The Influence of EMG-Triggered Robotic Movement on Walking, Muscle Force and Spasticity after an Ischemic Stroke

Improvements of mid-thigh circumferences following robotic rehabilitation in hemiparetic stroke patients

INTRODUCTION

Stroke has emerged as the leading cause of disability globally. The provision of long-term rehabilitation to stroke survivors poses a health care burden to many countries. Robotic devices have created a major turning point in stroke rehabilitation program. Currently, the anthropometric evidence to support the benefit of robotic rehabilitation (RR) among stroke patients is scarce. Therefore, the aim of this study was to evaluate the impact of RR on the mid-thigh circumferences of the paretic limbs in stroke patients.

METHODS

Twenty stroke patients from conventional rehabilitation (CR) (n = 10) and RR (n = 10) groups were recruited through a purposive sampling method. Patients in the CR group received a two-hour session of a five-day-a-week home-based CR program for 4 weeks. Patients in the RR group received a five-day-a-week of an hour combined physiotherapy and occupational therapy session and a one-hour robotic therapy session using the HAL® Cyberdyne lower-limb, for 4 weeks. The mid-thigh circumferences of both limbs were measured on day 1 (baseline), week 2 and week 4 of rehabilitation program.

RESULTS

The results revealed no statistically significant difference in the mid-thigh circumferences between the paretic (F1.05,9.44 = 1.96, p = 0.20), and the normal (F1.05,9.44 = 1.96, p = 0.20) sides in the CR group (n = 10). For the comparison between the paretic and normal sides in the RR group (n = 10), the paretic mid-thigh circumferences revealed significant time effect results (F2,18 = 11.91, p = 0.001), which were due to changes between baseline and week 2, and baseline and week 4 measurements. Interestingly, the normal mid-thigh circumferences also revealed a significant time effect (F2,18 = 6.56, p = 0.007), which is due to changes between baseline and week 4. One-way analysis of variance was employed to compare the mean average between groups due to the difference in the baseline measurements of the mid-thigh circumferences between the paretic side of the CR and the RR groups. With this adjustment, the average means mid-thigh circumferences after 4 weeks of therapy were shown to be significantly different between the CR and RR groups (F1,18 = 12.49, p = 0.02).

CONCLUSION

Significant increments in the mid-thigh circumferences following RR were seen in the paretic limbs of stroke patients. Hence, this study may provide some insights into further potential research related to the benefits of RR in stroke patients.

An Optimized Stimulation Control System for Upper Limb Exoskeleton Robot-Assisted Rehabilitation Using a Fuzzy Logic-Based Pain Detection Approach

The utilization of robotic systems in upper limb rehabilitation has shown promising results in aiding individuals with motor impairments. This research introduces an innovative approach to enhance the efficiency and adaptability of upper limb exoskeleton robot-assisted rehabilitation through the development of an optimized stimulation control system (OSCS). The proposed OSCS integrates a fuzzy logic-based pain detection approach designed to accurately assess and respond to the patient's pain threshold during rehabilitation sessions. By employing fuzzy logic algorithms, the system dynamically adjusts the stimulation levels and control parameters of the exoskeleton, ensuring personalized and optimized rehabilitation protocols. This research conducts comprehensive evaluations, including simulation studies and clinical trials, to validate the OSCS's efficacy in improving rehabilitation outcomes while prioritizing patient comfort and safety. The findings demonstrate the potential of the OSCS to revolutionize upper limb exoskeleton-assisted rehabilitation by offering a customizable and adaptive framework tailored to individual patient needs, thereby advancing the field of robotic-assisted rehabilitation.

The Effect of Robot-Assisted Training on Arm Function, Walking, Balance, and Activities of Daily Living After Stroke: A Systematic Review and Meta-Analysis

This meta-analysis aimed to compare the effects of robot-assisted training (RAT) with those of conventional therapy (CT), considering the potential sources of heterogeneity in the previous studies. We searched three international electronic databases (MEDLINE, Embase, and the Cochrane Library) to identify relevant studies. Risk of bias assessment was performed using the Cochrane's Risk of Bias 1.0 tool. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations method. The meta-analyses for each outcome of the respective domains were performed using 24 randomized controlled trials (RCTs) on robot-assisted arm training (RAAT) for arm function, 7 RCTs on RAAT for activities of daily living (ADL), 12 RCTs on robot-assisted gait training (RAGT) for balance, 6 RCTs on RAGT for walking, and 7 RCTs on RAGT for ADL. The random-effects model for the meta-analysis revealed that RAAT has significant superiority over CT in improving arm function, and ADL. We also showed that RAGT has significant superiority over CT in improving balance. Our study provides high-level evidence for the superiority of RAT over CT in terms of functional recovery after stroke. Therefore, physicians should consider RAT as a therapeutic option for facilitating functional recovery after stroke.

Customized Manual Muscle Testing for Post-Stroke Upper Extremity Assessment

In neuro-rehabilitation, the assessment of post-stroke patients’ motor function of damaged upper extremities (UEs) is essential. Clinicians need clear and concise assessment instruments to monitor progress recorded in intensive rehabilitation sessions. One such instrument is Manual Muscle Testing (MMT), which, in our view, requires a modified scoring model aimed at improving the assessment process of patients’ motor and functional UE status, and recording their step-by-step-progress, especially if patients undergo a short length of hospitalization (of about 10 therapy days). Hence, this paper presents a new scoring system developed by the authors. This systemresults in a more precise MMT grading scale, which has more grades and can provide a more specific muscular assessment, while offering more clarity in quantifying patients’ progress after physical therapy. A prospective study was made of 41 post-stroke patients with upper extremity (UE) impairments. To determine the validity of the assessment tool for hypothesizing, and the unidimensionality and internal consistency of the customized model, exploratory and confirmatory factor analysis (CFA) with a structural equation model (SEM), Cronbach’s Alpha, and Pearson correlation coefficients were used with Fugl−Meyer (FM) assessments, the Modified Ashworth Scale (MAS), AROM, and the Modified Rankin Scale (MRS). Considering the unidimensionality of the instrument used, we performed a linear regression to identify whether certain movements performed segmentally by the manually evaluated muscles influence the measured manual score of the whole UE. All indices suggested a good model fit, and a Cronbach’s Alpha of 0.920 suggested strong internal consistency. The Pearson correlation coefficient of the MMT-customized score with AROM was 0.857, p < 0.001; that with FMUE was 0.905, p < 0.001; that with MRS was −0.608, p = 0.010; and that with MAS was −0.677, p < 0.001. The linear regression results suggest that wrist extensors, shoulder abductors, and finger flexors can influence the manual assessment of the muscle strength of the whole UE, thereby improving post-stroke patient management. The results of our research suggest that, using the proposed scoring, MMT may be a useful tool for UE assessment in post-stroke patients.