Empowering Neurorehabilitation Through Wearable Sensing

The November Interdisciplinary Rehabilitative Research Seminar brought together faculty, students, and clinicians from Duke’s Doctor of Physical Therapy (DPT) and Occupational Therapy Doctorate (OTD) programs for an engaging session led by visiting professor Catherine E. Lang, PT, PhD, FASNR, FAPTA, Barbara J. Norton Professor of Physical Therapy, Professor of Neurology and Occupational Therapy, and Associate Director for Movement Science PhD Program at WashU Medicine. Her presentation, “From Motion to Meaning: Empowering Neurorehabilitation Across the Lifespan via Wearable Sensing,” explored how wearable motion sensors can transform neurorehabilitation research and clinical practice.

Lang shared her journey from being a “problem scientist” focused on stroke recovery and rehabilitation to becoming a “tool scientist” leveraging wearable technology to measure movement in daily life. This change reflects a growing focus on integrating digital health tools into rehabilitation to capture real-world activity and outcomes.

“I used to think of myself as a ‘problem scientist,’ focused on solving the challenge of stroke recovery and rehabilitation. Today, I see myself as a ‘tool scientist,’ creating solutions through wearable motion sensors that bring therapy into daily life.”

A central theme of the seminar was the complexity of developing and validating biomarkers for neurorehabilitation. Lang emphasized that biomarker development requires a solid conceptual model, preliminary evidence, and iterative investigations to determine whether a signal warrants further pursuit. “The first investigation is just the first step,” she noted, highlighting the long journey to achieving biomarker status.

She also introduced the V3+ model—Verification, Usability Validation, Analytical Validation, and Clinical Validation—highlighting the challenges and opportunities in ensuring wearable devices measure what they are supposed to and can be effectively added into clinical workflows.

Current research questions include whether movement can serve as a risk biomarker early in life, exploring the heritability and stability of motor liabilities, identifying children at risk, and understanding connections between brain structures and motor behavior. These studies could lead to earlier interventions and better outcomes across the lifespan.

Lang wrapped up with lessons learned from over a decade of working with wearable sensors:

• The importance of measuring daily-life activity in neurorehabilitation.
• The potential for sensor-based motor signals to predict traits, such as autism risk.
• There is much work to do to realize the potential of wearable sensing in clinical care.

This seminar demonstrates Duke’s dedication to interdisciplinary collaboration and progress in rehabilitation science, paving the way for technology-driven solutions that empower both patients and clinicians.