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Kaufmann P, Zweier L, Baca A, Kainz H. Muscle synergies are shared across fundamental subtasks in complex movements of skateboarding. Sci Rep 2024; 14:12860. [PMID: 38834832 DOI: 10.1038/s41598-024-63640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
A common theory of motor control posits that movement is controlled by muscle synergies. However, the behavior of these synergies during highly complex movements remains largely unexplored. Skateboarding is a hardly researched sport that requires rapid motor control to perform tricks. The objectives of this study were to investigate three key areas: (i) whether motor complexity differs between skateboard tricks, (ii) the inter-participant variability in synergies, and (iii) whether synergies are shared between different tricks. Electromyography data from eight muscles per leg were collected from seven experienced skateboarders performing three different tricks (Ollie, Kickflip, 360°-flip). Synergies were extracted using non-negative matrix factorization. The number of synergies (NoS) was determined using two criteria based on the total variance accounted for (tVAF > 90% and adding an additional synergy does not increase tVAF > 1%). In summary: (i) NoS and tVAF did not significantly differ between tricks, indicating similar motor complexity. (ii) High inter-participant variability exists across participants, potentially caused by the low number of constraints given to perform the tricks. (iii) Shared synergies were observed in every comparison of two tricks. Furthermore, each participant exhibited at least one synergy vector, which corresponds to the fundamental 'jumping' task, that was shared through all three tricks.
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Affiliation(s)
- Paul Kaufmann
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Lorenz Zweier
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
| | - Hans Kainz
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria.
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.
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Ye S, Tao L, Gong S, Ma Y, Wu J, Li W, Kang J, Tang M, Zuo G, Shi C. Upper limb motor assessment for stroke with force, muscle activation and interhemispheric balance indices based on sEMG and fNIRS. Front Neurol 2024; 15:1337230. [PMID: 38694770 PMCID: PMC11061400 DOI: 10.3389/fneur.2024.1337230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Upper limb rehabilitation assessment plays a pivotal role in the recovery process of stroke patients. The current clinical assessment tools often rely on subjective judgments of healthcare professionals. Some existing research studies have utilized physiological signals for quantitative assessments. However, most studies used single index to assess the motor functions of upper limb. The fusion of surface electromyography (sEMG) and functional near-infrared spectroscopy (fNIRS) presents an innovative approach, offering simultaneous insights into the central and peripheral nervous systems. Methods We concurrently collected sEMG signals and brain hemodynamic signals during bilateral elbow flexion in 15 stroke patients with subacute and chronic stages and 15 healthy control subjects. The sEMG signals were analyzed to obtain muscle synergy based indexes including synergy stability index (SSI), closeness of individual vector (CV) and closeness of time profile (CT). The fNIRS signals were calculated to extract laterality index (LI). Results The primary findings were that CV, SSI and LI in posterior motor cortex (PMC) and primary motor cortex (M1) on the affected hemisphere of stroke patients were significantly lower than those in the control group (p < 0.05). Moreover, CV, SSI and LI in PMC were also significantly different between affected and unaffected upper limb movements (p < 0.05). Furthermore, a linear regression model was used to predict the value of the Fugl-Meyer score of upper limb (FMul) (R2 = 0.860, p < 0.001). Discussion This study established a linear regression model using force, CV, and LI features to predict FMul scale values, which suggests that the combination of force, sEMG and fNIRS hold promise as a novel method for assessing stroke rehabilitation.
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Affiliation(s)
- Sijia Ye
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- University of Chinese Academy of Sciences, Beijing, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, China
| | - Liang Tao
- Department of Neurological Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Shuang Gong
- Department of Neurological Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Yehao Ma
- Robotics Institute, Ningbo University of Technology, Ningbo, China
| | - Jiajia Wu
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, China
| | - Wanyi Li
- Department of Neurological Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Jiliang Kang
- Department of Neurological Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Min Tang
- Department of Neurological Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Guokun Zuo
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- University of Chinese Academy of Sciences, Beijing, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, China
| | - Changcheng Shi
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- University of Chinese Academy of Sciences, Beijing, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, China
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Tannus J, Naves ELM, Morere Y. Post-stroke functional assessments based on rehabilitation games and their correlation with clinical scales: A scoping review. Med Biol Eng Comput 2024; 62:47-60. [PMID: 37723382 DOI: 10.1007/s11517-023-02933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
Considering that stroke is one of the main causes of adult impairment and the growing interest in Virtual Reality (VR) as a potential assessment and treatment tool for the rehabilitation of stroke patients, a scoping review was conducted to check whether user's motion data obtained from VR games and simulations can be clinically valid. This was done by reviewing studies on parameters for assessing the functional skills and rehabilitation progress using data from VR games or simulations. Then, identifying the most widely used and validated parameters for the quantification of motor ability in a virtual environment and suggesting challenges for future research. For the validation of the parameters obtained from the VR software, only the studies that correlated them with traditional physiotherapy scales were considered. In December 2022, a search of the following databases was performed: IEEE Xplore, ACM Digital Library, PubMed and PEDro. The selection criteria were studies published in English during the past 10 years, with upper-limb based interaction and tested on more than one stroke patient. A total of 14 were included in the PRISMA scoping review. Favorable results were found in 12 of the 14 studies, which reported positive or strongly positive correlations with clinical scales, even when diverse variables were used. In-depth research using a larger sample size is needed. The results demonstrate that data collected while playing a virtual serious game has the potential to be clinically valid, after conducting high-quality supportive studies with controlled variables, potentially helping the practice in terms of time and resources.
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Affiliation(s)
- Julia Tannus
- Faculty of Electrical Engineering, Assistive Technologies Group, Federal University of Uberlandia, Av Joao Naves de Avila, 2121 -Bloco 1A, Uberlandia, Brazil.
| | - Eduardo L M Naves
- Faculty of Electrical Engineering, Assistive Technologies Group, Federal University of Uberlandia, Av Joao Naves de Avila, 2121 -Bloco 1A, Uberlandia, Brazil
| | - Yann Morere
- LCOMS Laboratory, University of Lorraine, Metz, France
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Gigli A, Gijsberts A, Nowak M, Vujaklija I, Castellini C. Progressive unsupervised control of myoelectric upper limbs. J Neural Eng 2023; 20:066016. [PMID: 37883969 DOI: 10.1088/1741-2552/ad0754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/26/2023] [Indexed: 10/28/2023]
Abstract
Objective.Unsupervised myocontrol methods aim to create control models for myoelectric prostheses while avoiding the complications of acquiring reliable, regular, and sufficient labeled training data. A limitation of current unsupervised methods is that they fix the number of controlled prosthetic functions a priori, thus requiring an initial assessment of the user's motor skills and neglecting the development of novel motor skills over time.Approach.We developed a progressive unsupervised myocontrol (PUM) paradigm in which the user and the control model coadaptively identify distinct muscle synergies, which are then used to control arbitrarily associated myocontrol functions, each corresponding to a hand or wrist movement. The interaction starts with learning a single function and the user may request additional functions after mastering the available ones, which aligns the evolution of their motor skills with an increment in system complexity. We conducted a multi-session user study to evaluate PUM and compare it against a state-of-the-art non-progressive unsupervised alternative. Two participants with congenital upper-limb differences tested PUM, while ten non-disabled control participants tested either PUM or the non-progressive baseline. All participants engaged in myoelectric control of a virtual hand and wrist.Main results.PUM enabled autonomous learning of three myocontrol functions for participants with limb differences, and of all four available functions for non-disabled subjects, using both existing or newly identified muscle synergies. Participants with limb differences achieved similar success rates to non-disabled ones on myocontrol tests, but faced greater difficulties in internalizing new motor skills and exhibited slightly inferior movement quality. The performance was comparable with either PUM or the non-progressive baseline for the group of non-disabled participants.Significance.The PUM paradigm enables users to autonomously learn to operate the myocontrol system, adapts to the users' varied preexisting motor skills, and supports the further development of those skills throughout practice.
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Affiliation(s)
- Andrea Gigli
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Wessling, Germany
- Assistive Intelligent Robotics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Markus Nowak
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Wessling, Germany
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Claudio Castellini
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Wessling, Germany
- Assistive Intelligent Robotics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Clancy EA, Morin EL, Hajian G, Merletti R. Tutorial. Surface electromyogram (sEMG) amplitude estimation: Best practices. J Electromyogr Kinesiol 2023; 72:102807. [PMID: 37552918 DOI: 10.1016/j.jelekin.2023.102807] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023] Open
Abstract
This tutorial intends to provide insight, instructions and "best practices" for those who are novices-including clinicians, engineers and non-engineers-in extracting electromyogram (EMG) amplitude from the bipolar surface EMG (sEMG) signal of voluntary contractions. A brief discussion of sEMG amplitude extraction from high density sEMG (HDsEMG) arrays and feature extraction from electrically elicited contractions is also provided. This tutorial attempts to present its main concepts in a straightforward manner that is accessible to novices in the field not possessing a wide range of technical background (if any) in this area. Surface EMG amplitude, also referred to as the sEMG envelope [often implemented as root mean square (RMS) sEMG or average rectified value (ARV) sEMG], quantifies the voltage variation of the sEMG signal and is grossly related to the overall neural excitation of the muscle and to peripheral parameters. The tutorial briefly reviews the physiological origin of the voluntary sEMG signal and sEMG recording, including electrode configurations, sEMG signal transduction, electronic conditioning and conversion by an analog-to-digital converter. These topics have been covered in greater detail in prior tutorials in this series. In depth descriptions of state-of-the-art methods for computing sEMG amplitude are then provided, including guidance on signal pre-conditioning, absolute value vs. square-law detection, selection of appropriate sEMG amplitude smoothing filters and attenuation of measurement noise. The tutorial provides a detailed list of best practices for sEMG amplitude estimation.
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Affiliation(s)
| | - Evelyn L Morin
- Department of Electrical and Computer Engineering, Queen's University, Kingston, Ontario, Canada.
| | - Gelareh Hajian
- Toronto Rehab Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Roberto Merletti
- LISiN, Dept. of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy.
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Sun R, Su S, He Q. Method for Assessing the Motor Coordination of Runners Based on the Analysis of Multichannel EMGs. Appl Bionics Biomech 2023; 2023:7126696. [PMID: 37250363 PMCID: PMC10219771 DOI: 10.1155/2023/7126696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
In this paper, we propose a method to evaluate the motor coordination of runners based on the analysis of amplitude and spatiotemporal dynamics of multichannel electromyography. A new diagnostic index for the coordination of runners was proposed, including the amplitude of electromyography, the spatiotemporal stability coefficient, and the symmetry coefficient of muscle force. The motor coordination of 13 professional runners was studied. Detailed anthropometric information was recorded about the professional runners. It has been found that professional athletes are characterized by the stability of movement repetition (more than 83%) and the high degree of symmetry of muscle efforts of the left and right legs (more than 81%) regardless of the changes in load during running at a speed of 8-12 km/hr. Scientific and technological means can support the scientific training of athletes. The end of the Winter Olympic Games has shown us the powerful power of a series of intelligent scientific equipment, including electro-magnetic gun, in sports training. We also look forward to the continuous innovation of these advanced technologies, which will contribute to the intelligent development of sports scientific research.
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Affiliation(s)
- Ren Sun
- Department of Physical, Beijing Institute of Technology, Zhuhai 519000, Guangdong, China
| | - Shuijun Su
- José Rizal University, Mandaluyong City 1552, Metro Manila, Philippines
| | - Quantao He
- Sport School of Shenzhen University, Shenzhen 518000, Guangdong, China
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Zhao K, Zhang Z, Wen H, Liu B, Li J, Andrea d’Avella, Scano A. Muscle synergies for evaluating upper limb in clinical applications: A systematic review. Heliyon 2023; 9:e16202. [PMID: 37215841 PMCID: PMC10199229 DOI: 10.1016/j.heliyon.2023.e16202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/11/2023] [Accepted: 05/09/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Muscle synergies have been proposed as a strategy employed by the central nervous system to control movements. Muscle synergy analysis is a well-established framework to examine the pathophysiological basis of neurological diseases and has been applied for analysis and assessment in clinical applications in the last decades, even if it has not yet been widely used in clinical diagnosis, rehabilitative treatment and interventions. Even if inconsistencies in the outputs among studies and lack of a normative pipeline including signal processing and synergy analysis limit the progress, common findings and results are identifiable as a basis for future research. Therefore, a literature review that summarizes methods and main findings of previous works on upper limb muscle synergies in clinical environment is needed to i) summarize the main findings so far, ii) highlight the barriers limiting their use in clinical applications, and iii) suggest future research directions needed for facilitating translation of experimental research to clinical scenarios. METHODS Articles in which muscle synergies were used to analyze and assess upper limb function in neurological impairments were reviewed. The literature research was conducted in Scopus, PubMed, and Web of Science. Experimental protocols (e.g., the aim of the study, number and type of participants, number and type of muscles, and tasks), methods (e.g., muscle synergy models and synergy extraction methods, signal processing methods), and the main findings of eligible studies were reported and discussed. RESULTS 383 articles were screened and 51 were selected, which involved a total of 13 diseases and 748 patients and 1155 participants. Each study investigated on average 15 ± 10 patients. Four to forty-one muscles were included in the muscle synergy analysis. Point-to-point reaching was the most used task. The preprocessing of EMG signals and algorithms for synergy extraction varied among studies, and non-negative matrix factorization was the most used method. Five EMG normalization methods and five methods for identifying the optimal number of synergies were used in the selected papers. Most of the studies report that analyses on synergy number, structure, and activations provide novel insights on the physiopathology of motor control that cannot be gained with standard clinical assessments, and suggest that muscle synergies may be useful to personalize therapies and to develop new therapeutic strategies. However, in the selected studies synergies were used only for assessment; different testing procedures were used and, in general, study-specific modifications of muscle synergies were observed; single session or longitudinal studies mainly aimed at assessing stroke (71% of the studies), even though other pathologies were also investigated. Synergy modifications were either study-specific or were not observed, with few analyses available for temporal coefficients. Thus, several barriers prevent wider adoption of muscle synergy analysis including a lack of standardized experimental protocols, signal processing procedures, and synergy extraction methods. A compromise in the design of the studies must be found to combine the systematicity of motor control studies and the feasibility of clinical studies. There are however several potential developments that might promote the use of muscle synergy analysis in clinical practice, including refined assessments based on synergistic approaches not allowed by other methods and the availability of novel models. Finally, neural substrates of muscle synergies are discussed, and possible future research directions are proposed. CONCLUSIONS This review provides new perspectives about the challenges and open issues that need to be addressed in future work to achieve a better understanding of motor impairments and rehabilitative therapy using muscle synergies. These include the application of the methods on wider scales, standardization of procedures, inclusion of synergies in the clinical decisional process, assessment of temporal coefficients and temporal-based models, extensive work on the algorithms and understanding of the physio-pathological mechanisms of pathology, as well as the application and adaptation of synergy-based approaches to various rehabilitative scenarios for increasing the available evidence.
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Affiliation(s)
- Kunkun Zhao
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Zhisheng Zhang
- School of Mechanical Engineering, Southeast University, Nanjing, China
| | - Haiying Wen
- School of Mechanical Engineering, Southeast University, Nanjing, China
| | - Bin Liu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Jianqing Li
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Andrea d’Avella
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Alessandro Scano
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), Milan, Italy
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Feng F, Luo XC, Chen YJ, Li JJ, Kang H, Yan BH. Effects of Tai Chi Yunshou on upper-limb function and balance in stroke survivors: A systematic review and meta-analysis. Complement Ther Clin Pract 2023; 51:101741. [PMID: 36868000 DOI: 10.1016/j.ctcp.2023.101741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND PURPOSE Physical rehabilitation plays an important role in the recovery of motor function after a stroke. This study aimed to evaluate the effects of Tai Chi Yunshou (TCY), a form of physical therapy, on upper-limb function and balance in stroke survivors. METHODS MEDLINE, Embase, CENTRAL and five Chinese databases were retrieved from inception to July 1, 2020 (updated on March 31, 2022). Randomized controlled trials of TCY versus no-treatment for stroke were included. The RoB-2 was used to evaluate the quality of included studies. Upper-limb motor impairment, balance, and activities of daily living (ADLs) were measured by Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Berg Balance Scale (BBS), and Barthel Index (BI), respectively. Data synthesis was performed using RevMan (v5.3), and expressed as mean difference (MD) with 95% confidence intervals (CI). RESULTS Seven studies with 529 participants were included. Compared with no-treatment, TCY improved FMA-UE (MD = 7.31, 95% CI: 5.86-8.77, minimal clinically important difference [MCID]: 9-10), BBS (MD = 4.68, 95% CI: 0.28-9.07, MCID: 4), and BI (MD = 4.12, 95% CI: 3.28-4.96, MCID: 1.85) in stroke survivors. CONCLUSION TCY may benefit balance and ADLs in rehabilitation after a stroke, but it may not improve upper-limb function clinically.
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Affiliation(s)
- Fen Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Chao Luo
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China; Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Ya-Jie Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jia-Jia Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Kang
- Nursing School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo-Hua Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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de Seta V, Toppi J, Colamarino E, Molle R, Castellani F, Cincotti F, Mattia D, Pichiorri F. Cortico-muscular coupling to control a hybrid brain-computer interface for upper limb motor rehabilitation: A pseudo-online study on stroke patients. Front Hum Neurosci 2022; 16:1016862. [PMID: 36483633 PMCID: PMC9722732 DOI: 10.3389/fnhum.2022.1016862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/26/2022] [Indexed: 10/05/2023] Open
Abstract
Brain-Computer Interface (BCI) systems for motor rehabilitation after stroke have proven their efficacy to enhance upper limb motor recovery by reinforcing motor related brain activity. Hybrid BCIs (h-BCIs) exploit both central and peripheral activation and are frequently used in assistive BCIs to improve classification performances. However, in a rehabilitative context, brain and muscular features should be extracted to promote a favorable motor outcome, reinforcing not only the volitional control in the central motor system, but also the effective projection of motor commands to target muscles, i.e., central-to-peripheral communication. For this reason, we considered cortico-muscular coupling (CMC) as a feature for a h-BCI devoted to post-stroke upper limb motor rehabilitation. In this study, we performed a pseudo-online analysis on 13 healthy participants (CTRL) and 12 stroke patients (EXP) during executed (CTRL, EXP unaffected arm) and attempted (EXP affected arm) hand grasping and extension to optimize the translation of CMC computation and CMC-based movement detection from offline to online. Results showed that updating the CMC computation every 125 ms (shift of the sliding window) and accumulating two predictions before a final classification decision were the best trade-off between accuracy and speed in movement classification, independently from the movement type. The pseudo-online analysis on stroke participants revealed that both attempted and executed grasping/extension can be classified through a CMC-based movement detection with high performances in terms of classification speed (mean delay between movement detection and EMG onset around 580 ms) and accuracy (hit rate around 85%). The results obtained by means of this analysis will ground the design of a novel non-invasive h-BCI in which the control feature is derived from a combined EEG and EMG connectivity pattern estimated during upper limb movement attempts.
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Affiliation(s)
- Valeria de Seta
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Jlenia Toppi
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Emma Colamarino
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Rita Molle
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Filippo Castellani
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Febo Cincotti
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Donatella Mattia
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Floriana Pichiorri
- Neuroelectric Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
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Li Y, Li C, Shu X, Sheng X, Jia J, Zhu X. A Novel Automated RGB-D Sensor-Based Measurement of Voluntary Items of the Fugl-Meyer Assessment for Upper Extremity: A Feasibility Study. Brain Sci 2022; 12:brainsci12101380. [PMID: 36291314 PMCID: PMC9599696 DOI: 10.3390/brainsci12101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022] Open
Abstract
Motor function assessment is essential for post-stroke rehabilitation, while the requirement for professional therapists’ participation in current clinical assessment limits its availability to most patients. By means of sensors that collect the motion data and algorithms that conduct assessment based on such data, an automated system can be built to optimize the assessment process, benefiting both patients and therapists. To this end, this paper proposed an automated Fugl-Meyer Assessment (FMA) upper extremity system covering all 30 voluntary items of the scale. RGBD sensors, together with force sensing resistor sensors were used to collect the patients’ motion information. Meanwhile, both machine learning and rule-based logic classification were jointly employed for assessment scoring. Clinical validation on 20 hemiparetic stroke patients suggests that this system is able to generate reliable FMA scores. There is an extremely high correlation coefficient (r = 0.981, p < 0.01) with that yielded by an experienced therapist. This study offers guidance and feasible solutions to a complete and independent automated assessment system.
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Affiliation(s)
- Yue Li
- State Key Laboratory of Machanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaokang Shu
- State Key Laboratory of Machanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Xinjun Sheng
- State Key Laboratory of Machanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200040, China
- Correspondence: (X.S.); (J.J.); Tel.: +86-021-34206547 (X.S.); +86-13617722357 (J.J.)
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Correspondence: (X.S.); (J.J.); Tel.: +86-021-34206547 (X.S.); +86-13617722357 (J.J.)
| | - Xiangyang Zhu
- State Key Laboratory of Machanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200040, China
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Seo G, Lee SW, Beer RF, Alamri A, Wu YN, Raghavan P, Rymer WZ, Roh J. Alterations in motor modules and their contribution to limitations in force control in the upper extremity after stroke. Front Hum Neurosci 2022; 16:937391. [PMID: 35967001 PMCID: PMC9365968 DOI: 10.3389/fnhum.2022.937391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
The generation of isometric force at the hand can be mediated by activating a few motor modules. Stroke induces alterations in motor modules underlying steady-state isometric force generation in the human upper extremity (UE). However, how the altered motor modules impact task performance (force production) remains unclear as stroke survivors develop and converge to the three-dimensional (3D) target force. Thus, we tested whether stroke-specific motor modules would be activated from the onset of force generation and also examined how alterations in motor modules would induce changes in force representation. During 3D isometric force development, electromyographic (EMG) signals were recorded from eight major elbow and shoulder muscles in the paretic arm of 10 chronic hemispheric stroke survivors and both arms of six age-matched control participants. A non-negative matrix factorization algorithm identified motor modules in four different time windows: three “exploratory” force ramping phases (Ramps 1–3; 0–33%, 33–67%, and 67–100% of target force magnitude, respectively) and the stable force match phase (Hold). Motor module similarity and between-force coupling were examined by calculating the scalar product and Pearson correlation across the phases. To investigate the association between the end-point force representation and the activation of the motor modules, principal component analysis (PCA) and multivariate multiple linear regression analyses were applied. In addition, the force components regressed on the activation profiles of motor modules were utilized to model the feasible force direction. Both stroke and control groups developed exploratory isometric forces with a non-linear relationship between EMG and force. During the force matching, only the stroke group showed abnormal between-force coupling in medial-lateral and backward-forward and medial-lateral and downward-upward directions. In each group, the same motor modules, including the abnormal deltoid module in stroke survivors, were expressed from the beginning of force development instead of emerging during the force exploration. The PCA and the multivariate multiple linear regression analyses showed that alterations in motor modules were associated with abnormal between-force coupling and limited feasible force direction after stroke. Overall, these results suggest that alterations in intermuscular coordination contribute to the abnormal end-point force control under isometric conditions in the UE after stroke.
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Affiliation(s)
- Gang Seo
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, DC, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, DC, United States
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Randall F. Beer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Amani Alamri
- Department of Biology, Temple University, Philadelphia, PA, United States
| | - Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - William Z. Rymer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
- Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Jinsook Roh
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
- *Correspondence: Jinsook Roh,
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12
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Seo G, Kishta A, Mugler E, Slutzky MW, Roh J. Myoelectric interface training enables targeted reduction in abnormal muscle co-activation. J Neuroeng Rehabil 2022; 19:67. [PMID: 35778757 PMCID: PMC9250207 DOI: 10.1186/s12984-022-01045-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abnormal patterns of muscle co-activation contribute to impaired movement after stroke. Previously, we developed a myoelectric computer interface (MyoCI) training paradigm to improve stroke-induced arm motor impairment by reducing the abnormal co-activation of arm muscle pairs. However, it is unclear to what extent the paradigm induced changes in the overall intermuscular coordination in the arm, as opposed to changing just the muscles trained with the MyoCI. This study examined the intermuscular coordination patterns of thirty-two stroke survivors who participated in 6 weeks of MyoCI training. METHODS We used non-negative matrix factorization to identify the arm muscle synergies (coordinated patterns of muscle activity) during a reaching task before and after the training. We examined the extent to which synergies changed as the training reduced motor impairment. In addition, we introduced a new synergy analysis metric, disparity index (DI), to capture the changes in the individual muscle weights within a synergy. RESULTS There was no consistent pattern of change in the number of synergies across the subjects after the training. The composition of muscle synergies, calculated using a traditional synergy similarity metric, also did not change after the training. However, the disparity of muscle weights within synergies increased after the training in the participants who responded to MyoCI training-that is, the specific muscles that the MyoCI was targeting became less correlated within a synergy. This trend was not observed in participants who did not respond to the training. CONCLUSIONS These findings suggest that MyoCI training reduced arm impairment by decoupling only the muscles trained while leaving other muscles relatively unaffected. This suggests that, even after injury, the nervous system is capable of motor learning on a highly fractionated level. It also suggests that MyoCI training can do what it was designed to do-enable stroke survivors to reduce abnormal co-activation in targeted muscles. Trial registration This study was registered at ClinicalTrials.gov (NCT03579992, Registered 09 July 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03579992?term=NCT03579992&draw=2&rank=1 ).
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Affiliation(s)
- Gang Seo
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 3517 Cullen Blvd, SERC Room 2011, Houston, TX, 77204-5060, USA
| | - Ameen Kishta
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Emily Mugler
- Department of Neurology, Northwestern University, 320 E. Superior Ave., Searle 11-473, Chicago, IL, 60611, USA
| | - Marc W Slutzky
- Department of Neurology, Northwestern University, 320 E. Superior Ave., Searle 11-473, Chicago, IL, 60611, USA. .,Department of Neuroscience, Northwestern University, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
| | - Jinsook Roh
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 3517 Cullen Blvd, SERC Room 2011, Houston, TX, 77204-5060, USA.
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13
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Cho W, Barradas VR, Schweighofer N, Koike Y. Design of an Isometric End-Point Force Control Task for Electromyography Normalization and Muscle Synergy Extraction From the Upper Limb Without Maximum Voluntary Contraction. Front Hum Neurosci 2022; 16:805452. [PMID: 35693543 PMCID: PMC9184761 DOI: 10.3389/fnhum.2022.805452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Muscle synergy analysis via surface electromyography (EMG) is useful to study muscle coordination in motor learning, clinical diagnosis, and neurorehabilitation. However, current methods to extract muscle synergies in the upper limb suffer from two major issues. First, the necessary normalization of EMG signals is performed via maximum voluntary contraction (MVC), which requires maximal isometric force production in each muscle. However, some individuals with motor impairments have difficulties producing maximal effort in the MVC task. In addition, the MVC is known to be highly unreliable, with widely different forces produced in repeated measures. Second, synergy extraction in the upper limb is typically performed with a multidirection reaching task. However, some participants with motor impairments cannot perform this task because it requires precise motor control. In this study, we proposed a new isometric rotating task that does not require precise motor control or large forces. In this task, participants maintain a cursor controlled by the arm end-point force on a target that rotates at a constant angular velocity at a designated force level. To relax constraints on motor control precision, the target is widened and blurred. To obtain a reference EMG value for normalization without requiring maximal effort, we estimated a linear relationship between joint torques and muscle activations. We assessed the reliability of joint torque normalization and synergy extraction in the rotating task in young neurotypical individuals. Compared with normalization with MVC, joint torque normalization allowed reliable EMG normalization at low force levels. In addition, the extraction of synergies was as reliable and more stable than with the multidirection reaching task. The proposed rotating task can, therefore, be used in future motor learning, clinical diagnosis, and neurorehabilitation studies.
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Affiliation(s)
- Woorim Cho
- School of Engineering, Tokyo Institute of Technology, Yokohama, Japan
| | - Victor R Barradas
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
| | - Nicolas Schweighofer
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Yasuharu Koike
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
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14
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Maistrello L, Rimini D, Cheung VCK, Pregnolato G, Turolla A. Muscle Synergies and Clinical Outcome Measures Describe Different Factors of Upper Limb Motor Function in Stroke Survivors Undergoing Rehabilitation in a Virtual Reality Environment. SENSORS 2021; 21:s21238002. [PMID: 34884003 PMCID: PMC8659727 DOI: 10.3390/s21238002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
Recent studies have investigated muscle synergies as biomarkers for stroke, but it remains controversial if muscle synergies and clinical observation convey the same information on motor impairment. We aim to identify whether muscle synergies and clinical scales convey the same information or not. Post-stroke patients were administered an upper limb treatment. Before (T0) and after (T1) treatment, we assessed motor performance with clinical scales and motor output with EMG-derived muscle synergies. We implemented an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) to identify the underlying relationships among all variables, at T0 and T1, and a general linear regression model to infer any relationships between the similarity between the affected and unaffected synergies (Median-sp) and clinical outcomes at T0. Clinical variables improved with rehabilitation whereas muscle-synergy parameters did not show any significant change. EFA and CFA showed that clinical variables and muscle-synergy parameters (except Median-sp) were grouped into different factors. Regression model showed that Median-sp could be well predicted by clinical scales. The information underlying clinical scales and muscle synergies are therefore different. However, clinical scales well predicted the similarity between the affected and unaffected synergies. Our results may have implications on personalizing rehabilitation protocols.
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Affiliation(s)
- Lorenza Maistrello
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy; (L.M.); (G.P.); (A.T.)
| | - Daniele Rimini
- Medical Physics Department—Clinical Engineering, Salford Care Organisation, Salford M6 8HD, UK
- Correspondence: ; Tel.: +44-61620 (ext. 64859)
| | - Vincent C. K. Cheung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China;
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy; (L.M.); (G.P.); (A.T.)
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy; (L.M.); (G.P.); (A.T.)
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15
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Clinical Use of Surface Electromyography to Track Acute Upper Extremity Muscle Recovery after Stroke: A Descriptive Case Study of a Single Patient. APPLIED SYSTEM INNOVATION 2021; 4. [PMID: 34778722 PMCID: PMC8589300 DOI: 10.3390/asi4020032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Arm recovery varies greatly among stroke survivors. Wearable surface electromyography (sEMG) sensors have been used to track recovery in research; however, sEMG is rarely used within acute and subacute clinical settings. The purpose of this case study was to describe the use of wireless sEMG sensors to examine changes in muscle activity during acute and subacute phases of stroke recovery, and understand the participant’s perceptions of sEMG monitoring. Beginning three days post-stroke, one stroke survivor wore five wireless sEMG sensors on his involved arm for three to four hours, every one to three days. Muscle activity was tracked during routine care in the acute setting through discharge from inpatient rehabilitation. Three- and eight-month follow-up sessions were completed in the community. Activity logs were completed each session, and a semi-structured interview occurred at the final session. The longitudinal monitoring of muscle and movement recovery in the clinic and community was feasible using sEMG sensors. The participant and medical team felt monitoring was unobtrusive, interesting, and motivating for recovery, but desired greater in-session feedback to inform rehabilitation. While barriers in equipment and signal quality still exist, capitalizing on wearable sensing technology in the clinic holds promise for enabling personalized stroke recovery.
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16
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Irastorza-Landa N, García-Cossio E, Sarasola-Sanz A, Brötz D, Birbaumer N, Ramos-Murguialday A. Functional synergy recruitment index as a reliable biomarker of motor function and recovery in chronic stroke patients. J Neural Eng 2021; 18. [PMID: 33530072 DOI: 10.1088/1741-2552/abe244] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Objective. Stroke affects the expression of muscle synergies underlying motor control, most notably in patients with poorer motor function. The majority of studies on muscle synergies have conventionally approached this analysis by assuming alterations in the inner structures of synergies after stroke. Although different synergy-based features based on this assumption have to some extent described pathological mechanisms in post-stroke neuromuscular control, a biomarker that reliably reflects motor function and recovery is still missing.Approach. Based on the theory of muscle synergies, we alternatively hypothesize that functional synergy structures are physically preserved and measure the temporal correlation between the recruitment profiles of healthy modules by paretic and healthy muscles, a feature hereafter reported as the FSRI. We measured clinical scores and extracted the muscle synergies of both ULs of 18 chronic stroke survivors from the electromyographic activity of 8 muscles during bilateral movements before and after 4 weeks of non-invasive BMI controlled robot therapy and physiotherapy. We computed the FSRI as well as features quantifying inter-limb structural differences and evaluated the correlation of these synergy-based measures with clinical scores.Main results. Correlation analysis revealed weak relationships between conventional features describing inter-limb synergy structural differences and motor function. In contrast, FSRI values during specific or combined movement data significantly correlated with UL motor function and recovery scores. Additionally, we observed that BMI-based training with contingent positive proprioceptive feedback led to improved FSRI values during the specific trained finger extension movement.Significance. We demonstrated that FSRI can be used as a reliable physiological biomarker of motor function and recovery in stroke, which can be targeted via BMI-based proprioceptive therapies and adjuvant physiotherapy to boost effective rehabilitation.
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Affiliation(s)
- Nerea Irastorza-Landa
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | | | - Andrea Sarasola-Sanz
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | - Doris Brötz
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Niels Birbaumer
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Ander Ramos-Murguialday
- Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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17
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Ambrosini E, Parati M, Peri E, De Marchis C, Nava C, Pedrocchi A, Ferriero G, Ferrante S. Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study. J Neuroeng Rehabil 2020; 17:35. [PMID: 32106874 PMCID: PMC7047376 DOI: 10.1186/s12984-020-00662-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Muscle synergies analysis can provide a deep understanding of motor impairment after stroke and of changes after rehabilitation. In this study, the neuro-mechanical analysis of leg cycling was used to longitudinally investigate the motor recovery process coupled with cycling training augmented by Functional Electrical Stimulation (FES) in subacute stroke survivors. METHODS Subjects with ischemic subacute stroke participated in a 3-week training of FES-cycling with visual biofeedback plus usual care. Participants were evaluated before and after the intervention through clinical scales, gait spatio-temporal parameters derived from an instrumented mat, and a voluntary pedaling test. Biomechanical metrics (work produced by the two legs, mechanical effectiveness and symmetry indexes) and bilateral electromyography from 9 leg muscles were acquired during the voluntary pedaling test. To extract muscles synergies, the Weighted Nonnegative Matrix Factorization algorithm was applied to the normalized EMG envelopes. Synergy complexity was measured by the number of synergies required to explain more than 90% of the total variance of the normalized EMG envelopes and variance accounted for by one synergy. Regardless the inter-subject differences in the number of extracted synergies, 4 synergies were extracted from each patient and the cosine-similarity between patients and healthy weight vectors was computed. RESULTS Nine patients (median age of 75 years and median time post-stroke of 2 weeks) were recruited. Significant improvements in terms of clinical scales, gait parameters and work produced by the affected leg were obtained after training. Synergy complexity well correlated to the level of motor impairment at baseline, but it did not change after training. We found a significant improvement in the similarity of the synergy responsible of the knee flexion during the pulling phase of the pedaling cycle, which was the mostly compromised at baseline. This improvement may indicate the re-learning of a more physiological motor strategy. CONCLUSIONS Our findings support the use of the neuro-mechanical analysis of cycling as a method to assess motor recovery after stroke, mainly in an early phase, when gait evaluation is not yet possible. The improvement in the modular coordination of pedaling correlated with the improvement in motor functions and walking ability achieved at the end of the intervention support the role of FES-cycling in enhancing motor re-learning after stroke but need to be confirmed in a controlled study with a larger sample size. TRIAL REGISTRATION ClinicalTrial.gov, NCT02439515. Registered on May 8, 2015, .
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Affiliation(s)
- Emilia Ambrosini
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Monica Parati
- Istituti Clinici Scientifici Maugeri, IRCSS, Lissone, Italy.
| | - Elisabetta Peri
- Department of Electrical Engineering, Laboratory of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Claudia Nava
- Istituti Clinici Scientifici Maugeri, IRCSS, Lissone, Italy
| | - Alessandra Pedrocchi
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | | | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
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18
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Hesam-Shariati N, Trinh T, Thompson-Butel AG, Shiner CT, Redmond SJ, McNulty PA. Improved Kinematics and Motor Control in a Longitudinal Study of a Complex Therapy Movement in Chronic Stroke. IEEE Trans Neural Syst Rehabil Eng 2019; 27:682-691. [DOI: 10.1109/tnsre.2019.2895018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Cheung VCK, Niu CM, Li S, Xie Q, Lan N. A Novel FES Strategy for Poststroke Rehabilitation Based on the Natural Organization of Neuromuscular Control. IEEE Rev Biomed Eng 2019; 12:154-167. [DOI: 10.1109/rbme.2018.2874132] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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On the Reliability and Repeatability of Surface Electromyography Factorization by Muscle Synergies in Daily Life Activities. Appl Bionics Biomech 2018; 2018:5852307. [PMID: 30595715 PMCID: PMC6282145 DOI: 10.1155/2018/5852307] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/24/2018] [Accepted: 08/17/2018] [Indexed: 12/02/2022] Open
Abstract
Muscle synergy theory is a new appealing approach for different research fields. This study is aimed at evaluating the robustness of EMG reconstruction via muscle synergies and the repeatability of muscle synergy parameters as potential neurophysiological indices. Eight healthy subjects performed walking, stepping, running, and ascending and descending stairs' trials for five repetitions in three sessions. Twelve muscles of the dominant leg were analyzed. The “nonnegative matrix factorization” and “variability account for” were used to extract muscle synergies and to assess EMG goodness reconstruction, respectively. Intraclass correlation was used to quantify methodology reliability. Cosine similarity and coefficient of determination assessed the repeatability of the muscle synergy vectors and the temporal activity patterns, respectively. A 4-synergy model was selected for EMG signal factorization. Intraclass correlation was excellent for the overall reconstruction, while it ranged from fair to excellent for single muscles. The EMG reconstruction was found repeatable across sessions and subjects. Considering the selection of neurophysiological indices, the number of synergies was not repeatable neither within nor between subjects. Conversely, the cosine similarity and coefficient of determination values allow considering the muscle synergy vectors and the temporal activity patterns as potential neurophysiological indices due to their similarity both within and between subjects. More specifically, some synergies in the 4-synergy model reveal themselves as more repeatable than others, suggesting focusing on them when seeking at the neurophysiological index identification.
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21
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Savc M, Glaser V, Kranjec J, Cikajlo I, Matjacic Z, Holobar A. Comparison of Convolutive Kernel Compensation and Non-Negative Matrix Factorization of Surface Electromyograms. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1935-1944. [PMID: 30281464 DOI: 10.1109/tnsre.2018.2869426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We compared non-negative matrix factorization (NMF) and convolution kernel compensation techniques for high-density electromyogram decomposition. The experimental data were recorded from nine healthy persons during controlled single degree of freedom (DOF) wrist flexion-extension, supination-pronation, and ulnar-radial deviation movements. We assembled the identified motor units and NMF components into three groups. Those active mostly during the first and the second movement direction per DOF were placed in the G1 and G3 groups, respectively. The remaining components were nonspecific for movement direction and were placed in the G2 group. In ulnar and radial deviation, the relative energies of identified cumulative motor unit spike trains (CSTs) and NMF components were similarly distributed among the groups. In other two movement types, the energy of NMF components in the G2 group was significantly larger than the energy of CSTs. We further performed a coherence analysis between CSTs and sums of NMF components in each group. Both decompositions demonstrated a solid match, but only at frequencies <3 Hz. At higher frequencies, the coherence hardly exceeded the value of 0.5. Potential reasons for these discrepancies include the negative impact of motor unit action potential shapes and noise on NMF decomposition.
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22
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The Effects of Selective Muscle Weakness on Muscle Coordination in the Human Arm. Appl Bionics Biomech 2018; 2018:5637568. [PMID: 30402139 PMCID: PMC6192169 DOI: 10.1155/2018/5637568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022] Open
Abstract
Despite the fundamental importance of muscle coordination in daily life, it is currently unclear how muscle coordination adapts when the musculoskeletal system is perturbed. In this study, we quantified the impact of selective muscle weakness on several metrics of muscle coordination. Seven healthy subjects performed 2D and 3D isometric force target matches, while electromyographic (EMG) signals were recorded from 13 elbow and shoulder muscles. Subsequently, muscle weakness was induced by a motor point block of brachialis muscle. Postblock subjects repeated the force generation tasks. We quantified muscle coordination pre- and postblock using three metrics: tuning curve preferred direction, tuning curve area, and motor modules analysis via nonnegative matrix factorization. For most muscles, the tuning direction for the 2D protocol was not substantially altered postblock, while tuning areas changed more drastically. Typically, five motor modules were identified from the 3D task, and four motor modules were identified in the 2D task; this result held across both pre- and postblock conditions. The composition of one or two motor modules, ones that involved mainly the activation of shoulder muscles, was altered postblock. Our results demonstrate that selective muscle weakness can induce nonintuitive alternations in muscle coordination in the mechanically redundant human arm.
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23
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Pan B, Sun Y, Xie B, Huang Z, Wu J, Hou J, Liu Y, Huang Z, Zhang Z. Alterations of Muscle Synergies During Voluntary Arm Reaching Movement in Subacute Stroke Survivors at Different Levels of Impairment. Front Comput Neurosci 2018; 12:69. [PMID: 30186130 PMCID: PMC6111238 DOI: 10.3389/fncom.2018.00069] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/30/2018] [Indexed: 01/07/2023] Open
Abstract
Motor system uses muscle synergies as a modular organization to simplify the control of movements. Motor cortical impairments, such as stroke and spinal cord injuries, disrupt the orchestration of the muscle synergies and result in abnormal movements. In this paper, the alterations of muscle synergies in subacute stroke survivors were examined during the voluntary reaching movement. We collected electromyographic (EMG) data from 35 stroke survivors, ranging from Brunnstrom Stage III to VI, and 25 age-matched control subjects. Muscle synergies were extracted from the activity of 7 upper-limb muscles via nonnegative matrix factorization under the criterion of 95% variance accounted for. By comparing the structure of muscle synergies and the similarity of activation coefficients across groups, we can validate the increasing activation of pectoralis major muscle and the decreasing activation of elbow extensor of triceps in stroke groups. Furthermore, the similarity of muscle synergies was significantly correlated with the Brunnstrom Stage (R = 0.52, p < 0.01). The synergies of stroke survivors at Brunnstrom Stage IV–III gradually diverged from those of control group, but the activation coefficients remained the same after stroke, irrespective of the recovery level.
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Affiliation(s)
- Bingyu Pan
- Sensor Network and Application Research Center, School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Yingfei Sun
- Sensor Network and Application Research Center, School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Bin Xie
- Rehabilitation Department, Peking University First Hospital, Beijing, China
| | - Zhipei Huang
- Sensor Network and Application Research Center, School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Jiankang Wu
- Sensor Network and Application Research Center, School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Jiateng Hou
- Sensor Network and Application Research Center, School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Yijun Liu
- Rehabilitation Department, Peking University First Hospital, Beijing, China
| | - Zhen Huang
- Rehabilitation Department, Peking University First Hospital, Beijing, China
| | - Zhiqiang Zhang
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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A Systematic Review on Muscle Synergies: From Building Blocks of Motor Behavior to a Neurorehabilitation Tool. Appl Bionics Biomech 2018; 2018:3615368. [PMID: 29849756 PMCID: PMC5937559 DOI: 10.1155/2018/3615368] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
The central nervous system (CNS) is believed to utilize specific predefined modules, called muscle synergies (MS), to accomplish a motor task. Yet questions persist about how the CNS combines these primitives in different ways to suit the task conditions. The MS hypothesis has been a subject of debate as to whether they originate from neural origins or nonneural constraints. In this review article, we present three aspects related to the MS hypothesis: (1) the experimental and computational evidence in support of the existence of MS, (2) algorithmic approaches for extracting them from surface electromyography (EMG) signals, and (3) the possible role of MS as a neurorehabilitation tool. We note that recent advances in computational neuroscience have utilized the MS hypothesis in motor control and learning. Prospective advances in clinical, medical, and engineering sciences and in fields such as robotics and rehabilitation stand to benefit from a more thorough understanding of MS.
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Feasibility of Muscle Synergy Outcomes in Clinics, Robotics, and Sports: A Systematic Review. Appl Bionics Biomech 2018; 2018:3934698. [PMID: 29808098 PMCID: PMC5902115 DOI: 10.1155/2018/3934698] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 01/04/2023] Open
Abstract
In the last years, several studies have been focused on understanding how the central nervous system controls muscles to perform a specific motor task. Although it still remains an open question, muscle synergies have come to be an appealing theory to explain the modular organization of the central nervous system. Even though the neural encoding of muscle synergies remains controversial, a large number of papers demonstrated that muscle synergies are robust across different tested conditions, which are within a day, between days, within a single subject, and between subjects that have similar demographic characteristics. Thus, muscle synergy theory has been largely used in several research fields, such as clinics, robotics, and sports. The present systematical review aims at providing an overview on the applications of muscle synergy theory in clinics, robotics, and sports; in particular, the review is focused on the papers that provide tangible information for (i) diagnosis or pathology assessment in clinics, (ii) robot-control design in robotics, and (iii) athletes' performance assessment or training guidelines in sports.
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Hesam-Shariati N, Trinh T, Thompson-Butel AG, Shiner CT, McNulty PA. A Longitudinal Electromyography Study of Complex Movements in Poststroke Therapy. 1: Heterogeneous Changes Despite Consistent Improvements in Clinical Assessments. Front Neurol 2017; 8:340. [PMID: 28804474 PMCID: PMC5532386 DOI: 10.3389/fneur.2017.00340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/29/2017] [Indexed: 12/29/2022] Open
Abstract
Poststroke weakness on the more-affected side may arise from reduced corticospinal drive, disuse muscle atrophy, spasticity, and abnormal coordination. This study investigated changes in muscle activation patterns to understand therapy-induced improvements in motor-function in chronic stroke compared to clinical assessments and to identify the effect of motor-function level on muscle activation changes. Electromyography (EMG) was recorded from five upper limb muscles on the more-affected side of 24 patients during early and late therapy sessions of an intensive 14-day program of Wii-based Movement Therapy (WMT) and for a subset of 13 patients at 6-month follow-up. Patients were classified according to residual voluntary motor capacity with low, moderate, or high motor-function levels. The area under the curve was calculated from EMG amplitude and movement duration. Clinical assessments of upper limb motor-function pre- and post-therapy included the Wolf Motor Function Test, Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale. Clinical assessments improved over time (p < 0.01) with an effect of motor-function level (p < 0.001). The pattern of EMG change by late therapy was complex and variable, with differences between patients with low compared to moderate or high motor-function levels. The area under the curve (p = 0.028) and peak amplitude (p = 0.043) during Wii-tennis backhand increased for patients with low motor-function, whereas EMG decreased for patients with moderate and high motor-function levels. The reductions included movement duration during Wii-golf (p = 0.048, moderate; p = 0.026, high) and Wii-tennis backhand (p = 0.046, moderate; p = 0.023, high) and forehand (p = 0.009, high) and the area under the curve during Wii-golf (p = 0.018, moderate) and Wii-baseball (p = 0.036, moderate). For the pooled data over time, there was an effect of motor-function (p = 0.016) and an interaction between time and motor-function (p = 0.009) for Wii-golf movement duration. Wii-baseball movement duration decreased as a function of time (p = 0.022). There was an effect on Wii-tennis forehand duration for time (p = 0.002), an interaction of time and motor-function (p = 0.005) and an effect of motor-function level on the area under the curve (p = 0.034) for Wii-golf. This study demonstrated different patterns of EMG changes according to residual voluntary motor-function levels, despite heterogeneity within each level that was not evident following clinical assessments alone. Thus, rehabilitation efficacy might be underestimated by analyses of pooled data.
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Affiliation(s)
- Negin Hesam-Shariati
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Terry Trinh
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Angelica G. Thompson-Butel
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Christine T. Shiner
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Penelope A. McNulty
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
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