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Research project: Mechanical Muscle Activity with Real-time Kinematics (M-MARK): A novel combination of existing technologies to improve arm recovery following stroke

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The M-MARK system will help stroke patients regain arm function by supporting independent home-exercise and allowing patients to have the recommended 45 minutes of daily therapy more flexibly. Therapists prescribe a set of real-world exercises which encompass appropriate physiotherapy movements for the patient, such as opening a jar, pouring a drink and wiping a table with a cloth.   Exercise data is collected using mechanomyography (MMG) and inertial measurement unit (IMU) sensors to provide feedback to patients and therapists via a computer tablet. MMG sensors are similar to a microphone, and detect vibrations when muscles are active. IMU sensors are similar to those found in a mobile phone and detect motion. In combination they can be used to describe the amount and quality of movement.   Patients are provided with immediate feedback during the exercise programme with corrective voice and text guidance in addition to a visual representation of their movements using an on-screen avatar (an anatomically-correct animation) which supports self-correction. Both patients and therapists can review previous exercise data.   Therapists can access more detailed information which supports clinical decision-making and monitoring progress, making therapy more efficient and effective. Patients and therapists told us this is what is needed.   This low-cost wearable device will provide guidance and feedback automatically. Intensive practice leads to better recovery, but re-learning to move more normally is also important and is traditionally guided by therapists, which is expensive.

Aims and Objectives

Create a wearable device that stroke patients could use independently at home to regain arm function and enable accurate assessment by therapists. Objectives: 1) design a garment with embedded sensors to measure amount and quality of movement and muscle activity; 2) test sensors for reliability and usefulness; 3) write software to provide feedback; 4) tests with patients; 5) CE mark the device.


Stroke survivors receive rehabilitation at home. 60% fail to regain useful arm function. Intensive practice improves recovery, but is expensive.


The multi-disciplinary team worked with patients, carers and therapists in a person-centred approach. Sensors were tested for validity and reliability in the laboratory. Garment and user interfaces were designed. We designed processing techniques and User Interfaces (UI) to provide feedback. System feasibility was tested.

Key findings

Sensors were valid and reliable. Eleven tasks were selected and UIs provide feedback with simple messages for patients and more detailed measures for therapists. An Avatar was developed that accurately represented movement. Case studies with 6 patients and 2 therapists showed the garment was easy to don and doff, feedback was useful and reflected clinical judgement. The system was safe and CE marked.

Dissemination, Outputs and Impact

Results have and will be published and presented at conferences. M-MARK has been demonstrated with patients. A plan has been made to commercialise the system.

Patient and Public Involvement

Our patient representatives advised us throughout, attended the launch of M-MARK at the European Neuro-Convention and the Dissemination Workshop, and have made videos with us.

Conclusions and future plans

A proposed follow-on i4i project will improve the garment and UIs, miniaturise electronics, explore other applications and conduct a pilot study. We are planning a feasibility trial and seeking funds to train therapists. A spin-out company will manufacture and distribute M-MARK.


This report is independent research funded by the National Institute for Health Research (Invention for Innovation, Mechanical Muscle Activity with Real-time Kinematics (M-MARK): A novel combination of existing technologies to improve arm recovery following stroke, II-LB-0814-20006). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

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