Feasibility of Smartphone-Based Exercise Training Integrated with Functional Electrical Stimulation After Stroke (SETS): A Preliminary Study

Abstract

One emerging method in home stroke rehabilitation is digital technology. However, existing approaches typically target one domain (e.g., upper limb). Moreover, existing interventions do not cater to older adults with stroke (OAwS), especially those with high motor impairment, who require adjunct therapeutic agents to independently perform challenging exercises. We examined the feasibility of Smartphone-based Exercise Training after Stroke (SETS) with Functional Electrical Stimulation (FES). A total of 12 participants (67 ± 5 years) with stroke (onset > 6 months) exhibiting moderate-to-high motor impairment (Chedoke McMaster Leg ≤ 4/7) underwent 6 weeks of multicomponent (gait, functional strength, dynamic balance) training integrated with FES to paretic lower limb muscles. Primary measures included safety and adherence. Secondary measures included motivation, acceptability and attitude, usability, and clinical measures of gait and balance function like the 10-Meter Walk Test and Mini-BESTest. Participants reported no adverse events and moderate-to-high adherence (84.17 ± 11.24%) and improvement (up to 40%) in motivation, acceptability, and attitude and system usability. Participants also showed pre-post improvements in all measures of gait and balance function (p < 0.05). Integrating SETS and FES is feasible and yields short-term gains in gait and balance function among OAwS. Future studies could validate our findings by examining its efficacy with control groups to identify the differential effects of SETS and FES.

Keywords: balance; digital technology; home; older adults; rehabilitation; strength; stroke; walking.

Figure 1

Intervention protocol for SETS (Smartphone Exercise Training after Stroke) with three domains, including dynamic balance, functional strength, and gait. Each component included three levels of exercise progression, examples of which are provided under each domain.

Figure 2

Box and whisker plots with individual data points for outcomes of gait and balance function. Boxes represent the interquartile ranges (25–75%) of data variance, bold lines within boxes represent the mean, and whiskers represent the standard deviations for (a) Timed-Up and Go test (TUG), measured in seconds; (b) 30-Second Chair Stand Test (30CST), measured in repetitions; (c) 10-Meter Walk Test (10MWT), measured in meters per second; (d) Berg Balance Scale (BBS), scored out of 56; (e) Mini-Balance Evaluation System Test (Mini-BESTest), scored out of 28; and (f) Short Physical Performance Battery (SPPB), scored out of 12 assessed during pre- and post-testing sessions. * p < 0.05, ** p < 0.01, *** p < 0.0001.