean difference, single-task = 0.70; dual-task = 0.71) and turned (z-score mean difference, single-task = 0.69; dual-task = 0.70) slower (p < 0.001) under both gait conditions, with less rhythm under dual-task gait (z-score difference = 0.21; p = 0.001). DTC was not different between groups. Higher NSI somatic subscore was related to higher single- and dual-task gait variability as well as slower dual-task pace and turning (p < 0.01). Persons with chronic mTBI and persistent symptoms exhibited altered gait, particularly under dual-task, and worse gait performance related to greater symptom severity. Future gait research in chronic mTBI should assess the possible underlying physiological mechanisms for persistent symptoms and gait deficits.


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[Abstract] An Omnidirectional Assistive Platform Integrated With Functional Electrical Stimulation for Gait Rehabilitation: A Case Study


This paper presents a novel omnidirectional platform for gait rehabilitation of people with hemiparesis after stroke. The mobile platform, henceforth the “walker”, allows unobstructed pelvic motion during walking, helps the user maintain balance and prevents falls. The system aids mobility actively by combining three types of therapeutic intervention: forward propulsion of the pelvis, controlled body weight support, and functional electrical stimulation (FES) for compensation of deficits in angular motion of the joints. FES is controlled using gait data extracted from a set of inertial measurement units (IMUs) worn by the user. The resulting closed-loop FES system synchronizes stimulation with the gait cycle phases and automatically adapts to the variations in muscle activation caused by changes in residual muscle activity and spasticity. A pilot study was conducted to determine the potential outcomes of the different interventions. One chronic stroke survivor underwent five sessions of gait training, each one involving a total of 30 minutes using the walker and FES system. The patient initially exhibited severe anomalies in joint angle trajectories on both the paretic and the non-paretic side. With training, the patient showed progressive increase in cadence and self-selected gait speed, along with consistent decrease in double-support time. FES helped correct the paretic foot angle during swing phase, and likely was a factor in observed improvements in temporal gait symmetry. Although the experiments showed favorable changes in the paretic trajectories, they also highlighted the need for intervention on the non-paretic side.

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[ARTICLE] Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review – Full Text PDF

Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.

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via Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review – Sensors – X-MOL


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[Abstract] A novel motion detecting strategy for rehabilitation in smart home


Recent years have witnessed the flourish in research and development efforts towards clinical rehabilitation systems in smart home applications. One of the most prior is that such systems are needed to provide real-time motion information about patients. In this paper, a motion detecting approach is proposed for efficiently understanding the human movement on the foundation of the Internet of Things (IoT) based architecture. Specifically, the detection algorithm is based on the fuzzy neural network (FNN), which learns to detect the variation among different gait phases. The moving phases as well as the instability of the tester are identified for recognition. On the tasks of identifying the subject motion using wearable sensing devices, this model achieves a significant high accuracy. Experimental results prove that the system is feasible for application designs and could be implemented on technological platforms.

via A novel motion detecting strategy for rehabilitation in smart home – ScienceDirect

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[ARTICLE] Wearable technology in stroke rehabilitation: towards improved diagnosis and treatment of upper-limb motor impairment – Full Text


Stroke is one of the main causes of long-term disability worldwide, placing a large burden on individuals and society. Rehabilitation after stroke consists of an iterative process involving assessments and specialized training, aspects often constrained by limited resources of healthcare centers. Wearable technology has the potential to objectively assess and monitor patients inside and outside clinical environments, enabling a more detailed evaluation of the impairment and allowing the individualization of rehabilitation therapies. The present review aims to provide an overview of wearable sensors used in stroke rehabilitation research, with a particular focus on the upper extremity. We summarize results obtained by current research using a variety of wearable sensors and use them to critically discuss challenges and opportunities in the ongoing effort towards reliable and accessible tools for stroke rehabilitation. Finally, suggestions concerning data acquisition and processing to guide future studies performed by clinicians and engineers alike are provided.


Stroke is one of the leading causes of disability worldwide [], with a global prevalence estimated at 42.4 million in 2015 []. Stroke results in permanent motor disabilities in 80% of cases []. During the acute and subacute stages (< 6 months after stroke []), patients receive rehabilitation therapies at specialized healthcare centers, consisting of an iterative process involving impairment assessments, goal definition, intervention, and progress evaluation []. After being discharged from the rehabilitation center (i.e. after entering the chronic stage, e.g., 6 months after stroke), 65% of patients are unable to integrate affected limbs into everyday-life activities [], showing a need for further treatment. Phrased differently, the rehabilitative process after stroke depends on the effective assessment of motor deficit and congruent allocation to treatment (diagnostics), accurate appraisal of treatment effects (recovery/adaptation evaluation), and prolonged treatment for continuous recovery during the chronic stage (extended training).

Each of these three aspects present practical challenges. Assigned treatments depend on the assessed early-stage disability []. A variety of assessment scales exist to evaluate motor impairment after stroke, designed to capture aspects such as joint range of motion (ROM), synergistic execution of movements, reaching and grasping capabilities, object manipulation, etc. []. These assessments are normally applied by specialized medical personnel, which entails certain variability between assessments []. Besides consistency in repeated measurements, some scales like the Fugl-Meyer assessment (FMA) [], are unable to capture the entire spectrum of motor function in patients due to limited sensitivity or ceiling effects [].

In addition to thorough standardized assessment scales, progress in patients is observable during the execution of activities of daily living (e.g., during occupational therapy sessions). Nevertheless, task completion not always reflects recovery, as patients often adopt different synergistic patterns to compensate for lost function [], and such behavior is not always evident.

Main provision of rehabilitation therapies occurs at hospitals and rehabilitation centers. Evidence of enhanced recovery related to more extensive training has been found [], but limited resources at these facilities often obstruct extended care during the chronic stage. This calls for new therapeutic options allowing patients to train intensively and extensively after leaving the treatment center, while ensuring the treatment’s quality, effectiveness and safety.

Wearable sensors used during regular assessments can reduce evaluation times and provide objective, quantifiable data on the patients’ capabilities, complementing the expert yet subjective judgement of healthcare specialists. These recordings are more objective and replicable than regular observations. They have the potential of reducing diagnostic errors affecting the choice for therapies and their eventual readjustment. Additional information (e.g., muscle activity) extracted during the execution of multiple tasks can be used to better characterize motor function in patients, allowing for finer stratification into more specific groups, which can then lead to better targeted care (i.e. personalized therapies). These devices also make it possible to acquire data unobtrusively and continuously, which enables the study of motor function while patients perform daily-life activities. Further, the prospect of remotely acquiring data shows promise in the implementation of independent rehabilitative training outside clinics, allowing patients to work more extensively towards recovery.

The objective of this review is to provide an overview of wearable sensors used in stroke rehabilitation research, with a particular focus on the upper extremity, aiming to present a roadmap for translating these technologies from “bench to bedside”. We selected articles based on their reports about tests conducted with actual stroke patients, with the exception of conductive elastomer sensors, on which extensive research exists without tests in patients. In the section “Wearable devices used in stroke patients”, we summarize results obtained by current research using a variety of wearable sensors and use them to critically discuss challenges and opportunities in the ongoing effort towards reliable and accessible tools for stroke rehabilitation. In the “Discussion” section, we present suggestions concerning data acquisition and processing, as well as opportunities arising in this field, to guide future studies performed by clinicians and engineers alike.

Wearable devices used in stroke patients

Recent availability of ever more compact, robust and power-efficient wearable devices has presented research and development groups in academia and industry with the means of studying and monitoring activities performed by users on a daily basis.

Over the past years, multiple research groups have worked towards a reliable, objective and unobtrusive way of studying human movement. From the array of sensors and devices created, a few have gained popularity in time due to their practicality. The next subsections will focus on the wearable devices most frequently used in the study of human motion, with special emphasis on monitoring of upper limbs in stroke patients.

Inertial measurement units (IMUs)

Inertial measurement units (IMUs) are devices combining the acceleration readings from accelerometers and the angular turning rate detection of gyroscopes []. Recent versions of such devices are equipped with a magnetometer as well, adding an estimation of the orientation of the device with respect to the Earth’s magnetic field []. A general description of how inertial data are used to extract useful information from these devices is offered by Yang and Hsu []. High-end IMUs used for human motion tracking, such as the “MTw Awinda” sensor (Xsens®, Enscheda, Overijssel, The Netherlands) [], acquire data at sampling rates as high as 1 kHz (sensitivities of ±2000 deg/s, ±160 m/s2, ±1.9 G). More affordable sensors (e.g. “MMR” (mbientlab Inc.®, San Francisco, California, USA) []) stream data at 100 Hz (max sensitivities of ±2000 deg/s, ±16 g, 13 G). The necessary sampling rate depends on the application, and must be defined such that aliasing is avoided (i.e. Nyquist rate, 2 times the frequency of the studied phenomenon). Figure 1 shows an example of motion tracking using these devices.


Multiple scales exist for assessing motor function in stroke patients []. However, limitations exist in terms of objectivity and test responsiveness to subtle changes [], as well as on the amount of time needed to apply these tests. Therefore, several research groups have focused on the use of IMUs to assess motor function more objectively. Hester et al. [] were able to predict hand and arm stages of the Chedoke-McMaster clinical score, while Yu et al. [] built Brunnstrom stage [] classifiers, assigning each patient to one of six classes of synergistic movements in affected limbs. The Wolf Motor test [], the FMA [] and the Action Research Arm Test (ARAT) [], frequently used to assess motor function in clinical settings, have also been automated.[…]


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[Abstract + References] Design and Development of a Robotic Platform Based on Virtual Reality Scenarios and Wearable Sensors for Upper Limb Rehabilitation and Visuomotor Coordination – Conference paper


The work reintegration following shoulder biomechanical overload illness is a multidimensional process, especially for those tasks requiring strength, movement control and arm dexterity. Currently different robotic devices used for upper limb rehabilitation are available on the market, but these devices are not based on activities focused on the work reintegration. Furthermore, the rehabilitation programmes aimed to the work reintegration are insufficiently focused on the recovery of the necessary skills for the re-employment.

In this study the details of the design of an innovative robotic platform integrated with wearable sensors and virtual reality scenarios for upper limbs motor rehabilitation and visuomotor coordination is presented. The design of control strategy will also be introduced. The robotic platform is based on a robotic arm characterized by seven degrees of freedom and by an adaptive control, wearable sensorized insoles, virtual reality (VR) scenarios and the Leap Motion device to track the hand gestures during the rehabilitation training. Future works will address the application of deep learning techniques for the analysis of the acquired big amount of data in order to automatically adapt both the difficulty level of the VR serious games and amount of motor assistance provided by the robot.


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[ARTICLE] Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke – Full Text



Gait is usually assessed by clinical tests, which may have poor accuracy and be biased, or instrumented systems, which potentially solve these limitations at the cost of being time-consuming and expensive. The different versions of the Microsoft Kinect have enabled human motion tracking without using wearable sensors at a low-cost and with acceptable reliability. This study aims: First, to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging; Second, to determine its concurrent validity with standardized clinical tests in individuals with stroke; Third, to quantify its inter and intra-rater reliability, standard error of measurement, minimal detectable change; And, finally, to investigate its ability to identify fall risk after stroke.


The most widely used spatiotemporal and kinematic gait parameters of 82 individuals post-stroke and 355 healthy subjects were estimated with the Kinect v2-based system. In addition, participants with stroke were assessed with the Dynamic Gait Index, the 1-min Walking Test, and the 10-m Walking Test.


The system successfully characterized the performance of both groups. Significant concurrent validity with correlations of variable strength was detected between all clinical tests and gait measures. Excellent inter and intra-rater reliability was evidenced for almost all measures. Minimal detectable change was variable, with poorer results for kinematic parameters. Almost all gait parameters proved to identify fall risk.


Results suggest that although its limited sensitivity to kinematic parameters, the Kinect v2-based gait analysis could be used as a low-cost alternative to laboratory-grade systems to complement gait assessment in clinical settings.


The physiological basis of cerebrovascular accidents make gait deficits a common sequelae after stroke [1]. More than 60% of stroke survivors are unable to walk independently after the injury [2] and, even after rehabilitation, more than half of the cases still present gait-related deficits [3]. Most prevailing deficits after stroke include reduced speed [4] and increased gait inter-limb asymmetry [5]. These gait impairments can be aggravated in the elderly, due to the natural musculoskeletal and cognitive decline with age [67], where the incidence of stroke is higher [8]. Importance of these deficits relies on their great impact on independence [9], quality of life [10], and fall risk [11]. Consequently, their adequate assessment is necessary for a proper diagnosis and to plan, if required, customized interventions to each individual’s condition and evaluate the effectiveness of these interventions.

Assessment of gait is commonly performed in the clinical setting using standardized scales and tests that evaluate different aspects of human locomotion and, in some cases, compare the results of the person being tested with those obtained by a matched healthy sample [12]. Although these tools are easy to administer and, in general, not time-consuming, they can present lack of specificity and, more importantly, may have poor accuracy and be biased by subjective evaluations [13]. Over the years, different technological solutions have been proposed to overcome these limitations. Accurate estimation of spatiotemporal parameters has been enabled by instrumented walkways [14] and force plates [15], generally, from ground reaction forces during walking. Estimation of kinematic parameters, however, require the position of several joints to be tracked during the test, which has been indirectly facilitated by different technological solutions that estimate the position of some sensors that are attached to specific body parts [16,17,18]. Among them, optical motion tracking has become the most common alternative for accurate investigation of kinematic gait parameters [19]. Although instrumented systems allow for accurate spatiotemporal and kinematic analysis, their high cost and large size have restricted their use to research laboratories and large clinical centers with high economic resources [20].

In the last years, the Microsoft Kinect (Microsoft, Redmond, WA), a portable off-the-shelf infrared camera originally intended for entertainment, has enabled human motion tracking without using wearable sensors at a very low-cost. Reliability studies have shown comparable performance of the Kinect to laboratory-grade gait analysis systems, for both the first [2122] and the second version of the device [23], known as the Kinect v2, which features improved depth accuracy and number of joints tracked [24]. Characteristics of the Kinect v2 have motivated their use for assessing spatiotemporal [25,26,27] and kinematic parameters of gait [2628] with promising results in healthy individuals, even on treadmills [2829]. Its reliability in stroke population, however, remains almost unexplored. Little evidence suggests that data retrieved from the Kinect v2 can be used to differentiate healthy subjects from individuals with stroke [30] and to complement clinical assessment [31]. Despite of the existing data supporting the reliability of the Kinect v2 to assess spatiotemporal and kinematic gait parameters, the unavailability of the software, the limited investigation in individuals with stroke, and the unknown psychometric properties of Kinect-based tests in this population could compromise the clinical relevance of these results.

The objective of this study was fourfold. First, to compare a cohort of individuals with stroke with respect to a group of healthy controls to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging. Second, to determine the concurrent validity of the system with standardized clinical tests in individuals with stroke. Third, to quantify its reliability as defined by the inter and intra-rater reliability, the standard error of measurement, and the minimal detectable change. And, finally, to investigate the ability of the system to identify risk of falls after stroke.



Continue —>  Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

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[Abstract] Wearable Movement Sensors for Rehabilitation: A Focused Review of Technological and Clinical Advances – PM&R


Recent technologic advancements have enabled the creation of portable, low-cost, and unobtrusive sensors with tremendous potential to alter the clinical practice of rehabilitation. The application of wearable sensors to track movement has emerged as a promising paradigm to enhance the care provided to patients with neurologic or musculoskeletal conditions. These sensors enable quantification of motor behavior across disparate patient populations and emerging research shows their potential for identifying motor biomarkers, differentiating between restitution and compensation motor recovery mechanisms, remote monitoring, telerehabilitation, and robotics. Moreover, the big data recorded across these applications serve as a pathway to personalized and precision medicine. This article presents state-of-the-art and next-generation wearable movement sensors, ranging from inertial measurement units to soft sensors. An overview of clinical applications is presented across a wide spectrum of conditions that have potential to benefit from wearable sensors, including stroke, movement disorders, knee osteoarthritis, and running injuries. Complementary applications enabled by next-generation sensors that will enable point-of-care monitoring of neural activity and muscle dynamics during movement also are discussed.


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[BLOG POST] Advantages of incorporating tele-rehabilitation into healthcare

The technology applied to the field of rehabilitation provides multiple benefits for both the health system and the patient.  Next, we explain why tele-rehabilitation will help optimize healthcare resources and improve patients’ quality of life.

A better picture: lack of specialists and long waiting lists in rehabilitation

“The Spanish health system is not prepared to respond to the advance of medical rehabilitation and the epidemic of disability due to ageing,” concluded the Spanish Society for Rehabilitation and Physical Medicine (Sermef) in its latest edition held from 30 May to 1 June in Gijón (Asturias).

This shortage throughout the country requires incorporating tele-rehabilitation into the Spanish health system.  However, Manuel Rodríguez-Piñero, from Sermef’s board of directors, stated, “the Rehabilitation services suffer from technological obsolescence, which, if not taken care of, will become obsolete and out of the 21st century”. Such as this news from ABC in Seville underlines, the director added: “The integration of robotics or virtual reality systems into rehabilitation assistance, to give two examples, are common to all European rehabilitation centers and is, unfortunately, the story of our hospitals”.

Sermef calls for unified action to improve the detection and treatment of disability situations and to promote a reorganization of rehabilitation for rational care, as well as an adequate definition of portfolios of services and procedures that allow efficient management. 

Recently, La Sexta Noticias also announced that the lack of physiotherapists, the number of chronically ill, and the current model of care contribute to the congestion of the centers and, consequently, a delay of more than two months for rehabilitation in public health care. Professionals stress the importance of receiving physical therapy on time, and more so after an operation. Failure to do so can have lifelong consequences.

How to solve it: distance rehabilitation therapies

Remote rehabilitation or tele-rehabilitation consists, in the first place, of diagnosing possible musculoskeletal pathologies through wearable sensors that record movements in real time and in a very precise way. The medical report is then shared with the physical therapist to determine the type of exercises the patient should follow. Through the internet connection, the patient can access a space, where he can easily find the exercises so he can do them whenever and wherever he wants, and he can consult with the doctor whenever the need.

DyCare wanted to bet on ReHub, a new solution based on an online platform that allows connecting the patient, the physiotherapist and the doctor. It facilitates the execution of the rehabilitation treatment from home, and it is always monitored by the rehabilitation professional.

Silvia Raga, CEO of the company, comments: “Our goal is to offer products of value to the patient. We want to show objective data to offer more personalized treatments for the patient, and, at the same time, contribute to savings in the health system”. With this in mind, DyCare does not lose focus on transforming the future of rehabilitation by developing the first digital solution for distance physical rehabilitation therapies.

Eight advantages of tele-rehabilitation

  1. Storage of and access to the patient’s medical records from any location
  2. A personalized program of the rehabilitation exercises, specifically adapted to the patient’s physical condition
  3. Real-time control and monitoring of the patient by the expert
  4. Remote adaptation of the exercises
  5. Continuous interaction between doctor, physiotherapist and patient
  6. Patient empowerment and adherence to treatment thanks to the biofeedback they receive in real time during the execution of the exercises
  7. Comfort when performing the exercises as they can be done where and when the patient wants
  8. Savings in travel costs and waiting time

If you have any questions or if you would like to receive more information from DyCare ReHub, please do not hesitate to contact us, we will be happy to contact you.


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[ARTICLE] Enabling Stroke Rehabilitation in Home and Community Settings: A Wearable Sensor-Based Approach for Upper-Limb Motor Training – Full Text

A conceptual representation of the wrist-worn sensor system for home-based upper-limb rehabilitation. The system consists of two wearable sensors, a tablet computer to be… View more


High-dosage motor practice can significantly contribute to achieving functional recovery after a stroke. Performing rehabilitation exercises at home and using, or attempting to use, the stroke-affected upper limb during Activities of Daily Living (ADL) are effective ways to achieve high-dosage motor practice in stroke survivors. This paper presents a novel technological approach that enables 1) detecting goal-directed upper limb movements during the performance of ADL, so that timely feedback can be provided to encourage the use of the affected limb, and 2) assessing the quality of motor performance during in-home rehabilitation exercises so that appropriate feedback can be generated to promote high-quality exercise. The results herein presented show that it is possible to detect 1) goal-directed movements during the performance of ADL with a c -statistic of 87.0% and 2) poorly performed movements in selected rehabilitation exercises with an F -score of 84.3%, thus enabling the generation of appropriate feedback. In a survey to gather preliminary data concerning the clinical adequacy of the proposed approach, 91.7% of occupational therapists demonstrated willingness to use it in their practice, and 88.2% of stroke survivors indicated that they would use it if recommended by their therapist.


Stroke is a leading cause of severe long-term disability. In the US alone, nearly 800,000 people suffer a stroke each year [1]. The number of individuals who suffer a stroke each year is expected to rise in the coming years because the prevalence of stroke increases with age and the world population is aging [2]. Approximately 85% of individuals who have a stroke survive, but they often experience significant motor impairments. Upper-limb paresis is the most common impairment following a stroke. It affects 75% of stroke survivors and leads to limitations in the performance of Activities of Daily Living (ADL) [4].

Inability to use the stroke-affected upper limb for ADL often leads to a phenomenon that is referred to as learned non-use [5]. As patients rely more and more on the unaffected (or less impaired) upper limb [5] they progressively lose motor abilities of the stroke-affected upper limb that they may have recovered as a result of a rehabilitation intervention [6].

A high dosage of motor practice using the stroke-affected upper limb during the performance of ADL, despite considerable difficulty, stimulates neuroplasticity and motor function recovery [7]–[8][9]. Thus, it is clinically important to encourage stroke survivors to continue making appropriate use of the affected upper limb [10]–[11][12][13], in addition to engaging in rehabilitation exercises that focus on range-of-motion and functional abilities [14]–[15][16].

The use of wearable sensors has recently emerged as an efficient way to monitor the amount of upper-limb use after a stroke [17]–[18][19][20][21][22]. However, despite growing evidence of the clinical potential of these devices [23], their widespread clinical deployment has been hindered by technical limitations. A shortcoming of currently available wrist-worn devices is that they cannot distinguish between Goal-Directed (GD) movements (i.e., movements performed for a specific purposeful task) and non-Goal-Directed (non-GD) movements (e.g., the arm swinging during gait). Instead, these sensors focus on recording the number and/or intensity of any type of arm movements [10]. Consequently, non-GD movements are reflected as part of the measurements with equal importance as GD movements. This results in an overestimation of the amount of actual arm use [24]. Furthermore, monitoring the aggregate number of stroke-affected upper limb movements is not sufficient for the purpose of providing timely feedback to encourage the use of the affected limb during the performance of ADL. To promote the use of the stroke-affected limb, it is critical that feedback reflects the relative use of the affected upper limb compared to the contralateral one.

Wrist-worn movement sensors have also been applied to monitoring rehabilitation exercises in the home setting [25]–[26][27][28]. However, existing systems primarily focus on quantifying the dosage/intensity of the exercises (e.g., the duration of the exercises and the number of movement repetitions) and do not monitor if the quality of the performed exercise is appropriate. Ensuring good quality of movement during the performance of rehabilitation exercises is critical for maximizing functional recovery after a stroke [29]. Moreover, providing customized feedback regarding the quality of exercise movements can increase motivation, promote long-term adherence to a prescribed exercise regimen, and ultimately maximize clinical outcomes [30]. One of the reasons for limited exercise participation by stroke survivors is the lack of access to resources to support exercise including performance feedback from rehabilitation specialists [31]. There are no technical solutions that provide feedback regarding the quality of exercise performance for upper-limb rehabilitation after stroke.

We propose a system for aiding in functional recovery after a stroke that consists of two wearable sensors, one worn on the stroke-affected upper limb and the other on the contralateral upper limb [32] (Fig. 1). The proposed system can be used to provide timely feedback when ADL are performed. If the system detects that the patient consistently performs GD movements with the unaffected upper limb, and rarely uses the stroke-affected upper limb, then a visual or vibrotactile reminder can be triggered to encourage the patient to attempt GD movements with the stroke-affected limb. A benefit of this approach is that if a movement is critical (e.g., signing a check), patients can use the unaffected upper limb without receiving negative feedback as long as they have performed a sufficient number of movements with the affected upper limb throughout the day. Furthermore, the system promotes high-dosage motor practice with appropriate feedback to extend components of rehabilitation interventions into the home environment.[…]

via Enabling Stroke Rehabilitation in Home and Community Settings: A Wearable Sensor-Based Approach for Upper-Limb Motor Training – IEEE Journals & Magazine

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