(1) Background: Hand and Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) is a high-dose evidence-based neurorehabilitation. This study aims to develop and validate a protocol using three inertial measurement units (IMUs) to objectively document upper and lower extremities’ (UE; LE) motor activity during a HABIT-ILE intervention in chronic stroke adults. (2) Method: Thirteen adults (57.1 y ± 11.3) who completed 65 h of HABIT-ILE (2 weeks, 6.5 h/d) were included. Daily motor activity was recorded with IMUs placed on both wrists and one thigh with nine IMU-derived variables extracted to evaluate motor activity and posture. Each variable was correlated with baseline abilities and day-to-day patterns were observed with subgroup analyses based on baseline dexterity and walking endurance. Day-to-day patterns were highlighted based on mean values and effect size analyses. (3) Results: Only the Magnitude and Use ratios showed high correlations with baseline abilities, with a day-to-day specific pattern highlighted for participants with moderate to good dexterity at baseline. (4) Conclusions: All participants reported a high level of engagement during HABIT-ILE independently of their baseline abilities. Although we could not detect a global trend to document the content of a HABIT-ILE intervention, these exploratory results suggest IMU monitoring to be relevant to characterize therapeutic content.

Introduction: Advances in acute stroke management have increased the number of individuals living with long-term disabilities, presenting challenges in maintaining prior levels of participation in life situations. Return to active participation can be seen as the goal of rehabilitation, given its clear impact on patients‘ quality of life. In this study, we aimed to develop the Participation in Life Situations-Stroke (PILS-Stroke) questionnaire, a self-reported Rasch-built tool for measuring patients' social involvement in meaningful life situations. Methods: We assembled a 72-item experimental version of PILS-Stroke, which was grounded on patients' and experts' perspectives via an initial item content review followed by item relevance/comprehensibility assessment. We then administered the questionnaire to 105 post-stroke individuals (58% males; mean ± SD: 62 ± 14 years) discharged for at least one month from hospital. Participants rated their involvement in life situations using a 3-point scale (0: “I would like to, but I don't get involved”; 1: “I get involved a little”; 2: “I get involved a lot”; ?: “I don't know/I don't want to get involved”). The responses were analyzed using the Rasch measurement model (RUMM2030+ software) to select the items presenting the best psychometric properties, resulting in an objective and unidimensional measurement tool. Construct validity was assessed using ten clinical measures covering International Classification of Functioning, Disability, and Health (ICF) domains (body functions, activities, participation). Results: The final 38-item PILS-Stroke demonstrated good reliability [Person Separation Index (PSI) = 0.89] and defined a unidimensional and linear scale for measuring stroke patients' social participation. There was a high correlation between social participation with satisfaction regarding activities/participation (SATIS-Stroke, r _s = 0.7, P < 0.001) and weak-to-moderate correlation with performance of motor activities (ACTIVLIM-CS, ABILHAND-CS, ABILOCO-CS; 0.20 ≤ r _s ≤ 0.39, P < 0.049) and certain psychological indicators (depression [HADS], r _s = −0.45, P < 0.001; confidence [CaSM], r _s = 0.47, P < 0.001). Conclusions: PILS-Stroke is a valid and reliable unidimensional tool specifically developed to measure stroke patients' social involvement in life situations. Its psychometric properties show promising potential for monitoring patients' social participation and quantifying the effectiveness of rehabilitation programs promoting their social inclusion.

The REAtouch^® Lite device was recently developed to support motor skill learning-based interventions, integrating both games/activities and assessment tools to enable home-based telerehabilitation. Given the importance of hand functions in rehabilitation of patients with brain lesions, this study aimed to validate a virtual version of the Box and Block Test (vBBT) implemented in the REAtouch^® device. A total of 205 healthy participants, 37 post-stroke adults, and 37 children with cerebral palsy (CP) performed the standard BBT, various versions of the newly designed vBBT (with/without a separation wall; with 6, 4, and free zones) and the Tower of London test assessing executive function/planning abilities. Friedman’s ANOVA revealed significant differences between the BBT and all versions of the vBBT scores in healthy participants (all p < 0.001). However, the vBBT-4 zones showed the largest intraclass correlation coefficient (ICC) with the BBT in healthy participants (0.58) and even higher correlations in participants with CP and stroke (>0.8). Only the vBBT-6 zones version showed a significant correlation with patients’ planning abilities (p < 0.01; r = −0.28). These findings highlight the vBBT-4 zones as the most relevant version to assess hand dexterity directly with the REAtouch^® device, potentially within telerehabilitation modalities. Further normative data must be established.

Background: Intensive therapies based on motor skill learning have been widely used in stroke rehabilitation for improving upper extremity abilities, demonstrating significant improvements in arm function and daily life activities. Based on the same therapeutic principles of motor skill learning, hand and arm bimanual intensive therapy including lower extremities (HABIT-ILE) was developed focusing on bimanual coordination and constant concomitant stimulation of trunk control and lower extremities. However, the implementation of such high-dosage interventions in stroke rehabilitation might face barriers due to limited accessibility and high resource requirements. Delivering HABIT-ILE therapy at home (HABIT-ILE@home) via telerehabilitation may reduce logistical barriers while maintaining efficacy. In addition, the added value of a 9-week specific follow-up program will be tested after high dosage interventions. Objective: The first randomized controlled trial (RCT1) aims to evaluate the noninferiority of a high-dosage HABIT-ILE@home program compared to its on-site counterpart. The second randomized controlled trial (RCT2) aims to test the superiority of a 9-week specific HABIT-ILE@home follow-up vs a nonspecific home program. Methods: A total of 48 adults with chronic stroke will be randomized to either HABIT-ILE@home or HABIT-ILE on-site group (RCT1, 65 hours over 2 weeks). HABIT-ILE@home will follow the same principles as HABIT-ILE on-site but will be delivered by caregivers with remote supervision by trained therapists and the use of a dedicated telerehabilitation device to facilitate intervention delivery and remote monitoring (ie, REAtouch Lite; Axinesis). All participants will then participate in a HABIT-ILE@home follow-up program or nonspecific follow-up (RCT2, 45 hours over 9 weeks). Primary outcomes will be the change in Fugl-Meyer Assessment (FMA), while secondary outcomes include feasibility and adherence questionnaires, upper and lower extremity motor function assessments, daily activities, and quality of life questionnaires. Assessments will be performed before (T0) and after (T1) the 2 weeks of high dosage intervention, followed by an assessment after the 9-week follow-up (T2). Results: Recruitment for the trial started in March 2023 and ended in March 2025, and data collection has been completed for this study. Data analysis is planned to start early 2026; we expect to submit the results for publication in spring 2026. Conclusion: This study will provide evidence on the feasibility and efficacy of delivering HABIT-ILE through a home-based telerehabilitation model for adults with chronic stroke. Demonstrating noninferiority of HABIT-ILE@home compared to on-site therapy would support wider accessibility to intensive rehabilitation while reducing logistical and human resource constraints. Additionally, showing the added benefit of a structured follow-up could emphasize the importance of continuity of care to sustain and enhance motor recovery after intensive interventions.

Background: Intensive motor learning interventions, such as Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), have demonstrated significant improvements in upper and lower extremity functions, as well as in bimanual performance and activities of daily living in children with cerebral palsy. However, the typical delivery of HABIT-ILE as a 2-week on-site camp can be inaccessible to families living in remote areas or with travel difficulties. Offering HABIT-ILE as a home-based telerehabilitation program could overcome these barriers. Objective: The study aims to evaluate the effectiveness of this approach through 2 randomized controlled trials. Methods: A total of 44 children with bilateral cerebral palsy (aged 5‐18 years) will participate. HABIT-ILE@home will follow the principles of HABIT-ILE on-site but will be delivered at home with the involvement of caregivers and remote supervision by trained therapists. A dedicated virtual device will facilitate intervention delivery and remote monitoring (REAtouch Lite). The first randomized controlled trial (RCT), RCT1, will assess the noninferiority of high-dose HABIT-ILE@home vs on-site HABIT-ILE (65 h over 2 weeks, 6.5 h/d). The second RCT (RCT2) will assess the superiority of a HABIT-ILE@home follow-up program delivered over 9 weeks compared to a nonspecific home follow-up (45 h in total, 5 h/wk). The Gross Motor Function Measure-66 (GMFM-66) is the primary outcome. Secondary outcomes include feasibility and adherence questionnaires, motor and functional outcome measures, as well as activities of daily living questionnaires, self-esteem, participation in life situations, and neuroimaging. Evaluations will be conducted before (T0) and after (T1) the 2 weeks of therapy, followed by a final assessment after the follow-up (T2). Results: Recruitment was completed in June 2024. All interventions were performed by November 2024. Data analysis was completed in May 2025. Conclusions: The results will first confirm or refute the noninferior efficacy of a telerehabilitation HABIT-ILE@home program compared to its typical on-site delivery. Second, the results will determine the added value of a specific HABIT-ILE@home follow-up after such high-dosage motor learning–based interventions.