{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:32:43Z","timestamp":1788449563480,"version":"build-2803163510"},"reference-count":51,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"Australian National Health and Medical Research Council (NHMRC) Ideas","doi-asserted-by":"publisher","award":["2004443"],"award-info":[{"award-number":["2004443"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>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\u2013moderately 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.<\/jats:p>","DOI":"10.3390\/s25237330","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:42:02Z","timestamp":1764960122000},"page":"7330","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined Individual Experience and Accelerometry Measurement of Upper Limb Use in Daily Activities in Real Time After Stroke"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4822-3799","authenticated-orcid":false,"given":"Isuru","family":"Senadheera","sequence":"first","affiliation":[{"name":"Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia"},{"name":"Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8479-3420","authenticated-orcid":false,"given":"Prasad","family":"Hettiarachchi","sequence":"additional","affiliation":[{"name":"Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia"},{"name":"Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4289-9328","authenticated-orcid":false,"given":"Brendon","family":"Haslam","sequence":"additional","affiliation":[{"name":"Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia"},{"name":"Neurorehabilitation and Recovery, The Florey, Melbourne, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6641-2153","authenticated-orcid":false,"given":"Rashmika","family":"Nawaratne","sequence":"additional","affiliation":[{"name":"Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8587-0934","authenticated-orcid":false,"given":"Michael","family":"Pollack","sequence":"additional","affiliation":[{"name":"Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW 2308, Australia"},{"name":"Hunter New England Health, New Lambton, NSW 2305, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6071-6137","authenticated-orcid":false,"given":"Susan","family":"Hillier","sequence":"additional","affiliation":[{"name":"Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8826-1621","authenticated-orcid":false,"given":"Michael","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW 2308, Australia"},{"name":"College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3291-888X","authenticated-orcid":false,"given":"Damminda","family":"Alahakoon","sequence":"additional","affiliation":[{"name":"Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6376-8613","authenticated-orcid":false,"given":"Leeanne M","family":"Carey","sequence":"additional","affiliation":[{"name":"Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia"},{"name":"Neurorehabilitation and Recovery, The Florey, Melbourne, VIC 3086, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Senadheera, I., Hettiarachchi, P., Haslam, B., Nawaratne, R., Sheehan, J., Lockwood, K.J., Alahakoon, D., and Carey, L.M. (2024). AI Applications in Adult Stroke Recovery and Rehabilitation: A Scoping Review Using AI. Sensors, 24.","DOI":"10.3390\/s24206585"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Pollock, A., Farmer, S.E., Brady, M.C., Langhorne, P., Mead, G.E., Mehrholz, J., and Van Wijck, F. (2014). Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst. Rev., 11.","DOI":"10.1002\/14651858.CD010820.pub2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"945","DOI":"10.3109\/09638288.2015.1068383","article-title":"Assessing the Impact of Upper Limb Disability Following Stroke: A Qualitative Enquiry Using Internet-Based Personal Accounts of Stroke Survivors","volume":"38","author":"Poltawski","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_4","unstructured":"Christiansen, C., and Townsend, E. (2013). Introduction to Occupation: The Art of Science and Living: Pearson New International Edition, Pearson Education, Limited."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1093\/rheumatology\/18.1.43","article-title":"Stroke Recovery: He Can but Does He?","volume":"18","author":"Andrews","year":"1979","journal-title":"Rheumatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1177\/1545968321999064","article-title":"A First Step toward the Operationalization of the Learned Non-Use Phenomenon: A Delphi Study","volume":"35","author":"Hirsch","year":"2021","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chen, Y., Demers, M., Lewthwaite, R., Schweighofer, N., Monterosso, J., Fisher, B.E., and Winstein, C.J. (2021). A Novel Combination of Accelerometry and Ecological Momentary Assessment for Post-Stroke Paretic Arm\/Hand Use: Feasibility and Validity. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061328"},{"key":"ref_8","unstructured":"World Health Organization (2002). Towards a Common Language for Functioning, Disability, and Health: ICF. The International Classification of Functioning, Disability and Health, WHO."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Csikszentmihalyi, M. (2014). Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi, Springer. [1st ed.].","DOI":"10.1007\/978-94-017-9088-8"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Csikszentmihalyi, M., and Larson, R. (2014). Flow. Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi, Springer.","DOI":"10.1007\/978-94-017-9088-8"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Baum, C.M., Christiansen, C.H., and Bass, J.D. (2024). The Person-Environment-Occupation-Performance (PEOP) Model. Occupational Therapy, Routledge.","DOI":"10.4324\/9781003522997-5"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chin, L.F., Hayward, K.S., Soh, A.J.A., Tan, C.M., Wong, C.J.R., Loh, J.W., Loke, G.J.H., and Brauer, S. (2019). An Accelerometry and Observational Study to Quantify Upper Limb Use after Stroke during Inpatient Rehabilitation. Physiother. Res. Int. J. Res. Clin. Phys. Ther., 24.","DOI":"10.1002\/pri.1784"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.jsams.2018.12.003","article-title":"Wrist-Specific Accelerometry Methods for Estimating Free-Living Physical Activity","volume":"22","author":"Kingsley","year":"2019","journal-title":"J. Sci. Med. Sport"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1080\/02640414.2020.1841394","article-title":"Deep Learning to Predict Energy Expenditure and Activity Intensity in Free Living Conditions Using Wrist-Specific Accelerometry","volume":"39","author":"Nawaratne","year":"2021","journal-title":"J. Sports Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Perrin, B.M., Diacogiorgis, D., Sullivan, C., Gerrard, J., Skinner, I., Skinner, T.C., Nawaratne, R., Alahakoon, D., and Kingsley, M.I. (2023). Habitual Physical Activity of People with or at Risk of Diabetes-Related Foot Complications. Sensors, 23.","DOI":"10.3390\/s23135822"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1017\/BrImp.2015.21","article-title":"Exploring the Role of Accelerometers in the Measurement of Real World Upper-Limb Use after Stroke","volume":"17","author":"Hayward","year":"2016","journal-title":"Brain Impair."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.apmr.2022.09.003","article-title":"Essential Role of Social Context and Self-Efficacy in Daily Paretic Arm\/Hand Use after Stroke: An Ecological Momentary Assessment Study with Accelerometry","volume":"104","author":"Chen","year":"2023","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/00005053-198709000-00004","article-title":"Validity and Reliability of the Experience-Sampling Method","volume":"175","author":"Csikszentmihalyi","year":"1987","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.clinpsy.3.022806.091415","article-title":"Ecological Momentary Assessment","volume":"4","author":"Shiffman","year":"2008","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Csikszentmihalyi, M., and Larson, R. (2014). Validity and Reliability of the Experience-Sampling Method. Flow and the Foundations of Positive Psychology, Springer.","DOI":"10.1007\/978-94-017-9088-8_3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/15459683241230027","article-title":"Associations of Circadian Rest-Activity Rhythms with Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study","volume":"38","author":"Lau","year":"2024","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1016\/j.apmr.2022.06.002","article-title":"Multimodal Ambulatory Monitoring of Daily Activity and Health-Related Symptoms in Community-Dwelling Survivors of Stroke: Feasibility, Acceptability, and Validity","volume":"103","author":"Lau","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/oti.23","article-title":"The Experience Sampling Method: Its Potential Use in Occupational Therapy Research","volume":"3","author":"Farnworth","year":"1996","journal-title":"Occup. Ther. Int."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hettiarachchi, P., Senadheera, I., Nawaratne, R., Haslam, B., Alahakoon, D., and Carey, L. (2024, January 8\u201311). Capturing Real-Time Behavior of Post Stroke Survivors Using Mobile Technologies. Proceedings of the 2024 16th International Conference on Human System Interaction (HSI), Paris, France.","DOI":"10.1109\/HSI61632.2024.10613559"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Forster, S.D., Gauggel, S., Loevenich, R., V\u00f6lzke, V., Petershofer, A., Zimmermann, P., Privou, C., Bonnert, J., and Mainz, V. (2022). A Microanalysis of Mood and Self-Reported Functionality in Stroke Patients Using Ecological Momentary Assessment. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.854777"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Nakamura, J., and Csikszentmihalyi, M. (2014). The Concept of Flow. Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi, Springer.","DOI":"10.1007\/978-94-017-9088-8"},{"key":"ref_27","unstructured":"Portney, L.G., and Watkins, M.P. (2014). Foundations of Clinical Research: Applications to Practice, Pearson. [3rd ed.]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/00004356-198112000-00001","article-title":"A Performance Test for Assessment of Upper Limb Function in Physical Rehabilitation Treatment and Research","volume":"4","author":"Lyle","year":"1981","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kwah, L.K., and Diong, J. (2014). National Institutes of Health Stroke Scale (NIHSS). J. Physiother., 60.","DOI":"10.1016\/j.jphys.2013.12.012"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1161\/01.STR.30.10.2131","article-title":"The Stroke Impact Scale Version 2.0: Evaluation of Reliability, Validity, and Sensitivity to Change","volume":"30","author":"Duncan","year":"1999","journal-title":"Stroke"},{"key":"ref_31","unstructured":"(2025, August 29). wGT3X-BT|Ametris Wearable Devices. Available online: https:\/\/ametris.com\/actigraph-wgt3x-bt."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Larson, R., and Csikszentmihalyi, M. (2014). The Experience Sampling Method. Flow and the Foundations of Positive Psychology, Springer.","DOI":"10.1007\/978-94-017-9088-8_2"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1177\/1545968315583720","article-title":"Quantifying Real-World Upper-Limb Activity in Nondisabled Adults and Adults with Chronic Stroke","volume":"29","author":"Bailey","year":"2015","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Neishabouri, A., Nguyen, J., Samuelsson, J., Guthrie, T., Biggs, M., Wyatt, J., Cross, D., Karas, M., Migueles, J.H., and Khan, S. (2022). Quantification of Acceleration as Activity Counts in ActiGraph Wearable. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-16003-x"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Poitras, I., Gagn\u00e9-Pelletier, L., Clou\u00e2tre, J., Flamand, V.H., Campeau-Lecours, A., and Mercier, C. (2024). Optimizing Epoch Length and Activity Count Threshold Parameters in Accelerometry: Enhancing Upper Extremity Use Quantification in Cerebral Palsy. Sensors, 24.","DOI":"10.3390\/s24041100"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bailey, R.R., Klaesner, J.W., and Lang, C.E. (2014). An Accelerometry-Based Methodology for Assessment of Real-World Bilateral Upper Extremity Activity. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0103135"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1249\/MSS.0b013e3181ed61a3","article-title":"Validation of Accelerometer Wear and Nonwear Time Classification Algorithm","volume":"43","author":"Choi","year":"2011","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/sleep\/17.3.201","article-title":"Activity-Based Sleep-Wake Identification: An Empirical Test of Methodological Issues","volume":"17","author":"Sadeh","year":"1994","journal-title":"Sleep"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1161\/01.STR.31.3.662","article-title":"Objective Measurement of Functional Upper-Extremity Movement Using Accelerometer Recordings Transformed with a Threshold Filter","volume":"31","author":"Uswatte","year":"2000","journal-title":"Stroke"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lee, J.P., Chen, S., Tsai, C.T., Chung, H.C., Chang, W.D., and Galeoto, G. (2020). Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis. Occup. Ther. Int., 2020.","DOI":"10.1155\/2020\/2387378"},{"key":"ref_41","unstructured":"Csikszentmihalhi, M. (2020). Finding Flow: The Psychology of Engagement with Everyday Life, Hachette UK."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Boone, A.E., Wolf, T.J., and Baum, C.M. (2022). Development and Initial Testing of the Electronic Activity Card Sort (ACS3) among Community-Dwelling Adults. Am. J. Occup. Ther., 76.","DOI":"10.5014\/ajot.2022.047522"},{"key":"ref_43","unstructured":"Edemekong, P.F., Bomgaars, D., Sukumaran, S., and Levy, S.B. (2019). Activities of Daily Living, StatPearls Publishing."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"460","DOI":"10.2522\/ptj.20120112","article-title":"(EPOS) Accuracy of Physical Therapists\u2019 Early Predictions of Upper-Limb Function in Hospital Stroke Units: The EPOS Study","volume":"93","author":"Nijland","year":"2013","journal-title":"Phys. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Buma, F.E., Raemaekers, M., Kwakkel, G., and Ramsey, N.F. (2015). Brain Function and Upper Limb Outcome in Stroke: A Cross-Sectional fMRI Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139746"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2868","DOI":"10.1080\/09638288.2020.1849429","article-title":"Understanding Activity Participation 3-Months after Stroke: A Mixed Methodology Study","volume":"44","author":"Tse","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Barth, J., Klaesner, J.W., and Lang, C.E. (2020). Relationships between Accelerometry and General Compensatory Movements of the Upper Limb after Stroke. J. Neuroeng. Rehabil., 17.","DOI":"10.1186\/s12984-020-00773-4"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1177\/02692155221141977","article-title":"Identity, Social Engagement and Community Participation Impact Physical Activity Levels of Stroke Survivors: A Mixed-Methods Study","volume":"37","author":"Espernberger","year":"2023","journal-title":"Clin. Rehabil."},{"key":"ref_49","unstructured":"Runco, M.A., and Pritzker, S.R. (2011). Flow and Optimal Experience. Encyclopedia of Creativity, Academic Press. [2nd ed.]."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kim, G.J., Parnandi, A., Eva, S., and Schambra, H. (2021). The Use of Wearable Sensors to Assess and Treat the Upper Extremity after Stroke: A Scoping Review. Disabil. Rehabil., 44.","DOI":"10.1080\/09638288.2021.1957027"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Ottiger, B., Van Wegen, E., Keller, K., Nef, T., Nyffeler, T., Kwakkel, G., and Vanbellingen, T. (2021). Getting into a \u201cFlow\u201d State: A Systematic Review of Flow Experience in Neurological Diseases. J. Neuroeng. Rehabil., 18.","DOI":"10.1186\/s12984-021-00864-w"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/23\/7330\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:46:16Z","timestamp":1764960376000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/23\/7330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":51,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["s25237330"],"URL":"https:\/\/doi.org\/10.3390\/s25237330","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,2]]}}}