The Use of Wearable Sensors for the Movement Assessment on Muscle Contraction Sequences in Post-Stroke Patients during Sit-to-Stand

Brain (EEG) and muscle (EMG) activity related to 3D sit-to-stand kinematics in healthy adults and in central neurological pathology - A systematic review

BACKGROUND

The sit-to-stand transfer is a fundamental functional movement during normal activities of daily living. Central nervous system disorders can negatively impact the execution of sit-to-stand transfers, often impeding successful completion. Despite its importance, the neurophysiological basis at muscle (electromyography (EMG)) and brain (electroencephalography (EEG)) level as related to the kinematic movement is not well understood.

OBJECTIVES

This review synthesises the published literature addressing central and peripheral neural activity during 3D kinematic capture of sit-to-stand transfers.

METHODS

A pre-registered systematic review was conducted. Electronic databases (PubMed, CINAHL Plus, Web of Science, Scopus and EMBASE) were searched from inception using search operators that included sit-to-stand, kinematics and EMG and/or EEG. The search was not limited by study type but was limited to populations comprising of healthy individuals or individuals with a central neurological pathology.

RESULTS

From a total of 28,770 identified papers, 59 were eligible for inclusion. Ten of these 59 studies received a moderate quality rating; with the remainder rated as weak using the Effective Public Health Practice Project tool. Fifty-eight studies captured kinematic data of sit-to-stand with associated EMG activity only and one study captured kinematics with co-registered EMG and EEG data. Fifty-six studies examined sit-to-stand transfer in healthy individuals, reporting four dynamic movement phases and three muscle synergies commonly used by most individuals to stand-up. Pre-movement EEG activity was reported in one study with an absence of data during execution. Eight studies examined participants following stroke and two examined participants with Parkinson's disease, both reporting no statistically significant differences between their kinematics and muscle activity and those of healthy controls.

SIGNIFICANCE

Little is known about the neural basis of the sit-to-stand transfer at brain level with limited focus in central neurological pathology. This poses a barrier to targeted mechanistic-based rehabilitation of the sit-to-stand movement in neurological populations.

Immediate effects of trunk Kinesio Taping® on functional parameters in the acute stage of patients with mild stroke: A randomized controlled trial

BACKGROUND

Improving early trunk control, balance, and sitting activity following acute stroke is critical for functional prognosis.

PURPOSE

To compare the immediate efficacy of Kinesio Taping® (KT) application on anterior and posterior trunk muscles in terms of improving trunk control, balance, and sit-to-stand performance in the acute stage of stroke.

METHODS

Sixty-nine patients with acute mild stroke were allocated to the anterior KT group (AKT) (age = 65.95 ± 9.67; 12 females, 11 males; Modified Rankin Score = 3), posterior KT group (PKT) (age = 65.39 ± 10.39; 10 females, 13 males; Modified Rankin Score = 3), and control group (CG) (age = 65.34 ± 8.91; 11 females, 12 males; Modified Rankin Score = 2). Trunk control, balance, and sit-to-stand performance were assessed at the baseline and after 45 minutes and 48 hours post-KT. Data were analyzed using repeated-measures ANOVA.

RESULTS

All outcome measures scores improved in all groups significantly after 48 hours (p < .001). A significant improvement after 45 minutes was only seen in trunk control compared to the CG (p < .001; d = 1.32 for AKT and p = .038; d = 0.75 for PKT). Trunk control, balance, and sit-to-stand performance improved in both AKT and PKT compared to the CG at 48 hours post-taping. Trunk control (p < .001; d = 0.26) and balance (p < .001; d = 0.72) results were in favor of the AKT, while sit-to-stand performance results did not make a difference between KT groups (p = .335; d = 0.47).

CONCLUSION

KT application on anterior or posterior trunk muscles was effective for improving trunk control, balance, and sit-to-stand performance in acute stage of stroke in the short term. KT application on anterior trunk muscles had the advantage of improving trunk control and balance.

The use of accelerometer bracelets to evaluate arm motor function over a stroke rehabilitation period - an explorative observational study

BACKGROUND

Assessments of arm motor function are usually based on clinical examinations or self-reported rating scales. Wrist-worn accelerometers can be a good complement to measure movement patterns after stroke. Currently there is limited knowledge of how accelerometry correlate to clinically used scales. The purpose of this study was therefore to evaluate the relationship between intermittent measurements of wrist-worn accelerometers and the patient's progression of arm motor function assessed by routine clinical outcome measures during a rehabilitation period.

METHODS

Patients enrolled in in-hospital rehabilitation following a stroke were invited. Included patients were asked to wear wrist accelerometers for 24 h at the start (T1) and end (T2) of their rehabilitation period. On both occasions arm motor function was assessed by the modified Motor Assessment Scale (M_MAS) and the Motor Activity Log (MAL). The recorded accelerometry was compared to M_MAS and MAL.

RESULTS

20 patients were included, of which 18 completed all measurements and were therefore included in the final analysis. The resulting Spearman's rank correlation coefficient showed a strong positive correlation between measured wrist acceleration in the affected arm and M-MAS and MAL values at T1, 0.94 (p < 0.05) for M_MAS and 0.74 (p < 0.05) for the MAL values, and a slightly weaker positive correlation at T2, 0.57 (p < 0.05) for M_MAS and 0.46 - 0.45 (p = 0.06) for the MAL values. However, no correlation was seen for the difference between the two sessions.

CONCLUSIONS

The results confirm that the wrist acceleration can differentiate between the affected and non-affected arm, and that there is a positive correlation between accelerometry and clinical measures. Many of the patients did not change their M-MAS or MAL scores during the rehabilitation period, which may explain why no correlation was seen for the difference between measurements during the rehabilitation period. Further studies should include continuous accelerometry throughout the rehabilitation period to reduce the impact of day-to-day variability.

Trunk and lower extremity biomechanics during sit-to-stand after stroke: A systematic review

OBJECTIVES

This systematic review aimed to pool available evidence of differences in trunk and lower extremity biomechanics during the different phases of a sit-to-stand (STS) task between persons with stroke and to healthy controls.

METHODS

Four electronic databases (Medline, Web of Science, EMBASE, and Cochrane Library) were systematically searched up to, and including, December 2021. Studies were included if they investigated kinematic, kinetic and/or electromyographic outcome measures of adults with stroke during STS and compared results with healthy controls. Data from eligible studies were categorized according to STS subphases if reported (Phase I: Movement onset to seat-off; Seat-off; Phase II: Seat-off to movement termination; Whole task [if no subtasks reported]). The Newcastle-Ottawa Scale was used to assess risk of bias.

RESULTS

Twenty-one studies were included in this systematic review. Methodological quality ranged from 13% to 75%; mean score was 55%. The findings of this systematic review suggest that after stroke, people rise to stand (phase I) with increased lateral trunk flexion and displacement of the center of pressure (COP) towards the non-paretic side, decreased anterior pelvic tilt, decreased hip flexion and altered timing of lower limb muscle activation. In addition, during phase II, lateral pelvic translation and weight distribution asymmetry was increased, knee extension velocity was decreased and delayed, stabilization was decreased and COP velocity was increased compared with healthy subjects.

CONCLUSIONS

This systematic review clearly showed changes in kinematics, kinetics and muscle recruitment after stroke, with differences between the different phases of STS. Therapeutic interventions should focus on subphases of this functional task to optimize performance in daily living.

Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke

BACKGROUND AND PURPOSE

A successful chair-rise is an important indicator of functional independence post-stroke. Lower extremity electromyographic analyses provide a basis for muscle activation from which clinical intervention protocols may be derived. Gluteus maximus activation during the chair-rise has not been thoroughly researched in the chronic stroke population. This study investigated the magnitude and onset of gluteus maximus activation during the chair-rise comparing adults post-stroke with healthy controls.

METHODS

In this cross-sectional study, adults with chronic stroke (n = 12) and healthy controls (n = 12) completed 4 natural-speed chair-rise trials. Magnitude and onset of bilateral gluteus maximus activation were measured during the movement with secondary comparative data from biceps femoris and vastus lateralis muscles. Kinetic and kinematic measurements were used to quantify chair-rise phases and movement cycle duration.

RESULTS

Significant decreases in paretic ( P = 0.002), and nonparetic ( P = 0.001) gluteus maximus magnitudes were noted post-stroke compared with ipsilateral extremities of healthy adults. Significant gluteus maximus onset delays were noted in paretic extremities compared with nonparetic extremities post-stroke ( P = 0.009) that were not apparent in comparative muscles. Similar onset times were noted when comparing the paretic extremity post-stroke to the ipsilateral extremity of healthy controls ( P = 0.714) despite prolonged movement cycle durations in those with chronic stroke ( P = 0.001). No onset delays were evident in the biceps femoris ( P = 0.72) or vastus lateralis ( P = 0.338) muscles.

DISCUSSION AND CONCLUSIONS

Despite apparent unilateral muscle weakness post-stroke, bilateral decreases in gluteus maximus activation magnitudes and compounding onset deficits of the paretic extremity were observed during chair-rising. Further research is needed to determine whether interventions maximizing bilateral activation magnitudes and improving temporal activation congruency during chair-rising will carry over to functional gainsVideo Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A387 ).

Long short-term memory (LSTM) recurrent neural network for muscle activity detection

BACKGROUND

The accurate temporal analysis of muscle activation is of great interest in many research areas, spanning from neurorobotic systems to the assessment of altered locomotion patterns in orthopedic and neurological patients and the monitoring of their motor rehabilitation. The performance of the existing muscle activity detectors is strongly affected by both the SNR of the surface electromyography (sEMG) signals and the set of features used to detect the activation intervals. This work aims at introducing and validating a powerful approach to detect muscle activation intervals from sEMG signals, based on long short-term memory (LSTM) recurrent neural networks.

METHODS

First, the applicability of the proposed LSTM-based muscle activity detector (LSTM-MAD) is studied through simulated sEMG signals, comparing the LSTM-MAD performance against other two widely used approaches, i.e., the standard approach based on Teager-Kaiser Energy Operator (TKEO) and the traditional approach, used in clinical gait analysis, based on a double-threshold statistical detector (Stat). Second, the effect of the Signal-to-Noise Ratio (SNR) on the performance of the LSTM-MAD is assessed considering simulated signals with nine different SNR values. Finally, the newly introduced approach is validated on real sEMG signals, acquired during both physiological and pathological gait. Electromyography recordings from a total of 20 subjects (8 healthy individuals, 6 orthopedic patients, and 6 neurological patients) were included in the analysis.

RESULTS

The proposed algorithm overcomes the main limitations of the other tested approaches and it works directly on sEMG signals, without the need for background-noise and SNR estimation (as in Stat). Results demonstrate that LSTM-MAD outperforms the other approaches, revealing higher values of F1-score (F1-score > 0.91) and Jaccard similarity index (Jaccard > 0.85), and lower values of onset/offset bias (average absolute bias < 6 ms), both on simulated and real sEMG signals. Moreover, the advantages of using the LSTM-MAD algorithm are particularly evident for signals featuring a low to medium SNR.

CONCLUSIONS

The presented approach LSTM-MAD revealed excellent performances against TKEO and Stat. The validation carried out both on simulated and real signals, considering normal as well as pathological motor function during locomotion, demonstrated that it can be considered a powerful tool in the accurate and effective recognition/distinction of muscle activity from background noise in sEMG signals.

Electromyographic Analyses of Trunk Musculature after Stroke: An Integrative Review

Background: Observational and intervention studies examining trunk electromyographic (EMG) activity following stroke are underpowered and fail criteria for systematic reviews of randomized control trials. Objective: To systematically evaluate and summarize evidence about trunk muscle activation after stroke during ADL and with diagnostic and therapeutic interventions.Methods: Search databases were Medline Complete, CINAHL and Health Sources: Nursing Academic Edition. Studies written in English after 1989 included these search terms: stroke, muscle activity, and trunk including abdominal or back muscles. Systematic reviews, single case studies, dissertations, or letters to the editor were excluded. Reviewers used Covidence to screen relevant research and extract information after title, abstract, and full-text screening. Information extracted related to stroke severity, time since onset, specific muscles and EMG analysis technique, and study limitations. Articles were classified as observational, intervention or device-related.Results: The electronic search yielded 188 articles and a hand search found 3. Title and abstract screening yielded 102 articles for full text screening. Ultimately, 45 articles were extracted. Trunk muscle recruitment during function and movement demonstrated significant differences in trunk EMG recruitment timing, magnitude, and symmetry after stroke when compared with healthy participants. Individuals with stroke demonstrated significant differences when comparing paretic to non-paretic side trunk EMG measures. Intervention studies showed some effect on improving trunk muscle activation but they had small sample sizes and methodological issues.Conclusions: Trunk muscle activation after stroke can be monitored with EMG during rehabilitation programs which challenge functional recovery.

Application of Modern Multi-Sensor Holter in Diagnosis and Treatment

Modern Holter devices are very trendy tools used in medicine, research, or sport. They monitor a variety of human physiological or pathophysiological signals. Nowadays, Holter devices have been developing very fast. New innovative products come to the market every day. They have become smaller, smarter, cheaper, have ultra-low power consumption, do not limit everyday life, and allow comfortable measurements of humans to be accomplished in a familiar and natural environment, without extreme fear from doctors. People can be informed about their health and 24/7 monitoring can sometimes easily detect specific diseases, which are normally passed during routine ambulance operation. However, there is a problem with the reliability, quality, and quantity of the collected data. In normal life, there may be a loss of signal recording, abnormal growth of artifacts, etc. At this point, there is a need for multiple sensors capturing single variables in parallel by different sensing methods to complement these methods and diminish the level of artifacts. We can also sense multiple different signals that are complementary and give us a coherent picture. In this article, we describe actual interesting multi-sensor principles on the grounds of our own long-year experiences and many experiments.