Migo tracker: seamless remote therapeutic monitoring of exercise adherence after stroke - one in four people will experience a stroke, with 50-70% experiencing chronic movement impairment

While intensive rehabilitation exercise reduces movement impairment, most individuals do not receive enough therapy during in-clinic visits to recover to their full potential and therapists routinely prescribe home exercise programs to supplement in-clinic therapy. However, individuals struggle to adhere to these prescribed programs. Thus, deploying strategies that promote adherence with prescribed home exercise is critical for maximizing recovery in individuals post stroke, especially during the heightened period of neuroplasticity early after stroke. In 2022, medicare released 5 new reimbursement codes for remote therapeutic monitoring or RTM. These RTM codes can be billed by physical and occupational therapists for remotely monitoring adherence to a home exercise program. These RTM codes thus represent a key opportunity for therapists to interface with their patients at home and encourage improved adherence to home exercises in a cost-effective way. However, there has been relatively low uptake of these new codes due to a lack of enabling technologies that address real-world implementation barriers. Recognizing this critical GAP, we began developing migo tracker, the first FDA-listed, wrist-worn exercise sensor that can be used to seamlessly implement RTM in routine post-stroke care. Migo tracker monitors adherence for any at-home exercise modality therapists already use (e.g. digital home exercise programs, printed handouts, or videos recorded on patients' phones; users simply DON the migo tracker before exercising and remove IT when they are done). Then, migo tracker uploads the data via a proprietary bluetooth- cellular gateway without any interaction with a user (i.e. no smartphone APP or internet access is required). Therapists can review migo tracker data and document their interactions with patients on a custom, easy-to-use RTM dashboard, which will include tools for electronic health record (EHR) integration and billing documentation to receive reimbursement. We believe that an RTM program that uses migo tracker will readily integrate with current rehabilitation workflows, enabling useful, data-driven remote interactions between therapists and patients that will lead to improved recovery outcomes. Our primary objectives for this direct to phase II project are: aim 1) complete migo tracker firmware development based on end-user feedback; aim 2) complete online hipaa-compliant RTM dashboard; aim 3) determine the safety and effectiveness of a migo tracker RTM program in a randomized controlled trial with individuals with subacute stroke (N=50). We hypothesize that the participants in the migo tracker RTM group will have significantly higher FM scores by a clinically meaningful amount at three-months post stroke than the usual care group. If successful, migo tracker will lead to increased home exercise adherence and improved health outcomes for thousands of individuals following stroke.