Idle-Time Exercise: Promoting More-Involved arm use in the Inpatient Rehabilitation Setting After Stroke

Research Objectives: Investigate potential benefits of idle-time exercise using “Souvenir”, a wearable technology, that cues and monitors idle-time activity of the more involved upper extremity (UE) during inpatient rehabilitation (IPR).

Design: Feasibility study.

Setting: IPR.

Participants: First-time stroke survivors in the acute phase of recovery.

Interventions: Souvenir consists of wrist-worn sensors (accelerometers) and a smartphone app that schedules delivery of haptic cues intended to motivate idle time exercise of the more involved arm. We designed 3 progressive-challenge self-paced exercises: the easiest draws attention to the user’s more affected limb, an intermediate-level exercise requires the less involved hand to assist the more involved elbow through its range of motion. The most difficult requires subjects to move the involved elbow through its range of motion unassisted.

Main Outcome Measures: Efficacy was assessed in the IPR setting by evaluating 1) amount of affected arm use during exercise periods, 2) amount of affected arm use during rest of the day.

Results: 19 participants completed at least one day performing the easiest exercise, 18 progressed to the intermediate exercise, and 13 progressed to the most challenging exercise. As expected, average arm use ratios in the cued exercise windows increased with increasing challenge (low: 0.38±0.50; med: 0.54±0.54; high: 5.3±5.0). Average arm use ratios in the silent monitoring periods also increased as the challenge of cued exercise increased, suggesting that effects of cued exercise may carry over into activities of daily living (low: 0.46 ±0.46; med: 0.51±0.44; high: 0.67±0.47). This carry-over had a small-to-medium effect size across the three exercise levels (Cohen's d=0.28) as well as across the intermediate and most challenging exercises (d=0.37).

Conclusions: Souvenir successfully elicited increasing levels of more-involved arm activity during acute recovery; spontaneous activity of the more-involved arm increased on days when participants were cued to exercise that limb more intensely.

Author(s) Disclosures: None.