Wearable Telemonitoring in Focal Spasticity: A Prospective Exploratory Pilot Study of Daily-Life Mobility Monitoring

Spasticity is a common and disabling consequence of upper motor neuron lesions, and its follow-up relies largely on clinical scales that may not fully reflect daily-life mobility. This prospective single-arm exploratory pilot study examined wearable-derived daily-life mobility metrics around a scheduled botulinum neurotoxin type A (BoNT-A) injection cycle and assessed their associations with established clinical measures. Thirteen patients with focal spasticity secondary to stroke (n = 11) or multiple sclerosis (n = 2) underwent baseline and 6-week follow-up assessment using the Modified Ashworth Scale (MAS), Motricity Index (MI), the Timed Up and Go test (TUG) and a multi-sensor wearable monitoring system. Device-derived outcomes included gait impairment, gait speed, stride length, angular velocity, and lack of movement. Clinical scales generally changed in the expected post-treatment direction, with reduced MAS scores and descriptive or directional improvements in MI scores and TUG performance. Wearable metrics captured descriptive changes in daily mobility, notably a reduction in lack of movement. Furthermore, in exploratory pooled analyses, selected gait-related metrics tended to be associated with TUG performance and lower-extremity MAS. These findings highlight the potential of wearable telemonitoring to complement conventional clinical scales by providing objective, real-world data, supporting its further validation as a tool for longitudinal spasticity management and neurorehabilitation. These device-derived metrics should be interpreted as mobility-related digital biomarkers rather than direct surrogate measures of spasticity.