Using Large-Scale Sensor Data to Test Factors Predictive of Perseverance in Home Movement Rehabilitation: Optimal Challenge and Steady Engagement

Edgar De Jesus Ramos Muñoz; Veronica Ann Swanson; Christopher Johnson; Raeda K Anderson; Amanda R Rabinowitz; Daniel K Zondervan; George H Collier; David J Reinkensmeyer

doi:10.3389/fneur.2022.896298

Using Large-Scale Sensor Data to Test Factors Predictive of Perseverance in Home Movement Rehabilitation: Optimal Challenge and Steady Engagement

Front Neurol. 2022 Jun 20:13:896298. doi: 10.3389/fneur.2022.896298. eCollection 2022.

Authors

Edgar De Jesus Ramos Muñoz¹, Veronica Ann Swanson¹, Christopher Johnson², Raeda K Anderson^{3

4}, Amanda R Rabinowitz⁵, Daniel K Zondervan⁶, George H Collier³, David J Reinkensmeyer^{1

7}

Affiliations

¹ Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA, United States.
² Department of Biomedical Engineering, Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA, United States.
³ Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA, United States.
⁴ Department of Sociology, Georgia State University, Atlanta, GA, United States.
⁵ Moss Rehabilitation Research Institute, Philadelphia, PA, United States.
⁶ Flint Rehabilitation Devices, LLC, Irvine, CA, United States.
⁷ Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, Irvine, CA, United States.

Abstract

Persevering with home rehabilitation exercise is a struggle for millions of people in the US each year. A key factor that may influence motivation to engage with rehabilitation exercise is the challenge level of the assigned exercises, but this hypothesis is currently supported only by subjective, self-report. Here, we studied the relationship between challenge level and perseverance using long-term, self-determined exercise patterns of a large number of individuals (N = 2,581) engaging in home rehabilitation with a sensor-based exercise system without formal supervision. FitMi is comprised of two puck-like sensors and a library of 40 gamified exercises for the hands, arms, trunk, and legs that are designed for people recovering from a stroke. We found that individuals showed the greatest perseverance with the system over a 2-month period if they had (1) a moderate level of motor impairment and (2) high but not perfect success during the 1st week at completing the exercise game. Further, a steady usage pattern (vs. accelerating or decelerating use) was associated with more overall exercise, and declines in exercise amount over time were associated with exponentially declining session initiation probability rather than decreasing amounts of exercise once a session was initiated. These findings confirm that an optimized challenge level and regular initiation of exercise sessions predict achievement of a greater amount of overall rehabilitation exercise in a group of users of commercial home rehabilitation technology and suggest how home rehabilitation programs and exercise technologies can be optimized to promote perseverance.

Keywords: engagement; exercise; perseverance; rehabilitation; stroke; telemedicine; therapy.