A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

Motivated by recent advances in technologies, ecological momentary assessment (EMA), and ecological momentary intervention (EMI) have seen a rise in behavioral medicine research that in real-time, informs the context for the behavior and prompts interventions to change that behavior in the natural setting when necessary. However, EMA and EMI have yet to be fully embraced in the field of stroke rehabilitation. Our objective is to provide a theoretically based perspective for the combined and synergistic use of EMA and EMI to promote person-centered, recovery-based durable changes in functional movement behaviors of stroke survivors. Research abounds for non-stroke populations with emerging evidence for the benefits of using real-time data capture techniques (i.e. EMA) coupled with EMI to better customize the content and timing of interventions to the inherent fluctuations in state and context that encompass the target behavior. We review existing EMA and EMI literature broadly in behavioral medicine and psychological science to identify how real-time repeated sampling technology has been used in the context of stroke rehabilitation and to delineate the pros and cons of this approach in general with non-stroke populations. We propose a coupled EMA and EMI strategy be used in conjunction with existing stroke recovery and rehabilitation practices. There is tremendous potential to effectively personalize recovery-promoting interventions to achieve durable behavior change, and importantly, shift the focus of rehabilitation practice from the health-care provider and clinical environment to the individual and their lived experience in the home and community.