## 4 Discussion  
Though the scope is limited, this case study is among the first to describe both the proof-of-concept of the preliminary implementation of commercial sEMG sensors directly in clinical and community settings to monitor upper extremity muscle activity in the acute and subacute phases of rehabilitation, and report the participant's experiences of recovery and perceptions of such sEMG monitoring after stroke. This study presented a unique opportunity to describe sEMG monitoring results together with qualitative participant perceptions of recovery and monitoring in a single individual who took place in two sets  
Figure 5: Contractions per minute by muscle group at discharge and follow up. Average contractions per minute during the last in-patient rehabilitation day and the three- and eight-month follow-up visit. Activity type for each session involved no therapy or workout but involved the participant’s daily activities. The vertical lines represent standard deviation, and no contractions between 100 and 500 ms were recorded for the Deltoid at the three-month follow up (X). of study procedures. Although previous work has examined the return of finger extension mobility beginning at 14 days post-stroke, or in subacute populations, most frequently studies incorporating sEMG examine upper extremity recovery of nonhospitalized chronic stroke survivors [17; 34; 35; 36]. The findings of this study indicate that the application of sEMG in acute recovery is feasible, and reflects recommendations in the previous literature indicating sEMG and other stimulation/biofeedback technology as both a means to detect and train the early return of limb movements and as a potential prognostic aid in directing stroke rehabilitation [9; 37; 38]. This is especially relevant given that current clinical rehabilitation assessments lack the ability to differentiate between true muscle recovery and compensation [24; 38; 39]. Changes in muscle activity detected by sEMG combined with observable improvement in function offer a more objective means to make this differentiation and potentially enhance stroke recovery outcomes. Further, since the return of finger and hand movements has been highlighted as a critical indicator of functional prognosis in stroke survivors, monitoring with sEMG can be an especially relevant tool for rehabilitation professionals, even prior to the visible active return of movement [35]. [PERSON]'s clinical assessments showed linear improvement, but the metrics from sEMG were highly variable. This may indicate that compensation was responsible for some of the improved functional scores during hospitalization [24]. While in the room, he showed an increase in contractions per minute over time, which points to the benefits described in the literature of sEMG monitoring outside of scheduled therapies or assessments, particularly to help mitigate learned nonuse behavior [22; 25]. While there is a lack of published data on contractions per minute expected in healthy or impaired adult upper extremities during functional tasks, one study used rates between 60 and 120 to evaluate sEMG signal properties at the wrist in healthy individuals, suggesting that [PERSON]'s maximal recorded rate of approximately 40 likely indicated residual functional limitation as recovery progressed, which was corroborated by his qualitative interview findings [40]. Nonetheless, this information can be useful to both the clinician and the patient, with prior research indicating that more objective feedback serves to motivate participation and improve self-efficacy during rehabilitation [23]. In this study, [PERSON] similarly expressed a desire for greater real-time feedback from the sEMG and easier access to long term data trends. Finally, this feasibility study points to the value of combining quantitative metrics with qualitative inquiry to better understand how patient motivation and technology acceptance contribute to stroke recovery.