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Yang SW, Ma SR, Choi JB. Effect of 3-Dimensional Robotic Therapy Combined with Electromyography-Triggered Neuromuscular Electrical Stimulation on Upper Limb Function and Cerebral Cortex Activation in Stroke Patients: A Randomized Controlled Trial. Bioengineering (Basel) 2023; 11:12. [PMID: 38247889 PMCID: PMC10813281 DOI: 10.3390/bioengineering11010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: This study investigated the effect of 3-dimensional robotic therapy (RT) combined with electromyography-triggered neuromuscular electrical stimulation (RT-ENMES) on stroke patients' upper-limb function and cerebral cortex activation. (2) Methods: Sixty-one stroke patients were assigned randomly to one of three groups. The stroke patients were in the subacute stage between 2 and 6 months after onset. The three groups received 20 min of RT and 20 min of electromyography-triggered neuromuscular electrical stimulation (ENMES) in the RT-ENMES group (n = 21), 40 min of RT in the RT group (n = 20), and 40 min of ENMES in the ENMES group (n = 20). The treatments were for 40 min, 5 days per week, and for 8 weeks. Upper-extremity function was evaluated using the Fugl-Meyer assessment for upper extremity (FMA-UE), Wolf motor function test, and action research arm test (ARAT); cerebral cortex activation and motor-evoked potential (MEP) amplitude were evaluated before and after the study. (3) Results: The analysis showed significant changes in all evaluation items for all three groups in the before-and-after comparisons. Significant changes were observed in the FMA-UE, ARAT, and MEP; in the posttest, the RT-ENMES group showed more significant changes in the FMA-UE, ARAT, and MEP than the other two groups. (4) Conclusions: The study analysis suggests that RT-ENMES effectively improves upper-limb function and cerebral cortex activation in patients with stroke.
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Affiliation(s)
- Seo-Won Yang
- Department of Occupational Therapy, Sangji University, 83 Sangjidae-gil, Wonju-si 26339, Republic of Korea;
| | - Sung-Ryong Ma
- Department of Occupational Therapy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea;
| | - Jong-Bae Choi
- Department of Occupational Therapy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea;
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The influence of distal and proximal muscle activation on neural crosstalk. PLoS One 2022; 17:e0275997. [PMID: 36282810 PMCID: PMC9595517 DOI: 10.1371/journal.pone.0275997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Previous research has indicated that neural crosstalk is asymmetric, with the dominant effector exerting a stronger influence on the non-dominant effector than vice versa. Recently, it has been hypothesized that this influence is more substantial for proximal than distal effectors. The current investigation was designed to determine the effects of distal ((First Dorsal Interosseous (FDI)) and proximal (triceps brachii (TBI)) muscle activation on neural crosstalk. Twelve right-limb dominant participants (mean age = 21.9) were required to rhythmically coordinate a 1:2 pattern of isometric force guided by Lissajous displays. Participants performed 10, 30 s trials with both distal and proximal effectors. Coherence between the two effector groups were calculated using EMG-EMG wavelet coherence. The results indicated that participants could effectively coordinate the goal coordination pattern regardless of the effectors used. However, spatiotemporal performance was more accurate when performing the task with distal than proximal effectors. Force distortion, quantified by harmonicity, indicated that more perturbations occurred in the non-dominant effector than in the dominant effector. The results also indicated significantly lower harmonicity for the non-dominant proximal effector compared to the distal effectors. The current results support the notion that neural crosstalk is asymmetric in nature and is greater for proximal than distal effectors. Additionally, the EMG-EMG coherence results indicated significant neural crosstalk was occurring in the Alpha bands (5-13 Hz), with higher values observed in the proximal condition. Significant coherence in the Alpha bands suggest that the influence of neural crosstalk is occurring at a subcortical level.
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Porta F, Celian C, Patton JL. Upper Extremity Functional Rehabilitation for Stroke Survivors Using Error-Augmented Visual Feedback: Interim Results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1318-1324. [PMID: 34891528 DOI: 10.1109/embc46164.2021.9630799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Stroke rehabilitation is often terminated once a plateau in motor recovery is observed, but new training modalities have demonstrated that further functional improvement is possible after the onset of the chronic phase. In particular, feedback technologies augmenting error proved to foster the relearning process. Here we explore the possibility of a robot-free implementation of Error-Augmentation (EA), where only visual feedback is distorted. We present the interim results from our ongoing blinded, randomized, controlled clinical trial testing the efficacy of parallel bimanual reaching with visual EA. Subjects trained in the virtual environment in 45-minute sessions, three times a week, for three weeks, half with and half without EA. A blinded therapist performed clinical evaluations before, 1 week after, and two months after training. Available results showed that both groups significantly improved. An advantage in the treatment group could be tracked at all time points, but no statistical significance was detectable between groups. Gains in the two groups were found to be compatible with the results of previous studies using robots and may prove to have similar effectiveness without the need for a costly and complicated robotic device. One new finding was that EA caused significantly higher inter-trial variability.
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Singh N, Saini M, Kumar N, Srivastava MVP, Kumaran SS, Mehndiratta A. A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke. Front Neurol 2021; 12:680733. [PMID: 34322080 PMCID: PMC8313089 DOI: 10.3389/fneur.2021.680733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In this study, a novel electromechanical robotic exoskeleton was developed for the rehabilitation of distal joints. The objective was to explore the functional MRI and the neurophysiological changes in cortical-excitability in response to exoskeleton training for a 9-year chronic stroke patient. Case-Report: The study involved a 52-year old female patient with a 9-year chronic stroke of the right hemisphere, who underwent 20 therapy sessions of 45 min each. Cortical-excitability and clinical-scales: Fugl-Mayer (FM), Modified Ashworth Scale (MAS), Brunnstrom-Stage (BS), Barthel-Index (BI), Range of Motion (ROM), were assessed pre-and post-therapy to quantitatively assess the motor recovery. Clinical Rehabilitation Impact: Increase in FM wrist/hand by 6, BI by 10, and decrease in MAS by 1 were reported. Ipsilesional Motor Evoked Potential (MEP) (obtained using Transcranial Magnetic Stimulation) was increased by 98 μV with a decrease in RMT by 6% and contralesional MEP was increased by 43 μV with a decrease in RMT by 4%. Laterality Index of Sensorimotor Cortex (SMC) reduced in precentral- gyrus (from 0.152 to -0.707) and in postcentral-gyrus (from 0.203 to -0.632). Conclusion: The novel exoskeleton-based training showed improved motor outcomes, cortical excitability, and neuronal activation. The research encourages the further investigation of the potential of exoskeleton training.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S. Senthil Kumaran
- Department of Nuclear Medicine and Resonance, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Singh N, Saini M, Kumar N, Srivastava MVP, Mehndiratta A. Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:76. [PMID: 33957937 PMCID: PMC8101163 DOI: 10.1186/s12984-021-00867-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training sessions with dose-matched conventional therapy in patients with stroke. Methods A pilot prospective parallel randomized controlled study at clinical settings was designed for patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 min each, five days a week for four weeks, in Robotic-therapy Group (RG) (n = 12) and conventional upper-limb rehabilitation in Control-Group (CG) (n = 11). We intended to evaluate the effects of a novel exoskeleton based therapy on the functional rehabilitation outcomes of upper-limb and cortical-excitability in patients with stroke as compared to the conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunnstrom-stage and Fugl-Meyer (FM) scale and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre- and post-therapy. Results No side effects were noticed in any of the patients. Both RG and CG showed significant (p < 0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p < 0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p < 0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p < 0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion Robotic-exoskeleton training showed improvement in motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial registry number: ISRCTN95291802 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00867-7.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All Indian Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Zhao S, Liu J, Gong Z, Lei Y, OuYang X, Chan CC, Ruan S. Wearable Physiological Monitoring System Based on Electrocardiography and Electromyography for Upper Limb Rehabilitation Training. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4861. [PMID: 32872111 PMCID: PMC7506771 DOI: 10.3390/s20174861] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 01/16/2023]
Abstract
Secondary injuries are common during upper limb rehabilitation training because of uncontrollable physical force and overexciting activities, and long-time training may cause fatigue and reduce the training effect. This study proposes a wearable monitoring device for upper limb rehabilitation by integrating electrocardiogram and electromyogram (ECG/EMG) sensors and using data acquisition boards to obtain accurate signals during robotic glove assisting training. The collected ECG/EMG signals were filtered, amplified, digitized, and then transmitted to a remote receiver (smart phone or laptop) via a low-energy Bluetooth module. A software platform was developed for data analysis to visualize ECG/EMG information, and integrated into the robotic glove control module. In the training progress, various hand activities (i.e., hand closing, forearm pronation, finger flexion, and wrist extension) were monitored by the EMG sensor, and the changes in the physiological status of people (from excited to fatigue) were monitored by the ECG sensor. The functionality and feasibility of the developed physiological monitoring system was demonstrated by the assisting robotic glove with an adaptive strategy for upper limb rehabilitation training improvement. The feasible results provided a novel technique to monitor individual ECG and EMG information holistically and practically, and a technical reference to improve upper limb rehabilitation according to specific treatment conditions and the users' demands. On the basis of this wearable monitoring system prototype for upper limb rehabilitation, many ECG-/EMG-based mobile healthcare applications could be built avoiding some complicated implementation issues such as sensors management and feature extraction.
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Affiliation(s)
- Shumi Zhao
- Sino-German College of Intelligent Manufacturing, Shenzhen Technology University, Shenzhen 518118, China; (J.L.); (Y.L.); (C.C.C.); (S.R.)
| | - Jianxun Liu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Zidan Gong
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Yisong Lei
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Xia OuYang
- Department of Electrical Engineering, The Hong Kong Polytechnic University, Hong Kong 518118, China;
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Chi Chiu Chan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Shuangchen Ruan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
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Qian Q, Nam C, Guo Z, Huang Y, Hu X, Ng SC, Zheng Y, Poon W. Distal versus proximal - an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial. J Neuroeng Rehabil 2019; 16:64. [PMID: 31159822 PMCID: PMC6545723 DOI: 10.1186/s12984-019-0537-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints. Methods Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions. Results Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05). Conclusions Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE. Clinical trial registration ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089
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Affiliation(s)
- Qiuyang Qian
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chingyi Nam
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ziqi Guo
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yanhuan Huang
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Stephanie C Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Nam C, Rong W, Li W, Xie Y, Hu X, Zheng Y. The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke. Front Neurol 2017; 8:679. [PMID: 29312116 PMCID: PMC5735084 DOI: 10.3389/fneur.2017.00679] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
Background Impaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand was designed previously, whereas its rehabilitation effects were not investigated. Objectives This study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke. Method A clinical trial with single-group design was conducted on chronic stroke participants (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS). Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs) of the target muscles in the upper limb. Results Significant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05), the ARAT (P < 0.05), and in the MAS (P < 0.05) were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD) and biceps brachii (P < 0.05), as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05). Conclusion The upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later. Trial registration ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yunong Xie
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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Qian Q, Hu X, Lai Q, Ng SC, Zheng Y, Poon W. Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm. Front Neurol 2017; 8:447. [PMID: 28928706 PMCID: PMC5591334 DOI: 10.3389/fneur.2017.00447] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Effective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was designed for the multi-joint physical training on the elbow, the wrist, and the fingers. Objectives To investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments. Method This study was a pilot randomized controlled trial with a 3-month follow-up. Subacute stroke participants were randomly assigned into two groups, and then received 20-session upper limb training with the EMG-driven NMES-robotic arm (NMES-robot group, n = 14) or the time-matched traditional therapy (the control, n = 10). For the evaluation of the training effects, clinical assessments including Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), Action Research Arm Test (ARAT), and Function Independence Measurement (FIM) were conducted before, after the rehabilitation training, and 3 months later. Session-by-session EMG parameters in the NMES-robot group, including normalized co-contraction Indexes (CI) and EMG activation level of target muscles, were used to monitor the progress in muscular coordination patterns. Results Significant improvements were obtained in FMA (full score and shoulder/elbow), ARAT, and FIM [P < 0.001, effect sizes (EFs) > 0.279] for both groups. Significant improvement in FMA wrist/hand was only observed in the NMES-robot group (P < 0.001, EFs = 0.435) after the treatments. Significant reduction in MAS wrist was observed in the NMES-robot group after the training (P < 0.05, EFs = 0.145) and the effects were maintained for 3 months. MAS scores in the control group were elevated following training (P < 0.05, EFs > 0.24), and remained at an elevated level when assessed 3 months later. The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii, as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group. Conclusion The NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy. It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014.
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Affiliation(s)
- Qiuyang Qian
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Xiaoling Hu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Qian Lai
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Stephanie C Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yongping Zheng
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Rong W, Li W, Pang M, Hu J, Wei X, Yang B, Wai H, Zheng X, Hu X. A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke. J Neuroeng Rehabil 2017; 14:34. [PMID: 28446181 PMCID: PMC5406922 DOI: 10.1186/s12984-017-0245-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 04/14/2017] [Indexed: 11/20/2022] Open
Abstract
Background It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. Method In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training. Results In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). Conclusions The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers. Trial registration ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014
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Affiliation(s)
- Wei Rong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Waiming Li
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mankit Pang
- Industry Centre, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Junyan Hu
- Institute of Textile & Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Xijun Wei
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Bibo Yang
- The Department of Logistics and Maritime Studies, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Honwah Wai
- Industry Centre, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Xiaoxiang Zheng
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China
| | - Xiaoling Hu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Go EJ, Lee SH. Effect of sensorimotor stimulation on chronic stroke patients' upper extremity function: a preliminary study. J Phys Ther Sci 2017; 28:3350-3353. [PMID: 28174449 PMCID: PMC5276758 DOI: 10.1589/jpts.28.3350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/09/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the effect of an intensive
sensorimotor stimulation program on the motor function of chronic hemiparetic patients.
[Subjects and Methods] The subjects were three chronic stroke patients whose sensory
function was intact, who had Mini-Mental State Examination − Korean version scores of more
than 26, and manual muscle test scores of more than fair for affected shoulder and elbow.
The research design was an A-B single subject experimental design. The intervention
consisted of 4 baselines phase sessions, and 12 sensorimotor stimulation phase sessions.
The sensory and motor stimulation was performed for 30 minutes per session. The efficacy
of the program was evaluated by the Box and Block test, and the 10-second test. [Results]
Box and Block test and 10-second test scores of each subject improved after the 8 weeks
intervention. [Conclusion] The intensive sensorimotor stimulation program for the upper
extremity may be an efficacious method for improving the function of the affected limb of
chronic stroke patients.
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Affiliation(s)
- Eun-Ji Go
- Department of Occupational Therapy, Soonchunhyang University Graduate School, Republic of Korea
| | - Sang-Heon Lee
- Department of Occupational Therapy, College of Medical Sciences, Soonchunhyang University, Republic of Korea
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Fasoli SE, Krebs HI, Hogan N. Robotic Technology and Stroke Rehabilitation: Translating Research into Practice. Top Stroke Rehabil 2015; 11:11-9. [PMID: 15592986 DOI: 10.1310/g8xb-vm23-1tk7-pwqu] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research on the effectiveness of robotic therapy for the paretic upper limb after stroke has shown statistically significant reductions in motor impairment during both acute and chronic phases of recovery. Despite growing empirical support for this technology and a stronger focus on optimizing rehabilitation outcomes and productivity, there continues to be a disconnect between research and clinical practice. We review studies on the use of robot-aided neurorehabilitation for the paretic arm after stroke and discuss ways in which this technology may provide opportunities for intensive training that complement more conventional therapy methods.
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Affiliation(s)
- Susan E Fasoli
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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13
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Hu XL, Tong RKY, Ho NSK, Xue JJ, Rong W, Li LSW. Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke. Neurorehabil Neural Repair 2014; 29:767-76. [PMID: 25549656 DOI: 10.1177/1545968314565510] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke. OBJECTIVE To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training. METHODS This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training. RESULTS The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05). CONCLUSIONS The NMES robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.
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Affiliation(s)
- Xiao-Ling Hu
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR
| | - Raymond Kai-yu Tong
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR Department of Electronic Engineering, the Chinese University of Hong Kong, Hong Kong, SAR
| | - Newmen S K Ho
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR
| | - Jing-jing Xue
- The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Rong
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR
| | - Leonard S W Li
- Tung Wah Hospital, the University of Hong Kong, Hong Kong, SAR
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14
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Hu X, Wang Y, Zhao T, Gunduz A. Neural coding for effective rehabilitation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:286505. [PMID: 25258708 PMCID: PMC4167232 DOI: 10.1155/2014/286505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/23/2014] [Accepted: 08/10/2014] [Indexed: 01/31/2023]
Abstract
Successful neurological rehabilitation depends on accurate diagnosis, effective treatment, and quantitative evaluation. Neural coding, a technology for interpretation of functional and structural information of the nervous system, has contributed to the advancements in neuroimaging, brain-machine interface (BMI), and design of training devices for rehabilitation purposes. In this review, we summarized the latest breakthroughs in neuroimaging from microscale to macroscale levels with potential diagnostic applications for rehabilitation. We also reviewed the achievements in electrocorticography (ECoG) coding with both animal models and human beings for BMI design, electromyography (EMG) interpretation for interaction with external robotic systems, and robot-assisted quantitative evaluation on the progress of rehabilitation programs. Future rehabilitation would be more home-based, automatic, and self-served by patients. Further investigations and breakthroughs are mainly needed in aspects of improving the computational efficiency in neuroimaging and multichannel ECoG by selection of localized neuroinformatics, validation of the effectiveness in BMI guided rehabilitation programs, and simplification of the system operation in training devices.
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Affiliation(s)
- Xiaoling Hu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yiwen Wang
- Qiushi Academy for Advanced Studies, Zhejiang University, Zhejiang 310027, China
| | - Ting Zhao
- Howard Hughes Medical Institute, Janelia Farm Research Campus, Ashburn, VA 20147, USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
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15
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Hu XL, Tong KY, Wei XJ, Rong W, Susanto EA, Ho SK. The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot. J Electromyogr Kinesiol 2013; 23:1065-74. [PMID: 23932795 DOI: 10.1016/j.jelekin.2013.07.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/05/2013] [Accepted: 07/13/2013] [Indexed: 01/10/2023] Open
Abstract
Loss of hand function and finger dexterity are main disabilities in the upper limb after stroke. An electromyography (EMG)-driven hand robot had been developed for post-stroke rehabilitation training. The effectiveness of the hand robot assisted whole upper limb training was investigated on persons with chronic stroke (n=10) in this work. All subjects attended a 20-session training (3-5times/week) by using the hand robot to practice object grasp/release and arm transportation tasks. Significant motor improvements were observed in the Fugl-Meyer hand/wrist and shoulder/elbow scores (p<0.05), and also in the Action Research Arm Test and Wolf Motor Function Test (p<0.05). Significant reduction in spasticity of the fingers as was measured by the Modified Ashworth Score (p<0.05). The training improved the muscle co-ordination between the antagonist muscle pair (flexor digitorum (FD) and extensor digitorum (ED)), associated with a significant reduction in the ED EMG level (p<0.05) and a significant decrease of ED and FD co-contraction during the training (p<0.05); the excessive muscle activities in the biceps brachii were also reduced significantly after the training (p<0.05).
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Affiliation(s)
- X L Hu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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Stinear C, Ackerley S, Byblow W. Rehabilitation is Initiated Early After Stroke, but Most Motor Rehabilitation Trials Are Not. Stroke 2013; 44:2039-45. [DOI: 10.1161/strokeaha.113.000968] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cathy Stinear
- From the Department of Medicine, University of Auckland, Private Bag, New Zealand (C.S., S.A.); Department of Sport & Exercise Science, University of Auckland, Private Bag, New Zealand (W.B.); and Centre for Brain Research, University of Auckland, Private Bag, New Zealand (C.S., S.A., W.B.)
| | - Suzanne Ackerley
- From the Department of Medicine, University of Auckland, Private Bag, New Zealand (C.S., S.A.); Department of Sport & Exercise Science, University of Auckland, Private Bag, New Zealand (W.B.); and Centre for Brain Research, University of Auckland, Private Bag, New Zealand (C.S., S.A., W.B.)
| | - Winston Byblow
- From the Department of Medicine, University of Auckland, Private Bag, New Zealand (C.S., S.A.); Department of Sport & Exercise Science, University of Auckland, Private Bag, New Zealand (W.B.); and Centre for Brain Research, University of Auckland, Private Bag, New Zealand (C.S., S.A., W.B.)
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Hu XL, Tong KY, Wei XJ, Rong W, Susanto EA, Ho SK. Coordinated upper limb training assisted with an electromyography (EMG)-driven hand robot after stroke. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:5903-5906. [PMID: 24111082 DOI: 10.1109/embc.2013.6610895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An electromyography (EMG)-driven hand robot had been developed for post-stroke rehabilitation training. The effectiveness of the hand robot assisted whole upper limb training on muscular coordination was investigated on persons with chronic stroke (n=10) in this work. All subjects attended a 20-session training (3-5 times/week) by using the hand robot to practice object grasp/release and arm transportation tasks. Improvements were found in the muscle co-ordination between the antagonist muscle pair (flexor digitorum and extensor digitorum) as measured by muscle co-contractions in EMG signals; and also in the reduction of excessive muscle activities in the biceps brachii. Reduced spasticity in the fingers was also observed as measured by the Modified Ashworth Score.
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18
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Hu XL, Tong KY, Li R, Chen M, Xue JJ, Ho SK, Chen PN. Post-stroke wrist rehabilitation assisted with an intention-driven functional electrical stimulation (FES)-robot system. IEEE Int Conf Rehabil Robot 2012; 2011:5975424. [PMID: 22275625 DOI: 10.1109/icorr.2011.5975424] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this work, a novel FES-robot system was developed for wrist rehabilitation training after stroke. The FES-robot system could be continuously controlled by electromyography (EMG) from the residual wrist muscles to facilitate wrist flexion and extension tracking tasks on a horizontal plane by providing assistance from both FES and robot parts. The system performance with five different assistive combinations from the FES and robot parts was evaluated by subjects with chronic stroke (n=5). The results suggested that the assistance from the robot part mainly improved the movement accuracy in the tracking tasks; and the assistance from the FES part mainly suppressed the excessive muscular activities from the elbow joint. The best combination was when the assistances from FES and robot was 1:1, and the results showed better wrist tracking performance with less muscle co-contraction from the elbow joint.
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Affiliation(s)
- X L Hu
- Dept. of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China, SAR
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Hu XL, Tong KY, Li R, Xue JJ, Ho SK, Chen P. The effects of electromechanical wrist robot assistive system with neuromuscular electrical stimulation for stroke rehabilitation. J Electromyogr Kinesiol 2012; 22:431-9. [PMID: 22277205 DOI: 10.1016/j.jelekin.2011.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/25/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022] Open
Abstract
An electromyography (EMG)-driven electromechanical robot system integrated with neuromuscular electrical stimulation (NMES) was developed for wrist training after stroke. The performance of the system in assisting wrist flexion/extension tracking was evaluated on five chronic stroke subjects, when the system provided five different schemes with or without NMES and robot assistance. The tracking performances were measured by range of motion (ROM) of the wrist and root mean squared error (RMSE). The performance is better when both NMES and robot assisted in the tracking than those with either NMES or robot only (P<0.05). The muscle co-contractions in the upper limb measured by EMG were reduced when NMES provided assistance (P<0.05). All subjects also attended a 20-session wrist training for evaluating the training effects (3-5 times/week). The results showed improvements on the voluntary motor functions in the hand, wrist and elbow functions after the training, as indicated by the clinical scores of Fugl-Meyer Assessment, Action Research Arm Test, Wolf Motor Function Test; and also showed reduced spasticity in the wrist and the elbow as measured by the Modified Ashworth Score of each subject. After the training, the co-contractions were reduced between the flexor carpi radialis and extensor carpi radialis, and between the biceps brachii and triceps brachii. Assistance from the robot helped improve the movement accuracy; and the NMES helped increase the muscle activation for the wrist joint and suppress the excessive muscular activities from the elbow joint. The NMES-robot assisted wrist training could improve the hand, wrist, and elbow functions.
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Affiliation(s)
- X L Hu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
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Hu XL, Tong KY, Li R, Chen M, Xue JJ, Ho SK, Chen PN. Effectiveness of functional electrical stimulation (FES)-robot assisted wrist training on persons after stroke. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:5819-22. [PMID: 21096914 DOI: 10.1109/iembs.2010.5627471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A functional electrical stimulation (FES)-robot system controlled by subjects' motor intention was developed in our previous study. The effectiveness of the FES-robot on wrist training was investigated in this work. Five hemiplegic subjects with chronic stroke were recruited for an FES-robot assisted wrist training with 20 sessions. After the training, motor improvements were found in the wrist and fingers, represented by significant increase (P < 0.05) in clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), and the Modified Ashworth Score (MAS). Muscle coordination in the upper limb was also improved during the training as assessed by electromyography. The increased ARAT scores suggested improved upper limb motor functions, especially in the hand and fingers, compared to no improvement in previous study with only interactive robot-assisted wrist training without FES.
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Affiliation(s)
- X L Hu
- Department of Health Technology and informatics, the Hong Kong Polytechnic University, China, SAR
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21
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Feijen L, Hodges NJ, Beek PJ. Acquiring a Novel Coordination Skill without Practicing the Correct Motor Commands. J Mot Behav 2010; 42:295-306. [DOI: 10.1080/00222895.2010.504760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
PURPOSE The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills. Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined. DISCUSSION AND CONCLUSION Although, there is strong evidence that early augmented exercise therapy time (expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.
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Affiliation(s)
- Gert Kwakkel
- De Hoogstraat Center of Excellence for Rehabilitation, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, and VU University Medical Center, Amsterdam, The Netherlands.
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23
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Hu XL, Tong KY, Song R, Zheng XJ, Leung WWF. A Comparison Between Electromyography-Driven Robot and Passive Motion Device on Wrist Rehabilitation for Chronic Stroke. Neurorehabil Neural Repair 2009; 23:837-46. [PMID: 19531605 DOI: 10.1177/1545968309338191] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background. The effect of using robots to improve motor recovery has received increased attention, even though the most effective protocol remains a topic of study. Objective . The objective was to compare the training effects of treatments on the wrist joint of subjects with chronic stroke with an interactive rehabilitation robot and a robot with continuous passive motion. Methods. This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-seven hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with a continuous electromyography (EMG)-driven robot (interactive group, n = 15) and a passive motion device (passive group, n = 12), completed within 7 consecutive weeks. Training effects were evaluated with clinical scores by pretraining and posttraining tests (Fugl-Meyer Assessment [FMA] and Modified Ashworth Score [MAS]) and with session-by-session EMG parameters (EMG activation level and co-contraction index). Results. Significant improvements in FMA scores (shoulder/elbow and wrist/hand) were found in the interactive group ( P < .05). Significant decreases in the MAS were observed in the wrist and elbow joints for the interactive group and in the wrist joint for the passive group ( P < .05). These MAS changes were associated with the decrease in EMG activation level of the flexor carpi radialis and the biceps brachii for the interactive group ( P < .05). The muscle coordination on wrist and elbow joints was improved in the interactive groups in the EMG co-contraction indexes across the training sessions ( P < .05). Conclusions. The interactive treatment improved muscle coordination and reduced spasticity after the training for both the wrist and elbow joints, which persisted for 3 months. The passive mode training mainly reduced the spasticity in the wrist flexor.
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Affiliation(s)
- Xiao Ling Hu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Kai-yu Tong
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Rong Song
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Xiu Juan Zheng
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Wallace W. F. Leung
- Department of Mechanical Engineering, Hong Kong Polytechnic University, Hong Kong
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Hemiplegic Shoulder Pain Syndrome: Frequency and Characteristics During Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2008; 89:1589-93. [DOI: 10.1016/j.apmr.2007.10.051] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 09/20/2007] [Accepted: 10/21/2007] [Indexed: 11/18/2022]
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25
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Nejat G, Yiyuan Sun, Nies M. Assistive Robots in Health Care Settings. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2008. [DOI: 10.1177/1084822308325695] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Excellence in patient care is achieved through the very latest in technological advancements such as assistive robots. The purpose of this article is to review the literature on the use of assistive robots in various health care settings. The article includes a discussion of the strengths and limitations for noninteractive and interactive robots in health care and a summary of the implications for practice.
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Affiliation(s)
| | - Yiyuan Sun
- University of North Carolina, Charlotte, NC
| | - Mary Nies
- University of North Carolina, Charlotte, NC
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26
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Hu XL, Tong KY, Song R, Zheng XJ, Lui KH, Leung WWF, Ng S, Au-Yeung SSY. Quantitative evaluation of motor functional recovery process in chronic stroke patients during robot-assisted wrist training. J Electromyogr Kinesiol 2008; 19:639-50. [PMID: 18490177 DOI: 10.1016/j.jelekin.2008.04.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 01/31/2008] [Accepted: 04/03/2008] [Indexed: 10/22/2022] Open
Abstract
This study was to investigate the motor functional recovery process in chronic stroke during robot-assisted wrist training. Fifteen subjects with chronic upper extremity paresis after stroke attended a 20-session wrist tracking training using an interactive rehabilitation robot. Electromyographic (EMG) parameters, i.e., EMG activation levels of four muscles: biceps brachii (BIC), triceps brachii (TRI, lateral head), flexor carpiradialis (FCR), and extensor carpiradialis (ECR) and their co-contraction indexes (CI) were used to monitor the neuromuscular changes during the training course. The EMG activation levels of the FCR (11.1% of decrease from the initial), BIC (17.1% of decrease from the initial), and ECR (29.4% of decrease from the initial) muscles decreased significantly during the training (P<0.05). Such decrease was associated with decreased Modified Ashworth Scores for both the wrist and elbow joints (P<0.05). Significant decrease (P<0.05) was also found in CIs of muscle pairs, BIC&TRI (21% of decrease from the initial), FCR&BIC (11.3% of decrease from the initial), ECR&BIC (49.3% of decrease from the initial). The decreased CIs related to the BIC muscle were mainly caused by the reduction in the BIC EMG activation level, suggesting a better isolation of the wrist movements from the elbow motions. The decreased CI of ECR& FCR in the later training sessions (P<0.05) was due to the reduced co-contraction phase of the antagonist muscle pair in the tracking tasks. Significant improvements (P<0.05) were also found in motor outcomes related to the shoulder/elbow and wrist/hand scores assessed by the Fugl-Meyer assessment before and after the training. According to the evolution of the EMG parameters along the training course, further motor improvements could be obtained by providing more training sessions, since the decreases of the EMG parameters did not reach a steady state before the end of the training. The results in this study provided an objective and quantitative EMG measure to describe the motor recovery process during poststroke robot-assisted wrist for the further understanding on the neuromuscular mechanism associated with the recovery.
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Affiliation(s)
- X L Hu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom Kowloon, Hong Kong
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Hu XL, Song R, Tong KY, Tsang SF, Leung OY, Li L. Coactivations of elbow and shoulder muscles in hemiplegic persons with chronic stroke during robot-assisted training. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2006:4933-5. [PMID: 17945868 DOI: 10.1109/iembs.2006.259575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The motor recovery procedure of chronic stroke during robot-assisted training has not been well studied previously. In this work, we analyzed the variations in the coactivating patterns of elbow and shoulder muscles (biceps, triceps lateral, anterior deltoid, and posterior deltoid) in hemiplegic persons with chronic stroke (n=4) during a 20-session's interactive robot-assisted treatment. Significant decreases in muscle cocontractions (P<0.05) for all muscle pairs started from the 8th session of the training. Improvements were also observed in motor scores of Fugl-Meyer and modified Ashworth scale after the treatment. The results suggested an increased dexterity and selective control on individual muscles for both elbow and shoulder joints in a designed task after the robot-assisted training.
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Affiliation(s)
- X L Hu
- Dept. of Health Technol. & Informatics, Hong Kong Polytech. Univ., China.
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28
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Hu X, Tong KY, Song R, Tsang VS, Leung PO, Li L. Variation of Muscle Coactivation Patterns in Chronic Stroke During Robot-Assisted Elbow Training. Arch Phys Med Rehabil 2007; 88:1022-9. [PMID: 17678665 DOI: 10.1016/j.apmr.2007.05.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the variation of muscle coactivation patterns during the course of robot-assisted rehabilitation on elbow flexion and extension for chronic stroke. DESIGN A detailed electromyographic analysis was conducted on muscle activation levels and muscle coactivation patterns, represented by a cocontraction index of a muscle pair, for the muscles of biceps brachii, triceps brachii, anterior deltoid, and posterior deltoid, during training of elbow extension and flexion, actively assisted by a robot, from 0 degrees to 90 degrees by tracking a target moving at a speed of 10 degrees /s on the screen. SETTING Rehabilitation center research laboratory. PARTICIPANTS Seven hemiplegic chronic stroke patients received elbow training. INTERVENTIONS Each subject received 20 sessions (1.5 hours/session) of the elbow training on his/her paretic side at an intensity of 3 to 5 times a week for a training period of 7 consecutive weeks. MAIN OUTCOME MEASURES Muscle cocontraction index, muscle activation level, and Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Status Scale (MSS) scores. RESULTS The electromyographic activation levels of the biceps brachii, triceps brachii, and anterior deltoid of each subject decreased during the training. The overall electromyographic activation levels of the biceps and triceps, which, summarizing the performance of all subjects, decreased significantly in the middle sessions (from the 8th to 12th sessions) of the training (P<.05), associated with the significant decrease (P<.05) in the MAS score. The overall electromyographic activation level of the anterior deltoid also decreased significantly from the 8th to 20th sessions (P<.05). Significant decreases in the cocontractions of all muscle pairs were observed in all subjects and also in the overall cocontraction index (P<.05). The cocontraction between the biceps and triceps significantly decreased when the overall electromyographic levels of the 2 muscles were stable from the 10th to 20th sessions (P<.05). Significant improvements (P<.05) on the FMA and MSS score were also found by the pre- and postassessments. CONCLUSIONS In the 20-session robot-assisted training, the excessive muscle activations reduced mainly in the first half of the training course, which could be related to the learning process of the tracking skill and also to the reduction in muscle spasticity. The muscle coordination for achieving elbow tracking improved significantly in the latter sessions of the training, represented as decreased cocontraction indexes between the muscle pairs.
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Affiliation(s)
- Xiaoling Hu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
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Abstract
Therapeutic activity is a mainstay of clinical neurorehabilitation, but is typically unstructured and directed at compensation rather than restoration of central nervous system function. Newer activity-based therapies (ABTs) are in early stages of development and testing. The ABTs attempt to restore function via standardized therapeutic activity based on principles of experimental psychology, exercise physiology, and neuroscience. Three of the best developed ABTs are constraint-induced therapy, robotic therapy directed at the hemiplegic arm, and treadmill training techniques aimed at improving gait in persons with stroke and spinal cord injury. These treatments appear effective in improving arm function and gait, but they have not yet been clearly demonstrated to be more effective than equal amounts of traditional techniques. Resistance training is clearly demonstrated to improve strength in persons with stroke and brain injury, and most studies show that it does not increase hypertonia. Clinical trials of ABTs face several methodological challenges. These challenges include defining dosage, standardizing treatment parameters across subjects and within treatment sessions, and determining what constitutes clinically significant treatment effects. The long-term goal is to develop prescriptive ABT, where specific activities are proven to treat specific motor system disorders. Activity-based therapies are not a cure, but are likely to play an important role in future treatment cocktails for stroke and spinal cord injury.
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Affiliation(s)
- Alexander W Dromerick
- Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC 20010-2949, USA.
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Masiero S, Celia A, Armani M, Rosati G, Tavolato B, Ferraro C, Ortolani M. Robot-aided intensive training in post-stroke recovery. Aging Clin Exp Res 2006; 18:261-5. [PMID: 16804374 DOI: 10.1007/bf03324658] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The successful motor rehabilitation of stroke patients requires an intensive and task-specific therapy approach. The plasticity of the adult human brain provides opportunities to enhance traditional rehabilitation programs for these individuals. Intensive robot-aided sensorimotor training may have a positive effect on reducing impairment and disability and increasing reorganization of the adult brain. This approach may therefore efficaciously complement standard post-stroke multidisciplinary programs as shown by recent experimental trials.
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Affiliation(s)
- Stefano Masiero
- Department of Rehabilitation Medicine, University of Padova, 35128 Padova, Italy.
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