The Feasibility and User Experience of a Program of Progressive Cued Activity to Promote Functional Upper Limb Activity in the Inpatient Rehabilitation Setting with Follow-Up at Home

Abstract

Although upper limb impairment is one of the most common deficits post-stroke and contributes substantially to diminished functional independence, many survivors receive low dosages of upper limb task training in the inpatient setting. This study evaluates the feasibility and user experience of a progressive-challenge cued activity program, delivered via wearable technology, to promote upper limb activity in an inpatient rehabilitation facility (IRF) post-stroke. Participants (N = 30) wore our wearable system Souvenir, which provided vibrotactile cues to prompt activity in the more-involved arm during idle time. Compliance with the program was high (94% in the IRF), and the system successfully prompted increased activity, as evidenced by significantly higher post-cue response rates compared to pre-cue activity rates (mean difference = 35.1%, t(28) = 9.398, p < 0.001). User experience was positive, with participants reporting high usability, satisfaction, and motivation. Follow-up data collected in unstructured home settings (n = 23) demonstrated continued high compliance (96%) and favorable user experience. These findings suggest that Souvenir and its cued activity program can effectively convert idle time into therapeutic activity while minimizing caregiver burden. Future research should focus on enhancing user engagement and evaluating the clinical efficacy of this approach in improving functional outcomes post-stroke.

Keywords: inpatient rehabilitation; mobile health; motivation; patient-centered therapy; satisfaction; stroke; usability; user experience; wearable devices.

Figure 1.

The study recruitment process illustrated, beginning with initial screening of potential participants and followed by eligibility assessment. Of the 77 eligible participants, 58 were approached, and 42 consented to participate in the study. A total of 30 participants completed the inpatient phase of the study.

Figure 2.

Souvenir comprises: two MetamotionR+ wearable activity monitors housed in silicone bands and worn on each wrist, an inexpensive Android smartphone with Bluetooth 5.0 capability, and a custom smartphone app that manages activity scheduling and data storage.

Figure 3.

Progressive challenge exercise program ranging from easiest (tapping; top) to more challenging (independent; bottom): (1) tap—the user simply draws their attention to the MI side by tapping their MI arm with their LI hand, (2) assist—the user guides their MI elbow through its full flexion and extension range of motion using their LI hand for support, or (3) independent—the user performs independent active elbow flexion and extension on their MI side without assistance from the LI arm and hand [27]. Labels a through c indicate the temporal order of actions for each exercise.

Figure 4.

(A) Paired average response rates across days for each participant. Pre-cue includes the 5 s of activity prior to cue delivery, and post-cue includes the 5 s following cue delivery. Black dots and lines indicate the overall mean and SEM. (B) Average response rates across all days within all participants for cues 1 through 180. See Supplementary Materials for supporting data tables (S4).

Figure 5.

Survey responses provided after system use; dashed lines indicate thresholds for passable scores. Mean scores and SEM are represented by colored horizontal and vertical bars, respectively. (A) Intrinsic Motivation Inventory (IMI) completed in the IRF. All scores met passable criteria on average, with value/importance rated highest on average. (B) System Usability Scale (SUS) completed in IRF and home setting is labeled going from left to right. Dashed lines in figures (A–C) indicate passable cut-off scores for the IMI, SUS, and QUEST surveys, respectively. Mean scores are represented by horizontal bars, and SEM is represented by vertical bars. See Supplementary Materials for supporting data tables (S4).

Figure 6.

Categories of the Quebec User Experience and Satisfaction with Assistive Technology (QUEST) users identified as most important for promoting a positive user experience. Ease of use, comfort, and effectiveness were identified most frequently out of the categories in both the IRF and home settings. See Supplementary Materials for supporting data tables (S4).