Bridging the Rehabilitation Gap: A Prospective Interventional Study of Multimodal AI-based Wearable Stimulation in Subacute Stroke Patients

Abstract

After discharge, many stroke patients are still in a period of active neural recovery. However, the amount of supervised rehabilitation usually decreases once they return home. This mismatch between ongoing brain plasticity and reduced therapy may affect upper limb recovery. This study examined whether a movement-responsive wearable stimulation system used at home is related to differences in upper limb motor recovery compared with usual home-based rehabilitation. A prospective controlled study was conducted with 351 patients in the subacute stage after stroke. Participants were randomly allocated using a computer-generated sequence to either a wearable stimulation group (n = 176) or a conventional home rehabilitation group (n = 175). Upper limb motor function was assessed using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) at discharge (T0), 1 month (T1), and 3 months (T2). FMA-UE scores increased over time in both groups. However, the pattern of change differed between groups (group × time interaction, F = 28.34, p < .001). At 3 months, the mean FMA-UE score was 58.2 ± 7.5 in the wearable group and 46.1 ± 9.2 in the control group. Within the wearable group, higher device use was associated with greater motor improvement (r = 0.72). The between-group difference at 3 months corresponded to a large effect size (Cohen’s d = 1.4). These findings suggest that movement-contingent stimulation may support motor recovery by providing feedback aligned with voluntary effort during daily activities. This approach may help sustain engagement during the post-discharge period when supervised therapy is reduced. Use of a movement-responsive wearable stimulation system during home-based rehabilitation was associated with improved upper limb motor recovery during the subacute stage after stroke.