Purpose To explore the effects of home-based high dose accelerometer-based feedback on (1) perception of paretic upper extremity (UE) use; (2) actual amount of use (AOU); and (3) capability. The secondary purpose was to characterize paretic UE use in the home setting. Materials and Methods : Prospective experimental pre/post design (trial reg: NCT02995213). Eight participants chronic post-stroke (57.03 ± 6.64 y.o.) wore bilateral wrist accelerometers for 3 weeks during which seven sessions of accelerometer-based feedback were administered in the home. Accelerometer data (overall use, unimanual use, bimanual use, paretic/nonparetic use ratio, different intensities of use) were collected at all follow-up visits; clinical outcomes/questionnaires were collected at baseline, mid-study, and post-intervention. Results : After receiving high dose accelerometer-based feedback, participants had significant perceived gains in how much (p = 0.017) and how well (p = 0.050) they used the paretic UE. However, there were no significant group changes in actual paretic UE AOU or capability. Conclusions : In home high dose accelerometer-based feedback increased perceived paretic UE use and overall awareness of paretic UE use. Perception of use may serve as a first step to promote the behavioral change necessary to encourage actual paretic UE use, potentially decreasing the maladaptive effects of learned nonuse on participation.
Keywords: Stroke; accelerometer; feedback; forced use; learned nonuse; upper extremity.