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Lin L, Qing W, Huang Y, Ye F, Rong W, Li W, Jiao J, Hu X. Comparison of Immediate Neuromodulatory Effects between Focal Vibratory and Electrical Sensory Stimulations after Stroke. Bioengineering (Basel) 2024; 11:286. [PMID: 38534560 DOI: 10.3390/bioengineering11030286] [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: 02/21/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Focal vibratory stimulation (FVS) and neuromuscular electrical stimulation (NMES) are promising technologies for sensory rehabilitation after stroke. However, the differences between these techniques in immediate neuromodulatory effects on the poststroke cortex are not yet fully understood. In this research, cortical responses in persons with chronic stroke (n = 15) and unimpaired controls (n = 15) were measured by whole-brain electroencephalography (EEG) when FVS and NMES at different intensities were applied transcutaneously to the forearm muscles. Both FVS and sensory-level NMES induced alpha and beta oscillations in the sensorimotor cortex after stroke, significantly exceeding baseline levels (p < 0.05). These oscillations exhibited bilateral sensory deficiency, early adaptation, and contralesional compensation compared to the control group. FVS resulted in a significantly faster P300 response (p < 0.05) and higher theta oscillation (p < 0.05) compared to NMES. The beta desynchronization over the contralesional frontal-parietal area remained during NMES (p > 0.05), but it was significantly weakened during FVS (p < 0.05) after stroke. The results indicated that both FVS and NMES effectively activated the sensorimotor cortex after stroke. However, FVS was particularly effective in eliciting transient involuntary attention, while NMES primarily fostered the cortical responses of the targeted muscles in the contralesional motor cortex.
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Affiliation(s)
- Legeng Lin
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Wanyi Qing
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, China
- Joint Research Centre for Biosensing and Precision Theranostics, The Hong Kong Polytechnic University, Hong Kong, China
- Research Centre on Data Science and Artificial Intelligence, The Hong Kong Polytechnic University, Hong Kong, China
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Li M, Pun SH, Chen F. Impacts of Cortical Regions on EEG-based Classification of Lexical Tones and Vowels in Spoken Speech. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083036 DOI: 10.1109/embc40787.2023.10340428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Speech impairment is one of the most serious problems for patients with communication disorders, e.g., stroke survivors. The brain-computer interface (BCI) systems have shown the potential to alternatively control or rehabilitate the neurological damages in speech production. The effects of different cortical regions in speech-based BCI systems are essential to be studied, which are favorable for improving the performance of speech-based BCI systems. This work aimed to explore the impacts of different speech-related cortical regions in the electroencephalogram (EEG) based classification of seventy spoken Mandarin monosyllables carrying four vowels and four lexical tones. Seven audible speech production-related cortical regions were studied, involving Broca's and Wernicke's areas, auditory cortex, motor cortex, prefrontal cortex, sensory cortex, left brain, right brain, and whole brain. Following the previous studies in which EEG signals were collected from ten subjects during Mandarin speech production, the features of EEG signals were extracted by the Riemannian manifold method, and a linear discriminant analysis (LDA) was regarded as a classifier to classify different vowels and lexical tones. The results showed that when using electrodes from whole brain, the classifier reached the best performances, which were 48.5% for lexical tones and 70.0% for vowels, respectively. The vowel classification results under Broca's and Wernicke's areas, auditory cortex, or prefrontal cortex were higher than those under the motor cortex or sensory cortex. No such differences were observed in the lexical tone classification task.
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Zhou S, Zhang J, Chen F, Wong TWL, Ng SSM, Li Z, Zhou Y, Zhang S, Guo S, Hu X. Automatic theranostics for long-term neurorehabilitation after stroke. Front Aging Neurosci 2023; 15:1154795. [PMID: 37261267 PMCID: PMC10228725 DOI: 10.3389/fnagi.2023.1154795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Sa Zhou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jianing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Thomson Wai-Lung Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids Beijing, Beijing, China
| | - Yongjin Zhou
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Shaomin Zhang
- Key Laboratory of Biomedical Engineering of Education Ministry, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Department of Biomedical Engineering, School of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Song Guo
- Department of Computing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
- University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Guo Z, Zhou S, Ji K, Zhuang Y, Song J, Nam C, Hu X, Zheng Y. Corticomuscular integrated representation of voluntary motor effort in robotic control for wrist-hand rehabilitation after stroke. J Neural Eng 2022; 19. [PMID: 35193124 DOI: 10.1088/1741-2552/ac5757] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/22/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The central-to-peripheral voluntary motor effort (VME) in physical practice of the paretic limb is a dominant force for driving functional neuroplasticity on motor restoration post-stroke. However, current rehabilitation robots isolated the central and peripheral involvements in the control design, resulting in limited rehabilitation effectiveness. The purpose of this study was to design a corticomuscular coherence (CMC) and electromyography (EMG)-driven (CMC-EMG-driven) system with central-and-peripheral integrated representation of VME for wrist-hand rehabilitation after stroke. APPROACH The CMC-EMG-driven control was developed in a neuromuscular electrical stimulation (NMES)-robot system, i.e., CMC-EMG-driven NMES-robot system, to instruct and assist the wrist-hand extension and flexion in persons after stroke. A pilot single-group trial of 20 training sessions was conducted with the developed system to assess the feasibility for wrist-hand practice on the chronic strokes (n=16). The rehabilitation effectiveness was evaluated through clinical assessments, CMC, and EMG activation levels. MAIN RESULTS The trigger success rate and laterality index (LI) of CMC were significantly increased in wrist-hand extension across training sessions (p<0.05). After the training, significant improvements in the target wrist-hand joints and suppressed compensation from the proximal shoulder-elbow joints were observed through the clinical scores and EMG activation levels (p<0.05). The central-to-peripheral VME distribution across upper extremity (UE) muscles was also significantly improved, as revealed by the CMC values (p<0.05). SIGNIFICANCE Precise wrist-hand rehabilitation was achieved by the developed system, presenting suppressed cortical and muscular compensation from the contralesional hemisphere and the proximal UE, and improved distribution of the central-and-peripheral VME on UE muscles.
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Affiliation(s)
- Ziqi Guo
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Kowloon, Nil, HONG KONG
| | - Sa Zhou
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, HONG KONG
| | - Kailai Ji
- The Hong Kong Polytechnic University, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Kowloon, Hong Kong, HONG KONG
| | - Yongqi Zhuang
- Biomedical Engineering, Hong Kong Polytechnic University, BME PolyU, Kowloon, HONG KONG
| | - Jie Song
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, Nil, HONG KONG
| | - Chingyi Nam
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, Nil, HONG KONG
| | - Xiaoling Hu
- Biomedical Engineering, Hong Kong Polytechnic University, Rm ST420, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, HONG KONG
| | - Yongping Zheng
- Biomedical Engineering, The Hong Kong Polytechnic University, BME PolyU, Hong Kong, Nil, CHINA
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Sheng B, Tang L, Moosman OM, Deng C, Xie S, Zhang Y. Development of a biological signal-based evaluator for robot-assisted upper-limb rehabilitation: a pilot study. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:789-801. [PMID: 31372900 DOI: 10.1007/s13246-019-00783-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 06/03/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
Bio-signal based assessment for upper-limb functions is an attractive technology for rehabilitation. In this work, an upper-limb function evaluator is developed based on biological signals, which could be used for selecting different robotic training protocols. Interaction force (IF) and participation level (PL, processed surface electromyography (sEMG) signals) are used as the key bio-signal inputs for the evaluator. Accordingly, a robot-based standardized performance testing (SPT) is developed to measure these key bio-signal data. Moreover, fuzzy logic is used to regulate biological signals, and a rules-based selector is then developed to select different training protocols. To the authors' knowledge, studies focused on biological signal-based evaluator for selecting robotic training protocols, especially for robot-based bilateral rehabilitation, has not yet been reported in literature. The implementation of SPT and fuzzy logic to measure and process key bio-signal data with a rehabilitation robot system is the first of its kind. Five healthy participants were then recruited to test the performance of the SPT, fuzzy logic and evaluator in three different conditions (tasks). The results show: (1) the developed SPT has an ability to measure precise bio-signal data from participants; (2) the utilized fuzzy logic has an ability to process the measured data with the accuracy of 86.7% and 100% for the IF and PL respectively; and (3) the proposed evaluator has an ability to distinguish the intensity of biological signals and thus to select different robotic training protocols. The results from the proposed evaluator, and biological signals measured from healthy people could also be used to standardize the criteria to assess the results of stroke patients later.
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Affiliation(s)
- Bo Sheng
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
| | - Lihua Tang
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| | - Oscar Moroni Moosman
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
| | - Chao Deng
- School of Mechanical Science & Engineering, Huazhong University of Science & Technology, Wuhan, China
| | - Shane Xie
- School of Electronic and Electrical Engineering, The University of Leeds, Leeds, UK
| | - Yanxin Zhang
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand.
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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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Buharin VE, Shinohara M. Corticospinal excitability for flexor carpi radialis decreases with baroreceptor unloading during intentional co-contraction with opposing forearm muscles. Exp Brain Res 2019; 237:1947-1958. [PMID: 31129694 DOI: 10.1007/s00221-019-05563-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/17/2019] [Indexed: 11/29/2022]
Abstract
Concurrent activation of antagonistic muscles (co-contraction) is used for stiffening a joint, whereas its neural control under hemodynamic stress (e.g., posture change, high gravity, and hemorrhage) is unknown. Corticospinal excitability during co-contraction may be altered with baroreceptor unloading due to potential modulations in spinal and/or inhibitory pathways (e.g., disynaptic group I inhibition and GABA-mediated intracortical inhibition). The purpose of this study was to understand the effect of baroreceptor unloading on corticospinal excitability during co-contraction in humans. Motor evoked potential and cortical silent period in a wrist flexor muscle were examined using transcranial magnetic stimulation in two groups of healthy young adults. All subjects performed isometric contraction of the wrist flexors (flexion) and co-contraction of the wrist flexors and extensors (co-contraction). Spinal disynaptic inhibition was also assessed with the ratio of H-reflex responses to unconditioned and conditioned electrical stimulations of the peripheral nerves for the muscles. In one of the groups, baroreflex unloading was induced by applying lower body negative pressure. There was no significant effect of baroreflex unloading on cortical silent period or H-reflex measure of disynaptic inhibition. With baroreflex unloading, motor evoked potential area in the flexor carpi radialis was decreased during co-contraction but not during flexion. The results indicated that baroreceptor unloading decreases corticospinal excitability during co-contraction of antagonistic muscles, apparently by influencing neural pathways that were not probed with cortical silent period or spinal disynaptic inhibition.
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Affiliation(s)
- Vasiliy E Buharin
- School of Biological Sciences, Georgia Institute of Technology, 555 14th Street NW, Atlanta, GA, 30332-0356, USA.,Activ Surgical, 840 Summer Street, Suite 108, Boston, MA, 02127, USA
| | - Minoru Shinohara
- School of Biological Sciences, Georgia Institute of Technology, 555 14th Street NW, Atlanta, GA, 30332-0356, USA.
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van der Krogt H, Kouwijzer I, Klomp A, Meskers CGM, Arendzen JH, de Groot JH. Loss of selective wrist muscle activation in post-stroke patients. Disabil Rehabil 2019; 42:779-787. [PMID: 30634868 DOI: 10.1080/09638288.2018.1509241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Loss of selective muscle activation after stroke contributes to impaired arm function, is difficult to quantify and is not systematically assessed yet. The aim of this study was to describe and validate a technique for quantification of selective muscle activation of wrist flexor and extensor muscles in a cohort of post-stroke patients. Patterns of selective muscle activation were compared to healthy volunteers and test-retest reliability was assessed.Materials and methods: Activation Ratios describe selective activation of a muscle during its expected optimal activation as agonist and antagonist. Activation Ratios were calculated from electromyography signals during an isometric maximal torque task in 31 post-stroke patients and 14 healthy volunteers. Participants with insufficient voluntary muscle activation (maximal electromyography signal <3SD higher than baseline) were excluded.Results: Activation Ratios at the wrist were reliably quantified (Intraclass correlation coefficients 0.77-0.78). Activation Ratios were significantly lower in post-stroke patients compared to healthy participants (p < 0.05).Conclusion: Activation Ratios allow for muscle-specific quantification of selective muscle activation at the wrist in post-stroke patients. Loss of selective muscle activation may be a relevant determinant in assigning and evaluating therapy to improve functional outcome.Implications for RehabilitationLoss of selective muscle activation after stroke contributes to impaired arm function, is difficult to quantify and is not systematically assessed yet.The ability for selective muscle activation is a relevant determinant in assigning and evaluating therapy to improve functional outcome, e.g., botulinum toxin.Activation Ratios allow for reliable and muscle-specific quantification of selective muscle activation in post-stroke patients.
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Affiliation(s)
- Hanneke van der Krogt
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid Kouwijzer
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Asbjørn Klomp
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J Hans Arendzen
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurriaan H de Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Sheng B, Tang L, Xie S, Deng C, Zhang Y. Alterations in muscle activation patterns during robot-assisted bilateral training: A pilot study. Proc Inst Mech Eng H 2018; 233:219-231. [DOI: 10.1177/0954411918819115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Robot-assisted bilateral training is being developed as a new rehabilitation approach for stroke patients. However, there is still a lack of understanding of muscle functions when performing robot-assisted synchronous movements. The aim of this work is to explore the muscle activation patterns and the voluntary effort of participants during different robot-assisted bilateral training protocols. To this end, 10 healthy participants were recruited to take part in a 60-minute experiment. The experiment included two different bilateral exercises, and each exercise contained four different training protocols. Trajectories of the robots, interaction force and surface electromyogram signals were recorded during training. The results show that the robots do affect the muscle activation patterns during different training protocols and exercises rather than the controller. Specifically, the activity of muscles is reduced in robot-assisted training but is increased in active force involved robot-assisted training when compared to robot-unassisted training. Meanwhile, the voluntary effort of participants can be presented by the adjusted trajectories via the controller. In addition, the results also suggest that the activations for the same muscle groups in the left and right arms are highly correlated with each other in both exercises. Furthermore, the training protocols and methods developed in this work could be further extended in future clinical trials to investigate therapeutic outcomes for patients as well as to better understand bilateral recovery processes.
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Affiliation(s)
- Bo Sheng
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Lihua Tang
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| | - Shengquan Xie
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Deng
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Yanxin Zhang
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
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Vinti M, Gracies JM, Gazzoni M, Vieira T. Localised sampling of myoelectric activity may provide biased estimates of cocontraction for gastrocnemius though not for soleus and tibialis anterior muscles. J Electromyogr Kinesiol 2018; 38:34-43. [DOI: 10.1016/j.jelekin.2017.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022] Open
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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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de Gooijer-van de Groep KL, de Vlugt E, van der Krogt HJ, Helgadóttir Á, Arendzen JH, Meskers CGM, de Groot JH. Estimation of tissue stiffness, reflex activity, optimal muscle length and slack length in stroke patients using an electromyography driven antagonistic wrist model. Clin Biomech (Bristol, Avon) 2016; 35:93-101. [PMID: 27149565 DOI: 10.1016/j.clinbiomech.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND About half of all chronic stroke patients experience loss of arm function coinciding with increased stiffness, reduced range of motion and a flexed wrist due to a change in neural and/or structural tissue properties. Quantitative assessment of these changes is of clinical importance, yet not trivial. The goal of this study was to quantify the neural and structural properties contributing to wrist joint stiffness and to compare these properties between healthy subjects and stroke patients. METHODS Stroke patients (n=32) and healthy volunteers (n=14) were measured using ramp-and-hold rotations applied to the wrist joint by a haptic manipulator. Neural (reflexive torque) and structural (connective tissue stiffness and slack lengths and (contractile) optimal muscle lengths) parameters were estimated using an electromyography driven antagonistic wrist model. Kruskal-Wallis analysis with multiple comparisons was used to compare results between healthy subjects, stroke patients with modified Ashworth score of zero and stroke patients with modified Ashworth score of one or more. FINDINGS Stroke patients with modified Ashworth score of one or more differed from healthy controls (P<0.05) by increased tissue stiffness, increased reflexive torque, decreased optimal muscle length and decreased slack length of connective tissue of the flexor muscles. INTERPRETATION Non-invasive quantitative analysis, including estimation of optimal muscle lengths, enables to identify neural and non-neural changes in chronic stroke patients. Monitoring these changes in time is important to understand the recovery process and to optimize treatment.
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Affiliation(s)
- Karin L de Gooijer-van de Groep
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Postzone B0-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Erwin de Vlugt
- Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, the Netherlands.
| | - Hanneke J van der Krogt
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Postzone B0-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Áróra Helgadóttir
- Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, the Netherlands.
| | - J Hans Arendzen
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Postzone B0-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Postzone B0-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Jurriaan H de Groot
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Postzone B0-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
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13
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Vinti M, Bayle N, Hutin E, Burke D, Gracies JM. Stretch-sensitive paresis and effort perception in hemiparesis. J Neural Transm (Vienna) 2015; 122:1089-97. [PMID: 25702036 DOI: 10.1007/s00702-015-1379-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/08/2015] [Indexed: 01/05/2023]
Abstract
In spastic paresis, stretch applied to the antagonist increases its inappropriate recruitment during agonist command (spastic co-contraction). It is unknown whether antagonist stretch: (1) also affects agonist recruitment; (2) alters effort perception. We quantified voluntary activation of ankle dorsiflexors, effort perception, and plantar flexor co-contraction during graded dorsiflexion efforts at two gastrocnemius lengths. Eighteen healthy (age 41 ± 13) and 18 hemiparetic (age 54 ± 12) subjects performed light, medium and maximal isometric dorsiflexion efforts with the knee flexed or extended. We determined dorsiflexor torque, Root Mean Square EMG and Agonist Recruitment/Co-contraction Indices (ARI/CCI) from the 500 ms peak voluntary agonist recruitment in a 5-s maximal isometric effort in tibialis anterior, soleus and medial gastrocnemius. Subjects retrospectively reported effort perception on a 10-point visual analog scale. During gastrocnemius stretch in hemiparetic subjects, we observed: (1) a 25 ± 7 % reduction of tibialis anterior voluntary activation (maximum reduction 98 %; knee extended vs knee flexed; p = 0.007, ANOVA); (2) an increase in dorsiflexion effort perception (p = 0.03, ANCOVA). Such changes did not occur in healthy subjects. Effort perception depended on tibialis anterior recruitment only (βARI(TA) = 0.61, p < 0.01) in healthy subjects (not on gastrocnemius medialis co-contraction) while it depended on both tibialis anterior agonist recruitment (βARI(TA) = 0.41, p < 0.001) and gastrocnemius medialis co-contraction (βCCI(MG) = 0.43, p < 0.001) in hemiparetic subjects. In hemiparesis, voluntary ability to recruit agonist motoneurones is impaired--sometimes abolished--by antagonist stretch, a phenomenon defined here as stretch-sensitive paresis. In addition, spastic co-contraction increases effort perception, an additional incentive to evaluate and treat this phenomenon.
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Affiliation(s)
- Maria Vinti
- AP-HP, Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil (UPEC), 50, av du Maréchal de Lattre de Tassigny, 94010, Créteil, France,
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14
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Gray V, Rice CL, Garland SJ. Factors that influence muscle weakness following stroke and their clinical implications: a critical review. Physiother Can 2013; 64:415-26. [PMID: 23997398 DOI: 10.3138/ptc.2011-03] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To provide a comprehensive review of changes that occur in the muscle after stroke and how these changes influence the force-generating capacity of the muscle. METHODS A literature search of PubMed, CINAHL, MEDLINE, and Embase was conducted using the search terms stroke, hemiparesis, muscle structure, cross sectional area, atrophy, force, velocity, and torque. There were 27 articles included in this review. RESULTS Three changes occur in the muscle after stroke: a decrease in muscle mass, a decrease in fibre length, and a smaller pennation angle. In addition, the tendon is stretched and becomes more compliant. All of these factors reduce the affected muscle's ability to generate forces similar to controls or to non-paretic muscles. The result is a leftward shift in the length-tension curve, a downward shift in the torque-angle curve, and a downward shift in the force-velocity curve. CONCLUSION Changes in muscle architecture contributing to weakness, such as muscle-fibre length, pennation angle, muscle atrophy, and tendon compliance, should be prevented or reversed by means of an appropriate rehabilitation programme.
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Affiliation(s)
- Vicki Gray
- Graduate Program in Health and Rehabilitation Science
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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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16
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Lee S, Cho S, Kim K. The Effects of Weight-Bearing Exercise on Upper Extremity Activities Performance in the Female Stroke Patients. INTERNATIONAL JOURNAL OF CONTENTS 2013. [DOI: 10.5392/ijoc.2013.9.1.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Li L, Tong KY, Hu XL, Hung LK, Koo TKK. Incorporating ultrasound-measured musculotendon parameters to subject-specific EMG-driven model to simulate voluntary elbow flexion for persons after stroke. Clin Biomech (Bristol, Avon) 2009; 24:101-9. [PMID: 19012998 DOI: 10.1016/j.clinbiomech.2008.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 07/11/2008] [Accepted: 08/01/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was to extend previous neuromusculoskeletal modeling efforts through combining the in vivo ultrasound-measured musculotendon parameters on persons after stroke. METHOD A subject-specific neuromusculoskeletal model of the elbow was developed to predict the individual muscle force during dynamic movement and then validated by joint trajectory. The model combined a geometrical model and a Hill-type musculotendon model, and used subject-specific musculotendon parameters as inputs. EMG signals and joint angle were recorded from healthy control subjects (n=4) and persons after stroke (n=4) during voluntary elbow flexion in a vertical plane. Ultrasonography was employed to measure the muscle optimal length and pennation angle of each prime elbow flexor (biceps brachii, brachialis, brachioradialis) and extensor (three heads of triceps brachii). Maximum isometric muscle stresses of the flexor and extensor muscle group were calibrated by minimizing the root mean square difference between the predicted and measured maximum isometric torque-angle curves. These parameters were then inputted into the neuromusculoskeletal model to predict the individual muscle force using the input of EMG signals directly without any trajectory fitting procedure involved. FINDINGS The results showed that the prediction of voluntary flexion in the hemiparetic group using subject-specific parameters data was better than that using cadaveric data extracted from the literature. INTERPRETATION The results demonstrated the feasibility of using EMG-driven neuromusculoskeletal modeling with direct ultrasound measurement for the prediction of voluntary elbow movement for both subjects without impairment and persons after stroke.
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Affiliation(s)
- L Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
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18
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Spatial resolution of spontaneous accelerations in reaching tasks. J Biomech 2008; 42:29-34. [PMID: 19062017 DOI: 10.1016/j.jbiomech.2008.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 11/21/2022]
Abstract
Reaching tasks are considered well-executed if they appear "smooth," a quality that is typically quantified by its opposite, jerk, the rate of change of acceleration. While jerk is a theoretically sound measure, its application to spastic individuals sometimes yields counter-intuitive results, and does not reveal motor impairment across the workspace. To more generally quantify spontaneous accelerative transients (SATs) within a movement, a pseudo-wavelet transform was devised that iteratively compared angular trajectories to a series of straight-line approximants. Cumulative linear fit errors were expressed in terms of flexion angle, yielding an SAT map of the entire motion. To compare SAT maps with traditional smoothness measures, two scalar indices were extracted from them: residual excursion deviation (RED), representing the integral over Deltatheta and the ratio of peak error to mean error (PEME) on the map. Fifteen subjects, including five subjects with chronic stroke performed elbow flexions throughout their entire ranges of motion, Deltatheta, at a comfortable pace with their arms supported in the transverse plane. Maps revealed that stroke subjects were significantly less coordinated than controls, as measured both by RED: 8.0+/-2.9 x 10(-3) versus 3.1+/-0.8 x 10(-3) and PEME: 6.6+/-0.9 versus 12.1+/-1.9, both P<0.001. Comparable jerk metrics, including integrated average jerk, did not report a significant performance deficit at the P<0.05 level. Map metrics for all subjects were independent of average velocity (correlation with theta : rho0.31), but jerk-based metrics for stroke subjects were spuriously co-variant with velocity rho=0.85, which may relate to the significantly higher mean arrest period ratio in stroke subjects (0.26+/-0.19 versus 0.09+/-0.08, P<0.001). We conclude that SAT maps provide reliable information on regional movement impairments at a wide range of proficiency levels.
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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: 50] [Impact Index Per Article: 3.1] [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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Cruz TH, Dhaher YY. Evidence of abnormal lower-limb torque coupling after stroke: an isometric study. Stroke 2007; 39:139-47. [PMID: 18063824 DOI: 10.1161/strokeaha.107.492413] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although stroke survivors often display abnormal joint torque patterns, studies of torque-coupling in the lower limb are lacking, despite their potential impact on gait abnormalities. METHODS Twenty-two chronic ambulating stroke subjects and 11 age-matched control subjects produced isometric hip torques in the frontal and sagittal planes with the hemiparetic leg (or randomly selected leg for the control group) in postures that resemble stages of gait. The involuntary knee torques were also recorded although no feedback or instructions were given. RESULTS In the toe-off and midswing postures, the stroke group had a significant torque bias toward extension and adduction, whereas the control group had a symmetric torque space. The stroke group also produced significantly smaller torques than the control group in the flexion and abduction/flexion directions. Finally, the stroke group displayed abnormal coupling of knee extension with hip adduction, unique to the toe-off position. CONCLUSIONS Whereas gait abnormalities after stroke have been attributed to a number of factors, including sagittal plane strength impairments at the hip, knee, and ankle, our findings indicate that neuromechanical changes after stroke may play a significant role in determining the nature of the movement abnormality. Specifically, abnormal hip adduction and knee extension torque coupling was observed, in addition to direction-specific hip torque weakness. Future studies are needed to delineate the differential contributions of each potential factor to gait abnormalities. Understanding the underlying neuromechanical changes after stroke may aid the development of rehabilitation strategies.
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Affiliation(s)
- Theresa Hayes Cruz
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
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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: 63] [Impact Index Per Article: 3.7] [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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Schaefer SY, Haaland KY, Sainburg RL. Ipsilesional motor deficits following stroke reflect hemispheric specializations for movement control. ACTA ACUST UNITED AC 2007; 130:2146-58. [PMID: 17626039 PMCID: PMC3769213 DOI: 10.1093/brain/awm145] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recent reports of functional impairment in the 'unaffected' limb of stroke patients have suggested that these deficits vary with the side of lesion. This not only supports the idea that the ipsilateral hemisphere contributes to arm movements, but also implies that such contributions are lateralized. We have previously suggested that the left and right hemispheres are specialized for controlling different features of movement. In reaching movements, the non-dominant arm appears better adapted for achieving accurate final positions and the dominant arm for specifying initial trajectory features, such as movement direction and peak acceleration. The purpose of this study was to determine whether different features of control could characterize ipsilesional motor deficits following stroke. Healthy control subjects and patients with either left- or right-hemisphere damage performed targeted single-joint elbow movements of different amplitudes in their ipsilateral hemispace. We predicted that left-hemisphere damage would produce deficits in specification of initial trajectory features, while right-hemisphere damage would produce deficits in final position accuracy. Consistent with our predictions, patients with left, but not right, hemisphere damage showed reduced modulation of acceleration amplitude. However, patients with right, but not left, hemisphere damage showed significantly larger errors in final position, which corresponded to reduced modulation of acceleration duration. Neither patient group differed from controls in terms of movement speed. Instead, the mechanisms by which speed was specified, through modulation of acceleration amplitude and modulation of acceleration duration, appeared to be differentially affected by left- and right-hemisphere damage. These findings support the idea that each hemisphere contributes differentially to the control of initial trajectory and final position, and that ipsilesional deficits following stroke reflect this lateralization in control.
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Affiliation(s)
- Sydney Y. Schaefer
- Department of Kinesiology, The Pennsylvania State University, University Park, PA
- The Gerontology Center, The Pennsylvania State University, University Park, PA
| | - Kathleen Y. Haaland
- Research Service, New Mexico Veterans Affairs Healthcare System, Albuquerque, NM, USA
- Departments of Psychiatry and Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Robert L. Sainburg
- Department of Kinesiology, The Pennsylvania State University, University Park, PA
- Department of Neurology, The Pennsylvania State University, University Park, PA
- The Penn State Neuroscience Institute, The Pennsylvania State University, University Park, PA
- The Gerontology Center, The Pennsylvania State University, University Park, PA
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Li L, Tong KY, Hu X. The effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound. Arch Phys Med Rehabil 2007; 88:243-50. [PMID: 17270524 DOI: 10.1016/j.apmr.2006.11.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the joint angle dependence of brachialis muscle architecture at rest and changes in brachialis muscle architecture during isometric voluntary contractions in people after stroke. DESIGN The pennation angle and fascicle length of the brachialis muscle were measured in the affected and unaffected sides of people after stroke at 9 different elbow angles ranging from 10 degrees to 90 degrees at the rest condition. Measurements were also carried out at a fixed joint angle of 90 degrees while the subjects were performing isometric muscle contractions at 5 incremental levels of maximal voluntary contraction (MVC) from 20% to 100% of MVC. The data obtained from the affected and unaffected sides of the subjects were compared. SETTING A research laboratory in a rehabilitation center. PARTICIPANTS Seven hemiplegic adults after stroke with passive range of motion in the elbow from 10 degrees to 90 degrees and Modified Ashworth Scale score larger than 1 were recruited. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Ultrasonography was used to measure brachialis muscle pennation angle and fascicle length at the rest condition and during isometric contractions. RESULTS The measured pennation angles and fascicle lengths were found to be joint-angle-dependent in both the affected and unaffected groups at the rest condition. Further comparisons found that the pennation angles of the affected brachialis muscle were significantly larger (P<.05) than the unaffected muscle in the most extended positions (<50 degrees ), whereas the affected fascicle lengths were significantly shorter (P<.05) than the unaffected muscle in most flexed positions (>20 degrees ). As the level of isometric voluntary contraction was increased incrementally from 20% to 100% of MVC, the results showed that pennation angle increased significantly (P<.05) while fascicle length decreased significantly (P<.01) in the unaffected muscle. However, the contraction level has a significant effect only on pennation angle (P<.05) but not on fascicle length in the affected side. In addition, the measured fascicle lengths in the unaffected group were significantly shorter than those in the affected group for isometric contractions above 40% MVC. CONCLUSIONS Our findings suggest that the architectural parameters of the brachialis muscle in people after stroke are elbow-joint-angle-dependent at the rest condition. In the affected side, pennation angle changed the most when the muscle was in an extension position and fascicle length changed the most in a flexed position when compared with the unaffected side. Immobilization and contracture might cause a shortening of the fascicle and an increase in pennation angle in the affected side. Smaller pennation angle and fascicle length changes in the affected side during isometric contraction might be due to weakness in the muscle after the onset of stroke.
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Affiliation(s)
- Le Li
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, China
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