Stroke is often a sudden, life changing event from which the pursuit for ‘normalcy’ and or regaining one’s ‘self’ in the context of ability, mood, and lifestyle associated behaviours can be challenging. Upper limb paresis presents a significant issue affecting approximately 87% of stroke survivors. Indeed, deficits in strength and motor control, ’ are ‘at the core of stroke-related disability’. Yet currently there exists no officially proven ‘treatment’ for upper limb impairment, nor any form of rehabilitation that has ‘meaningful impact at the level of impairment’.

Only half of all stroke survivors with an initial plegic (paralysed) upper limb regain ‘some useful’ function after six months. Current treatments are often primitive and lack evidence supporting their clinical effectiveness, with exercise programmes being difficult to maintain and failing to accommodate lifestyle choices and behaviours of the individual. Furthermore, there exists variations in post-stroke experiences depending on the level of deficit, geographical location (for availability and access to treatments) and behavioural attitudes that impact the course of recovery.

One year post-stroke upper-limb deficits are closely linked to declining states of mental health, specifically anxiety. This, along with the need to continually persist with rehabilitation has a direct impact on recovery, diminishing quality of life as individuals are expected to become ‘athletes of their condition’. Stroke incidence is set to increase by 123% over the next two decades. Where access to healthcare lags the improvement in nutrition in developing low-middle income countries and the costs of traditional stroke therapy are outside of the means of many individuals, mobile-based methods may be very important for these large populations. Further, current methods are not best suited for current and emerging lifestyles. This thesis addresses these two main areas through the lens of the garment. In doing so, the aim of this research is to therefore evaluate the potential for garments and e-textile to mediate stroke recovery.

By drawing upon the regular, ‘intimate’ correspondence the garment holds with the body, this PhD research re-considers the delivery and positioning of rehabilitation interventions relative to highly complex associations with ‘being’ and ‘becoming’; including identity and behavioural traits post-stroke. Rather than targeting time in therapy, this research presents a line of inquiry to enhance recovery at times between therapy, enhancing mobility, personal independence, and agency during activities of daily living across ‘public’ and ‘private’ contexts.

The PhD identifies that textile-based technologies have a compelling advantage in the frequency and manner in which the wearer engages with them that can influence the course of post-stroke recovery. Beyond this the research aims to understand the key elements of a garment that are expected, ‘familiar’, and desired, in order to utilise these qualities to improve uptake, compliance and integration of the intervention within contexts of everyday living.

The capability of garments to influence mood, behaviour and personal identity is widely known and appreciated within the literature. Where, the use of a garment as a medical device or intervention is not new, the manner in which it is used and its position within care lacks critical review. In view of this, this thesis evaluates the use of garments as therapeutic interventions and identifies key opportunities and challenges for doing so. Findings from technical experiments, design practice and people-centred studies carried out in this thesis support this proposition, further advancing the body of knowledge in this area. A discussion of the garment as an intervention and findings from the experiments are included in three rapid, iterative, user experience case studies (Chapter four) and one major case study (Chapters five to nine).

Notably, the major case study takes a practice-based approach in investigating the key underlying mechanisms that contribute to upper limb functional recovery, with a focus on how the components embedded in the garment itself could help modify levels of reticulospinal and corticospinal input to improve functional recovery of the upper limb. Methods of using nanofiber yarns and a novel ‘bead’ component are developed within this research to target forearm flexors and extensors, forming the major case study exploring the use of garments as an interventional tool.

In summary, this thesis introduces a methodological framework that may be implemented within other wearable healthcare research and development projects, as well as a critique of the positioning of the garment as a therapeutic device to inform future material development directions. In doing so, this thesis has begun to pave the way for intersecting materials science, design and neurology in developing new textile components with promising opportunities for future research in personalised and accessible healthcare.