A Smart Textile Biofeedback Training System for Upper Limb Rehabilitation After Stroke: Co-Design Development and Evaluation Study

Background: An increasing number of rehabilitation technologies are being developed to support upper limb rehabilitation after stroke, with smart textile solutions for surface electromyography (sEMG) emerging as a promising approach. Early end-user involvement is crucial for developing user-friendly and clinically valid rehabilitation tools. Objective: This study aims to refine and evaluate the prototype design and usability of a smart textile biofeedback system for self-administered upper limb training after stroke. Methods: The training system includes a knitted smart textile sleeve with integrated electrodes over the forearm muscles, an sEMG unit, and tablet-based biofeedback software. An iterative co-design process was followed, including initial testing, demonstration sessions with end users (9 clinicians and 10 individuals with stroke), and a final evaluation of the co-design process. Participants' experiences were gathered through semistructured interviews, analyzed using content analysis, and the User Experience Questionnaire. The co-design team included experts in stroke rehabilitation, textile engineering, biomedical engineering, software development, and human factors, as well as a research partner with lived experience after stroke. Results: The perspectives of the end users and the expert team were collectively integrated into prototype refinements of the sleeve and training software to meet the needs of the intended target group. The experiences of end users formed 2 main categories: "This could be an exciting new training tool for stroke rehabilitation" and "The tool works well, but some changes could enhance independent training." End users found the smart textile sleeve and biofeedback system easy to use and saw potential for integrating it into their training routines. Both end-user groups rated the system as attractive, stimulating, and novel. Conclusions: The results of this study establish a necessary ground toward the development of a smart textile sEMG biofeedback system for self-administered upper limb training after stroke. Findings from the co-design process support the continued development and evaluation of the system as a self-administered upper limb training tool for individuals living with stroke.