Combined Individual Experience and Accelerometry Measurement of Upper Limb Use in Daily Activities in Real Time After Stroke

Use of the upper limb to engage in everyday activities is a key indicator of functional recovery of stroke survivors. In addition to functional capacity, personal and environmental factors contribute to real-world upper limb use post-stroke. We aimed to combine data from the experience sampling method (ESM), a method used to capture real-time engagement in daily activities, with accelerometry, an objective measurement of arm use, to evaluate arm use behaviours of adult stroke survivors living in real-world environments. Thirty mild-moderately impaired stroke survivors and 30 age-standardized healthy individuals were monitored over 7 days, using accelerometers on both wrists and four ESM beeps per day to capture individual experiences in daily activities. Stroke survivors showed significantly lower use of the affected arm across all activity domains compared to the non-dominant arm of healthy participants and reported perceived lower skill and higher challenge levels. Physical context, motor capabilities and activity type were associated with affected arm use behaviour, with greater use observed during social settings and in physically demanding tasks. These findings demonstrate that combining ESM with accelerometry provides a novel, ecologically valid framework to capture and interpret the interplay between capacity, context, and behaviour in everyday life. This approach offers opportunities to design personalized, context-aware rehabilitation strategies that promote meaningful functional reintegration after stroke.