Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach

Figures & data

Figure 1. M-MARK system including garment, sensors and user interface.

Photograph of a man sitting at his kitchen table with his hand resting on a table. He is wearing a black top which has small movement and muscle sensors attached on the chest, upper arm, forearm and wrist. On view on the table is a computer tablet running an App saying: “Welcome to M-MARK.” A cup is on the table ready to be picked up.

Table 1. Categorization of arm and hand tasks with progressions based on the literature.

Level		Severe	Severe-moderate	Mild-moderate	Mild
Task type		Basic	Progression 1	Progression 2	Progression 3
Bilateral asymmetrical stabilization	1	With pronation	With supination power grip resting on lap/table	Power grip in mid-air or holding against resistance	Digital grips mid air
Bilateral symmetrical in-phase	2	Reach and touch	Reach to object and lift or push	Reach, lift, carry and place	Reach, grasp, move continuously or against gravity
Unilateral continuous repetitive	3	Move forwards / backwards on a table	Move sideways on table	Move up/down vs. gravity/object	Move in 3 dimensions
Unilateral supination /pronation	4	Turn halfway	Full range turn	Turn across body in mid air	Reach, grasp turn, release
Unilateral reach ± grasp, lift and place	5	Reach and place hand	Reach, grasp and push or lift	Reach, grasp, lift up and place (sitting)	Reach, grasp, lift up and place in standing or in different planes
Unilateral retrieve ± grasp and lift	6	Drag hand to body	Drag object to body	Grasp and bring to mouth	Grasp and bring to head
Unilateral reach down ± grasp and use	7	Reach down and touch	Reach down and move hand	Reach down and pick up	Reach down and use

Table 2. Categorization of potential tasks suggested by stroke participants and carers during 1-to-1 interviews and by healthcare professionals in the focus groups.

Task type	Tasks	# participants (0–10)	# focus groups (0,1,2)
Bilateral asymmetrical stabilization (1)	Stabilizing e.g., phone, plant pot, jar, cup, book, vegetables when preparing	5	2
Bilateral symmetrical in-phase (2)	Lift a washing basket/tray	2	0
	Put weight through bannisters on stairs or arms of a chair when standing up	1	0
	Roll pastry	0	1
Unilateral continuous repetitive (3)	Clean or wipe a surface (table/bathroom) in different directions	2	1
	Brush hair	2	0
Unilateral supination / pronation (4)	Turning (unspecified task)	2	1
	Turn a coaster, page, wooden spoon, etc.	2	1
	Pouring e.g., from a jug, pepper pot	2	0
Unilateral reach ± grasp, lift and place (5)	Unspecified tasks involving reach, grasp, picking up/lift/carry, release of objects	7	2
	Specific reach and lift tasks e.g., cans, kettle	3	0
	Reaching up into the air, high, to cupboards	5	0
Unilateral retrieve ± grasp and lift (6)	Bring hand to face (unspecified task)	0	1
	Bring hand to mouth - eating	1	0
	Bring hand to mouth - drinking	2	2
	Bring hand to head – holding shower	1	0
Unilateral reach down ± grasp and use (7)	Reach down	0	2
	Put on socks	1	0

The number of participants who cited each task is shown and whether it was cited in none, one or both focus groups.

Table 3. Final selection of tasks and their progressions used to populate the categorization matrix.

Level	Severe	Severe-moderate	Mild-moderate	Mild
Task type	Basic	Progression 1	Progression 2	Progression 3
Bilateral asymmetrical stabilization	Paper for writing	Phone or TV remote on lap	Hold jar to unscrew lid	Threading needle
Bilateral symmetrical in-phase	Reach and touch box or tray	Lift or push forward box or tray	Lift Box or tray and move forward or up	Push up from chair to stand
Unilateral continuous repetitive	Wipe cloth forward/back*	Wipe cloth sideways and in circles*	Polish window	Brush hair
Unilateral supination /pronation	Turn newspaper	Turn card or coaster	Pour drink	Turn door knob or key
Unilateral reach ± grasp, lift and place	Reach and place hand	Reach and push or grasp and lift object	Reach, grasp can, lift and place (sitting)**	Reach, grasp can, lift and place (standing)**
Unilateral retrieve ± grasp and lift	Drag hand to body	Drag object to body	Bring cup to mouth	Bring brush to head
Unilateral reach down ± grasp and use	Touch foot or object on floor	Move object on floor	Pick up shoe from floor	Put socks on (bilateral)

NB: The tasks in bold are the final 11 that were chosen to be tested further as part of the M-MARK system. Tasks marked */** were considered as one task within the system for testing but with a progression.

Table 4. The assessment tests and example tasks are classified by task category.

Task categories	Task examples that are potential items	Test # that includes a task (see key of tests below)
Bilateral asymmetrical stabilization	Hold jar to unscrew top, phone or TV remote to punch numbers, fruit to cut, ruler to draw line	2, 4
Bilateral symmetrical in-phase	Pick up large ball or container or pot and place in front; sit to stand	2, 4, 5, 9, 12, 14
Unilateral continuous repetitive	Comb hair, Clean a work surface	2, 10
Unilateral supination / pronation	Grasp and turn a door handle, key or card Pour from a jug, glass	1, 2, 4, 5, 6, 7, 9, 10, 12, 14
Unilateral reach ± grasp, lift and place	Forward, lateral, or upwards w/wo grasp, lift, move and place a can, block, ball, basket	1, 2, 3, 4, 5, 6, 8, 9, 10, 11, 13, 14
Unilateral retrieve ± grasp, and lift	Hand to mouth, hand on head, fork/spoon to mouth, phone to ear, can to mouth, retrieve weight	1, 2, 5, 8, 9, 12, 14
Unilateral reach down ± grasp and use	Sit and touch floor to right to left	9

For each category a number appears that reflects an assessment test that includes at least one task (but could be more) from that category. See key below.

Key of tests: 1 = Action Research Arm Test; 2 = Arm Motor Ability Test; 3 = Box and Blocks Test; 4 = Chedoke Arm and Hand Activity Inventory; 5 = Continuous Scale-Physical Functional Performance-Original; 6 = Functional Independence Measure; 7 = Fugl–Meyer Assessment-Arm; 8 = Jebsen Hand Function Test; 9 = Motor Assessment Scale; 10 = Postural Assessment Scale for Stroke; 11 = Physical Performance Test; 12 = Stroke Rehabilitation Assessment of Movement; 13 = Toronto Rehabilitation Institute Hand Function Test; 14 = Wolf Motor Function Test.