# Closed-loop versus open-loop “remind-to-move” treatment using wearables for hemiparetic upper extremity in patients after stroke: A proof-of-concept study

## TL;DR

A study compared wearable devices that remind stroke patients to move their affected arm, finding that closed-loop devices were more effective than open-loop ones.

## Contribution

This study introduces a closed-loop wearable device for stroke rehabilitation and demonstrates its superior effectiveness over open-loop systems.

## Key findings

- Both closed-loop and open-loop devices improved upper extremity function in stroke patients.
- Closed-loop devices showed greater improvements in movement frequency and actual arm use.
- Benefits from closed-loop training were maintained at a 4-week follow-up.

## Abstract

This is a proof-of-concept study to compare the effects of a 2-week program of “Remind-to-move” (RTM) treatment using closed-loop and open-loop wearables for hemiparetic upper extremity in patients with chronic stroke in the community. The RTM open-loop wearable device has been proven in our previous studies to be useful to address the learned nonuse phenomenon of the hemiparetic upper extremity. A closed-loop RTM wearable device, which emits reminding cues according to actual arm use, was developed in this study. A convenience sample of 16 participants with chronic unilateral stroke recruited in the community was engaged in repetitive upper extremity task-specific practice for 2 weeks while wearing either a closed-loop or an open-loop ambulatory RTM wearable device on their affected hand for 3 hrs a day. Evaluations were conducted at pre-/post-intervention and follow-up after 4 weeks using upper extremity motor performance behavioral measures, actual arm use questionnaire, and the kinematic data obtained from the device. Results showed that both open-loop and closed-loop training groups achieved significant gains in all measures at posttest and follow-up evaluations. The closed-loop group showed a more significant improvement in movement frequency, hand functions, and actual arm use than did the open-loop group. Our findings supported the use of closed-loop wearables, which showed greater effects in terms of promoting the hand use of the hemiparetic upper extremity than open-loop wearables among patients with chronic stroke.