Technology In Stroke Rehabilitation Research Articles

Brain-Computer Interface Technology in Stroke Rehabilitation

Brain-Computer Interface Technology in Stroke Rehabilitation

The Use of Robotic Technology in Stroke Rehabilitation – A Review

Stroke is a significant cause of death and disability in the world. It creates problems for families and nationaleconomies alike due to its disruptive nature. Rehabilitation is a way to treat disabilities in stroke survivors, apopulation that is steadily growing into a larger percentage of the population. However, stroke rehabilitation is notstandardized as there is no clear evidence-based guideline that can be applied to every person, leading to differencesin care. Other problems with rehabilitation include limitations with a therapist’s ability to work continuously andconsistently over longer periods of time. Robotics can help with solving both types of problems through their abilityto record data and work without requiring rest. There has already been development of rehabilitation robots since the1990s and more advanced robot platforms have begun to emerge in the literature. This article reviews the literatureon stroke rehabilitation and how robotics can positively affect a patient’s outcome in stroke rehabilitation. It alsoreviews several rehabilitation robots classified as either exoskeletons or end-effectors.

Effect of Robot Assistive Therapy on Hand Functional Ability in Stroke Patients: Meta-Analysis

Background: Stroke is a neurological deficit disease caused by bleeding or blockage of blood vessels in the brain which can cause disability or death. Vascular injuries cause various neurological disorders, motor disorders and functional disorders of the hands which are very necessary to carry out daily activities. Robot Assistive Therapy as a breakthrough in stroke rehabilitation technology can be used as an alternative therapy method for post-stroke rehabilitation. This study aims to determine the effectiveness of the use of robotic assistive therapy and conventional therapy on the functional abilities of stroke patients' hands. Subjects and Method: This study used a systematic review and meta-analysis design using the PRISMA flowchart guidelines and the PICO model (Population = Stroke patients. Intervention = Robot Assistive Therapy. Comparison = Conventional therapy. Outcome = Hand functional ability). The article search process was carried out using databases from PubMed, Science Direct, AJOT, Springer Link, and Google Scholar. The keywords used are “Robot Assistive Therapy” AND “stroke” AND “hand function” AND “randomized controlled trial” AND “Fugl Meyer Assessment”. The inclusion criteria in this study were full-text articles using the Randomized Controlled Trial (RCT) design from 2012 to 2022. The corresponding articles were then critically reviewed and analyzed using RevMan 5.3 software. Results: A meta-analysis was conducted on 9 randomized controlled trials (RCTs) from Belgium, Italy, Japan, Germany, Lithuania and Switzerland with a total sample of 537 stroke patients. The results of the meta-analysis showed that there was no difference in effectiveness between the use of robot assistive therapy and conventional therapy in improving the functional abilities of stroke patients' hands (SMD= -0.02; 95% CI= -0.42 to 0.38; p= 0.930). Conclusion: There is no difference in effectiveness between the use of assistive therapy robots and conventional therapy in improving the functional abilities of stroke patients' hands. Keywords: robot assistive therapy, stroke, hand functional abilities, meta-analysis Correspondence: Haris Sutopo, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: hartop4wd@gmail.com. Telepon: +628155010610.

Managing Somatosensory Impairments in Stroke: Current Clinical Practice and The Use of Technology

<h3>Research Objectives</h3> To identify current clinical practices and perspectives of physiotherapists and occupational therapists on the management of somatosensory impairment post-stroke, and the use of technology to objectively assess patient performance and deliver interventions. <h3>Design</h3> Questionnaire-based cross-sectional study. <h3>Setting</h3> Acute hospitals, community hospitals, and day-rehabilitation centres. <h3>Participants</h3> Licensed physiotherapists and occupational therapists (N = 132) with at least 1 year of clinical experience and were actively involved in stroke care within Singapore. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Perceptions, attitudes, and experiences measured by multiple-choice and 5-point Likert-scale questions, which included types of intervention, clinical assessment, and rehabilitation technology typically used in their daily practice. <h3>Results</h3> Most therapists (64.4%) spent no more than half of their clinical practice time per week on somatosensory interventions. Functional or task-specific training was primarily and regularly applied as an intervention for improving somatosensory functions post-stroke. Less than half (43.2%) reported using standardised assessments, with the sensory subscale of the Fugl-Meyer Assessment being the most frequently used, followed by the Nottingham Sensory Assessment. In comparison, the vast majority (97.7%) reported using non-standardised forms of assessment. While most therapists (86.2%) used technology to deliver interventions, technology adoption in clinical assessment was relatively scarce (30.3%). They believed that robotic technology combined with conventional therapy has the potential to optimise stroke rehabilitation, particularly for retraining proprioception. Price (89.4%), ease of use (73.5%), and lack of available space (68.9%) were identified as the major barriers to technology integration in clinical practice. <h3>Conclusions</h3> Somatosensory-specific interventions and standardised assessments were rarely implemented in clinical practice. Technology was more widely used for intervention, compared to assessment. These findings help inform policymakers to provide more standardised clinical guidelines related to the management of somatosensory impairments, and for relevant stakeholders to consider barriers to integrating technology in stroke rehabilitation. <h3>Author(s) Disclosures</h3> No competing interests.

Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation

Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.

A Socially Assistive Robot for Stroke Patients: Acceptance, Needs, and Concerns of Patients and Informal Caregivers.

Stroke patients often contend with long-term physical challenges that require treatment and support from both formal and informal caregivers. Socially Assistive Robots (SARs) can assist patients in their physical rehabilitation process and relieve some of the burden on the informal caregivers, such as spouses and family members. We collected and analyzed information from 23 participants (11 stroke patients and 12 informal caregivers) who participated in a total of six focus-group discussions. The participants responded to questions regarding using a SAR to promote physical exercises during the rehabilitation process: (a) the advantages and disadvantages of doing so; (b) specific needs that they wish a SAR would address; (c) patient-specific adaptations they would propose to include; and (d) concerns they had regarding the use of such technology in stroke rehabilitation. We found that the majority of the participants in both groups were interested in experiencing the use of a SAR for rehabilitation, in the clinic and at home. Both groups noted the advantage of having the constant presence of a motivating entity with whom they can practice their rehabilitative exercises. The patients noted how such a device can assist formal caregivers in managing their workload, while the informal caregivers indicated that such a system could ease their own workload and sense of burden. The main disadvantages that participants noted related to the robot not possessing human abilities, such as the ability to hold a conversation, to physically guide the patient's movements, and to express or understand emotions. We anticipate that the data collected in this study—input from the patients and their family members, including the similarities and differences between their points of view—will aid in improving the development of SARs for rehabilitation, so that they can better suit people who have had a stroke, and meet their individual needs.

Immersive Virtual Reality to Improve Outcomes in Veterans With Stroke: Protocol for a Single-Arm Pilot Study.

BackgroundOver the last decade, virtual reality (VR) has emerged as a cutting-edge technology in stroke rehabilitation. VR is defined as a type of computer-user interface that implements real-time simulation of an activity or environment allowing user interaction via multiple sensory modalities. In a stroke population, VR interventions have been shown to enhance motor, cognitive, and psychological recovery when utilized as a rehabilitation adjunct. VR has also demonstrated noninferiority to usual care therapies for stroke rehabilitation.ObjectiveThe proposed pilot study aims to (1) determine the feasibility and tolerability of using a therapeutic VR platform in an inpatient comprehensive stroke rehabilitation program and (2) estimate the initial clinical efficacy (effect size) associated with the VR platform using apps for pain distraction and upper extremity exercise for poststroke neurologic recovery.MethodsThis study will be conducted in the Comprehensive Integrated Inpatient Rehabilitation Program at the James A Haley Veterans’ Hospital. Qualitative interviews will be conducted with 10 clinical staff members to assess the feasibility of the VR platform from the clinician perspective. A prospective within-subject pretest-posttest pilot design will be used to examine the tolerability of the VR platform and the clinical outcomes (ie, upper extremity neurologic recovery, hand dexterity, pain severity) in 10 veteran inpatients. A VR platform consisting of commercially available pain distraction and upper extremity apps will be available at the participants’ bedside for daily use during their inpatient stay (approximately 4-6 weeks). Clinician interviews will be analyzed using qualitative descriptive analysis. Cohen d effect sizes with corresponding 95% CIs will be calculated for upper extremity neurologic recovery, hand dexterity, and pain. The proportion of participants who achieve minimal clinically important difference after using the VR platform will be calculated for each clinical outcome.ResultsThis study was selected for funding in August 2020. Institutional review board approval was received in October 2020. The project start date was December 2020. The United States Department has issued a moratorium on in-person research activities secondary to COVID-19. Data collection will commence once this moratorium is lifted.ConclusionsOur next step is to conduct a large multi-site clinical trial that will incorporate the lessons learned from this pilot feasibility study to test the efficacy of a VR intervention in inpatient rehabilitation and transition to home environments. When VR is used in patients’ rooms, it serves to provide additional therapy and may reduce clinician burden. VR also presents an opportunity similar to home-based practice exercises. VR can be implemented in both clinical settings and people’s own homes, where engagement in ongoing self-management approaches is often most challenging. This unique experience offers the potential for seamless transition from inpatient rehabilitation to the home.International Registered Report Identifier (IRRID)PRR1-10.2196/26133

A decentralised iterative learning control framework for collaborative tracking

Collaborative tracking control involves two or more subsystems working together to perform a global objective, and is increasingly used within a diverse range of applications. Decentralised iterative learning control schemes have demonstrated highly accurate collaborative tracking by using past experience gained over repeated attempts at the task. However they impose highly restrictive constraints on the system dynamics, and their reliance on inverse dynamics has degraded their robustness to model uncertainty.This paper proposes the first general decentralised iterative learning framework to address this problem, thereby enabling a wide range of existing iterative learning control methodologies to be applied in a decentralised manner to collaborative subsystems. This framework is illustrated through the derivation of a variety of new decentralised iterative learning control algorithms which balance collaborative tracking performance with optimisation of a general objective function. The framework is illustrated by application to wearable stroke rehabilitation technology in which each subsystem is a muscle artificially activated by electrical stimulation. These verify the framework’s simplified design and reduced hardware and communication overheads.

Physiotherapists' and occupational therapists' perspectives on information and communication technology in stroke rehabilitation.

The aim of this study was to explore the current and potential use of information and communication technology (ICT) to enhance coherent person-centred rehabilitation after stroke, from the perspectives of physiotherapists and occupational therapists. Five occupational therapists and four physiotherapists from different phases of the Danish stroke rehabilitation process were included and two focus group interviews were carried out. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. Three subcategories were identified from the analysis of interviews with participants: 1) ICT and apps as meaningful and supportive in the rehabilitation process, 2) ICT as a tool in communication and documentation and 3) Barriers to the integration of ICT and apps in the rehabilitation process. From these categories one core category emerged: The potential of a personalized app solution to facilitate coherent person-centred rehabilitation. ICT was perceived as important to integrate in stroke rehabilitation both for assessment, training and to compensate for remaining deficits. The development of a personalized app solution could accommodate stroke survivors' and significant others' need for insight into and overview over the rehabilitation process as well as access to relevant information, which would thereby empower them. Furthermore, a personalized app solution could also facilitate follow-up after discharge and was perceived to ease the communication and documentation within and between sectors, as well as communication with both stroke survivors and significant others.

Abstract WP185: How to Design Woke Stroke Tech: The STORIES Project

Introduction: There is little foundational evidence describing needs, wants, and concerns of stroke survivors and their carers regarding stroke rehabilitation technology. The aim of the STORIES Project (Stroke Tech- Overviews in Rehabilitation, Insights, and Experiences of Survivors &amp; carers) was to identify, characterize, and prioritize these needs and concerns, as well as differences in characterizations across subgroups, to inform socially inclusive design. Methods: Mixed-method, semi-structured interviews were conducted with 29 stroke survivors and 16 carers, including 12 matched patient-carer dyads. Participants used a 1-5 scale to rate confidence and interest in using technologies for stroke rehabilitation and to rate the importance of 41 aspects of rehabilitation technology use. Differences between subgroups were compared via student t-tests. Qualitative data was coded to add depth of understanding to quantitative results. Results: Across all participants, aspects rated most important were clear instructions, ability to return a product from home, ease of use, ability to see progress over time, and that technology use did not replace time with a therapist. Human interaction in rehabilitation was deeply important for motivation, effectiveness, and mental health. Compared to carers, patients found the following less important: training carers in rehabilitation technology use ( p =.006), ability to share progress ( p =.001), and ability to do exercises with therapists rather than carers ( p =.001). Non-whites more strongly valued including music in the rehabilitation technology experience ( p =.001). Medicaid beneficiaries cared more about time &amp; financial risk-minimization strategies ( p &lt;.000), but not direct cost ( p =.72). People without a Bachelor’s degree had less technology familiarity and interest ( p =.003). Finally, patients and carers of patients less than 12 months post-stroke were less interested in stroke rehabilitation technologies ( p &lt;.000). Conclusion: To increase adoption of stroke rehabilitation technologies, development should focus on improving multiple parts of the product experience, including clear instructions, ease of use, progress tracking, music inclusion, free trials, and free returns from home.

Getting Involved in Research With Stroke Rehabilitation Technologies.

Getting Involved in Research With Stroke Rehabilitation Technologies.

Significant others’ perspectives on person-centred information and communication technology in stroke rehabilitation – a grounded theory study

Aim: The aim of this study was to explore significant others’ perspectives on how information and communication technology can support the rehabilitation process after stroke and facilitate participation in everyday life.Method: Thirteen significant others were included in the study, and to capture their perspectives, two focus groups, and five individual interviews were carried out in Denmark and Sweden 6-12 months after the stroke incident. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis.Results: Five subcategories were identified from the analysis of the interviews: (1) Information and communication technology providing a sense of security, (2) Information and communication technology as a social mediator, (3) Information and communication technology as a compensator for deficits, (4) Information and communication technology as a way to reach information, and (5) Information and communication technology as a possibility to supplement the rehabilitation process. From these categories, one core category emerged: The potential of information and communication technology to facilitate participation in everyday life and thereby reduce the strains that significant others experience after stroke.Conclusion: Information and communication technology has the potential to facilitate participation in everyday life after stroke. It is important, therefore, to start using information and communication technology in the rehabilitation process after stroke, to bring meaning to everyday life and to support both the stroke survivors and their significant others.IMPLICATIONS FOR REHABILITATIONIntegration of information and communication technology in the rehabilitation process after stroke can accommodate several of the significant others´ needs.Educating stroke survivors to use information and communication technology as part of the rehabilitation process offloads their significant others.Integration of information and communication technology in the rehabilitation process after stroke can bring new meaning in everyday life and can facilitate both independence and participation in everyday life.

Effectiveness of Virtual Reality Using PS4 Gaming Technology in Stroke Rehabilitation for Improving Upper Limb Function-A Pilot Study

Effectiveness of Virtual Reality Using PS4 Gaming Technology in Stroke Rehabilitation for Improving Upper Limb Function-A Pilot Study

The Application of Blockchain Technology in Stroke Rehabilitation

Chang, Min Cheol MD; Hau, Yong Sauk PhD; Park, Jae Chan PhD; Lee, Jae Min MD Author Information

A qualitative study exploring views and experiences of people with stroke undergoing transcranial direct current stimulation and upper limb robot therapy

Background: Neurorehabilitation technologies used mainly in research such as robot therapy (RT) and transcranial direct current stimulation (tDCS) can promote upper limb motor recovery after stroke. Understanding the feasibility and efficacy of stroke rehabilitation technologies for upper limb impairments is crucial for effective implementation in practice. Small studies have explored views of RT by people with stroke; however experiences of people receiving tDCS in combination with RT have never been explored.Objective: To explore views and experiences of people with sub-acute and chronic stroke that had previously taken part in a randomised controlled trial involving tDCS and RT for their impaired upper limb.Methods: An interview study includes open and closed questions. Face-to-face interviews were audio recorded. Open-ended question responses were transcribed and analyzed using thematic analysis; closed questions were analyzed using descriptive analysis.Results: Participants felt that RT was enjoyable (90%) and beneficial for their affected arm (100%). From the open question data, it was found that the intervention was effective for the impaired arm especially in the sub-acute stage. Main reported concerns were that tDCS caused painful, itching and burning sensations and RT was sometimes tiring and difficult. Participants recommended that future research should focus on designing a more comfortable method of tDCS and develop a robot that promotes hand movements.Conclusions: This study provides new knowledge about the benefits and barriers associated with these technologies which are crucial to the future effective implementation of these tools in practice.

Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study.

BackgroundUsing technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation.ObjectiveThis project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption.MethodsWe invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions to enhance adoption.ResultsA total of 25 priorities were generated from the survey; these were reduced to 10 nonranked priorities through discussion, consensus activities, and voting at Workshop 1: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff, and performance feedback. The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies.ConclusionsThe key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence-based stroke rehabilitation.

Effects of Head-Mounted Display on kinematics of the Timed Up and GO (TUG) test: does the addition of a visual stimulus matter?

Effects of Head-Mounted Display on kinematics of the Timed Up and GO (TUG) test: does the addition of a visual stimulus matter?

Reported use of technology in stroke rehabilitation by physical and occupational therapists

Purpose: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs.Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.Implications for RehabilitationThe patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.Physical and occupational therapists do not widely use technology in stroke rehabilitation.Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

Abstract WP153: Establishing Kinimatic Age-referenced Normative Values of the Upper Extremity Using the InMotion 2 Robot

Introduction: The use of technology in stroke rehabilitation is growing rapidly. Upper extremity robotic devices provide both therapeutic intervention as well as objective kinematic assessment to evaluate arm ability of individuals with stroke. The InMotion 2® is a shoulder/elbow robot widely used in the clinic and within stroke rehabilitation research. It has the capability to provide kinematic assessment of the arm, however there are no age-referenced normative values available for comparison to a healthy population. The aim of this study was to establish normative kinematic values for the InMotion 2 robot. Hypothesis: Not Applicable. Methods: Forty healthy individuals with no history of stroke or other neurological conditions with full passive and active range of motion in both upper extremities were recruited from the community. Subjects were recruited based on age (40-49, 50-59, 60-69, 70-80), 10 subjects per group (5 males and 5 females). Subjects were assessed on circle and clock drawing tasks with their dominant and non-dominant arm over three trials. The kinematic parameters measured included smoothness, joint independence, hold deviation, and displacement. The mean (M) and standard deviation (SD) of dominant hand test 1 and 2 were averaged together for combined scores across age groups. Results: The following age referenced normative values were determined for each kinematic parameter: smoothness (m/s), mean and SD for 40-49 age group (.585; .027), 50-59 (.566; .033), 60-69 (.540; .048), and 70-80 (.561; .033); joint independence: 40-49 (.861; .019), 50-59 (.858; .0394), 60-69 (.839; .030), and 70-80 (.853; 024); hold deviation (meters), 40-49 (.017; .005), 50-59 (.019; .004), 60-69 (.019; .006), and 70-80 (.022; .004); displacement (meters), 40-49 (.132; .001), 50-59 (.132; .001), 60-69 (.132; .001), and 70-80 (.131; .0004). Conclusion: The analysis demonstrated that age, sex, and hand dominance did not have a significant effect on normative kinematic outcomes, however age referenced normative values establish baseline and ceiling levels which provide more meaning when interpreting scores for individuals with stroke. Further research investigating the reliability of the kinematic parameters is currently underway.

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Purpose: The envisage programme of research was funded to explore and evaluate the use of visualisation software tools using biomechanical data within rehabilitation. Three work packages were developed to evaluate the impact of the tools within stroke rehabilitation. The research presented here aimed at exploring the perceptions of rehabilitation therapists about the use of the visualisation software tools in the context of future randomised controlled trials and stroke rehabilitation practice. Methods: Sixteen therapists working in a range of stroke rehabilitation contexts participated in semi-structured interviews. Interview questions explored their current practice, and the perceived impact of the new visualisation technologies on their workplace environment and practice. Framework analysis was used to analyse the textual data. Results: In general, the stroke therapists were enthusiastic about the potential application of the visualisation software tools. Three themes were identified through qualitative framework analysis: potential uses of the visualisation tools; integration within current service provision; and trial involvement. Conclusions: The study highlights important contextual considerations which may impact significantly on the success of novel technologies in stroke rehabilitation. Normalisation process theory was proposed as a useful process evaluation methodology to optimise both trial evaluation and future service implementation.Implications for RehabilitationThere is limited research exploring the use of visual software technologies featuring biomechanical data within stroke rehabilitation.The perspectives of stroke rehabilitation therapists about the potential of such tools are useful both in terms of planning trial evaluations, and implementation.Therapists were generally positive about the contribution of visual software tools in stroke rehabilitation, but highlighted a number of practical constraints which required addressing.Normalisation process theory provides a useful process evaluation methodology which can support both trial evaluation and implementation of such novel technologies within stroke rehabilitation.