A Wearable Device Employing Biomedical Sensors for Advanced Therapeutics: Enhancing Stroke Rehabilitation

 These sensors DO NOTHING DIRECTLY to get survivors recovered! You need EXACT REHAB PROTOCOLS to apply based on the disability found. They don't exist, so fucking useless!

Does anyone in stroke have two functioning neurons to rub together for a spark of intelligence?

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHY you haven't created EXACT recovery protocols in the last decade with NO EXCUSES! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

A Wearable Device Employing Biomedical Sensors for Advanced Therapeutics: Enhancing Stroke Rehabilitation

                                 by

Gabriella Spinelli

^1,*,

Kimon Panayotou Ennes

¹,

Laura Chauvet

²,

Cherry Kilbride

²,

Marvellous Jesutoye

² and

Victor Harabari

³

¹

Brunel Design School, Brunel University of London, Uxbridge UB8 3PH, UK

²

Department of Health Science, Brunel University of London, Uxbridge UB8 3PH, UK

³

Reneural Technologies Limited, Leeds LS1 2HL, UK

^*

Author to whom correspondence should be addressed.

Electronics 2025, 14(6), 1171; https://doi.org/10.3390/electronics14061171

Submission received: 11 February 2025 / Revised: 13 March 2025 / Accepted: 13 March 2025 / Published: 17 March 2025

(This article belongs to the Special Issue Advances in AI, IoT and Smart Sensors for Digital Healthcare Applications)

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Abstract

Stroke is a leading cause of disability worldwide. The long-term effects of a stroke depend on the location and size of the affected brain area, resulting in diverse disabilities and experiences for survivors. More than 70% of people experiencing stroke suffer upper-limb dysfunction, which can significantly limit independence in daily life. The growing strain on national healthcare resources, coupled with the rising demand for personalised, home-based rehabilitation, along with increased familiarity with digital technologies, has set the stage for developing an advanced therapeutics system consisting of a wearable solution aimed at complementing current stroke rehabilitation to enhance recovery outcomes. Through a user-centred approach, supported by primary and secondary research, this study has developed an advanced prototype integrating electromyography smart sensors, functional electrical stimulation, and virtual reality technologies in a closed-loop system that is capable of supporting personalised recovery journeys. The outcome is a more engaging and accessible rehabilitation experience, designed and evaluated through the participation of stroke survivors. This paper presents the design of the therapeutic platform, feedback from stroke survivors, and considerations regarding the integration of the proposed technology across the stroke pathway, from early days in a hospital to later stage rehabilitation in the community.

Keywords:

stroke; rehabilitation; smart sensors; electromyography; functional electrical stimulation; user-centred design; digital health; med-tech; virtual reality

1. Introduction

Stroke is one of the leading causes of disability, and the second most common cause of death worldwide [1,2]. Depending on the size and location of the stroke, survivors can present with a variety of symptoms. The middle cerebral artery (MCA) is the most commonly affected vessel, which is the major vascular supply to the area of the brain responsible for the upper limbs [3]. According to the Stroke Association [4], 70% of stroke survivors present with lasting symptoms of functional difficulty within the upper limbs. This loss in motor and sensory control of the upper limbs can lead to potential alterations of muscle length and strength and the inability to engage in fine or dextrous hand movement, which is essential for bimanual tasks that affect function and therefore, quality of life [5].

Taub et al. [6] coined the term learned non-use to describe the phenomenon whereby people recovering from neurological insult, such as stroke, learn to compensate for the loss in function of the affected upper limb, and as such, no longer attempt to use it for everyday activities. After a sufficient period without using this limb, the muscles atrophy, and the efficiency of the motor areas of the brain corresponding to this limb will fade [7]. Conversely, the ability of the brain to re-adapt and re-adjust to form new connections in response to local injury and received neural input is known as neuroplasticity [8]. These changes are regulated by the “use it or lose it” principle [9]. In other words, high-repetition movements produce a high level of motor input and output to and from the brain. This elicits the formation of neural pathways in the specific brain areas, i.e., those responsible for upper-limb movements. However, these newly formed pathways require regular motor input; otherwise, they may fade [9]. Therefore, maintaining a rehabilitation plan that reflects this biological need for high repetition exercise is crucial for recovery in stroke survivors until the affected limb has been successfully re-incorporated into daily function/tasks [8,10].

In a systematic review by Serrada, McDonnell, and Hillier [11], it was found that only 21% of inpatient therapy time for people post-stroke was devoted to the upper limbs. More specifically, this equated to 24% of occupational therapy sessions and only 15% of physiotherapy sessions. Likewise, less than 20% of patients in the United Kingdom receive the recommended level of upper-limb rehabilitation [12,13], with the upper limb largely deprioritised in place of balance and walking practise [14]. Other factors limiting upper-limb rehabilitation include organisational drivers such as pressure for quicker discharge times, a shortage of quality research, and the limited resources of the healthcare system [15]. In stroke units, in the average upper-limb-focused rehabilitation session, the number of repetitions for each movement ranges from 23 to 86 [16]. However, animal studies have shown that neuroplastic changes are not seen within the motor cortex until approximately 400 or more repetitions are completed [17]. In the absence of a sufficient rehabilitation programme for the upper limbs, stroke survivors will not be able to meet the number of repetitions required to induce and maintain the neuroplastic changes that bring about recovery [8,10]. This highlights the need to develop and implement effective therapy adjuncts to support functional recovery of the upper limb post-stroke, thereby reducing dependency and improving quality of life post-stroke.

Functional electrical stimulation (FES) is one of the therapy adjuncts recommended to increase functional recovery of the upper limb after stroke [14,18]. Electromyogram-triggered functional electrical stimulation (EMG-FES) has been developed to enable motor activity to synchronise with motor intention [19]. The EMG responds to the nerve signal at the neuromuscular junction, even in patients with severe paresis [20]. EMG-FES triggers a motor response, but also creates a sensory stimulus to the corresponding region of the brain. This motor and sensory stimulation can impact neuroplasticity, thus impacting the formation and maintenance of the neural pathways necessary for targeted function [21].

Another therapy adjunct gaining traction within the field of stroke rehabilitation is virtual reality (VR) devices. With VR technology, users immerse themselves in fully interactive artificial worlds through goggles [22]. VR can deliver engaging and task-specific exercises in a supportive environment by providing multimodal (visual, auditory, and proprioceptive) feedback [23]. This gives clinicians the ability to prescribe a rehabilitation programme that is entertaining for the user and can replicate common therapy exercises, as well as mirroring everyday functional tasks. This makes it possible to personalise rehabilitation sessions by practising a task that is relevant to each person’s goals, while being able to control the sensitivity and difficulty through controlled virtual parameters. A combination of EMG-FES and VR opens the opportunity for stroke survivors with a range of impairments to enjoy the therapeutic effect of VR by reducing the effort required when carrying out activities [23]. Thus, the combination of FES and VR provides patients with an engaging strategy of attaining the necessary intensity and repetition that their rehabilitation requires.

The paper is structured into six main sections. Section 2, Related Work, provides a critical evaluation of previous research in the field. Section 3, Methods, outlines the research methodology, including the aims and objectives of the developed system, an overview of the interdisciplinary expertise of the team, and participant recruitment details. Section 4, Results, presents key insights derived from interviews with stroke survivors, including design personas, rehabilitation experiences captured through user journeys, and product requirement specifications based on both primary and secondary data. Section 5, System Development and Evaluation, details the iterative design and evaluation of the advanced therapeutics system, covering its key components such as sensors, functional electrical stimulation (FES), virtual reality (VR), wearable technology, and the companion app. Finally, Section 6 and Section 7 provide a discussion and the conclusions of the study, including limitations and further work.

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