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Additional file 1:. Additional Table 1 (.pdf) - Intervention actions employed in each phase of the Active Brains development process

Additional file 4:. Additional Table 4 (.pdf) - Behavioural analysis of Active Brains using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF)

Additional file 3:. Additional Table 3 (.pdf) - Excerpts from Table of Changes

Background: upper extremity (UE) movement is often compromised following a stroke. Constraint Induced Therapy (CIT) is an evidence-based intensive intervention (1) which involves people with stoke practicing activites with their affected hand whilst wearing a mitt on their other hand, but it relies on intensive therapy. A study trialling CIT in a community setting without a therapist present found key barriers to be lack of motivation to wear the mitt and comply with the exercise programme (2). A web supported CIT system (LifeCIT) for UE stroke rehabilitation was developed to address this barrier. Objective: to evaluate the impact of using LifeCIT for UE stroke rehabilitation compared to usual care in subacute/chronic stroke patients at home.Methods: subacute/chronic stroke patients were randomized into a three week intervention consisting of LifeCIT or control groups. UE impairment and function were assessed with the Motor activity log (MAL), Fugl-Meyer (FMA-UE) and Wolf Motor Function Test (WMFT) pre and post intervention and at a six month follow-up. Results: sixteen patients completed the trial. Between group differences, favouring the LifeCIT group in MAL (AOU and QOU) and WMFT (FAS) were identified post intervention (ANCOVA) and controlled for baseline clinical scores, Orpington score and Sub-acute/chronic. Mean improvement in the LifeCIT group MALfrom baseline to post treatment (1.02 AOU and QOU) and at six months (0.6 AOU and QOU) was above the minimally clinically important difference (MCID) for the MAL (MCID = 0.5) Improvement in the LifeCIT group WMFT (FAS) met MCID from baseline to post intervention (0.35) and at six months (0.3) FAS MCID=0.2 - 0.4. Interview data confirmed positive acceptance of LifeCIT. Conclusion: use of LifeCIT in the community improved UE function in subacute/chronic stroke patients following a three week intervention and at a six month follow-up, suggesting a larger scale study should be run. References(1) Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Journal of the American Medical Association 2006; 296(17):2095-2104.(2) Burns A, Burridge J.H., Pickering R.M. Does the use of a constraint mitten to encourage use of the hemiplegic upper limb improve arm function in adults with subacute stroke? Clin Rehabil 2007; 21:895-904.Supported by the National Institute for Health Research (NIHR) Research for Patient Benefit (RFPB)

This symposia will focus attention on the gap between technologies used in the lab and those used in the home. It addresses the question ‘how do we design technologies that will be used in home based practice for different types of impairments?’ Technologies are increasingly sophisticated and have many applications in supporting neuro-rehabilitation. Recent evidence from neurophysiological research and clinical studies has influenced rehabilitation interventions for the arm, providing valuable knowledge about how to apply technology-based therapy for people with neurological disorders, such as stroke and multiple sclerosis. However, home based use of such technologies remains limited. Do technologies need to be re-invented? The symposia will present some examples of novel home-based technologies, how they are underpinned by current understanding of neuroplasticity, users’ needs and expectations.

Background Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. Objective In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. Methods In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). Results Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. Conclusions The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. Trial Registration International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980 International Registered Report Identifier (IRRID) DERR1-10.2196/18929