Abstract
BackgroundIt is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs.MethodIn this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training.ResultsIn the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT).ConclusionsThe EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers.Trial registrationClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014
Highlights
It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs
In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and neuromuscular electrical stimulation (NMES), in comparison with those without the assistance from the system (P < 0.05)
Lowered muscle co-contractions were observed in the muscle pairs of flexor carpi radialis (FCR)&Biceps brachii (BIC) (P < 0.001 and F = 22.27, One-way analyses of variance (ANOVA), with Bonferroni post hoc test), extensor carpi ulnaris (ECU)-extensor digitorum (ED)&FCR (P < 0.001 and F = 10.43, One-way ANOVA, with Bonferroni post hoc test) and BIC&triceps brachii (TRI) (P = 0.004 and F = 7.66, One-way ANOVA, with Bonferroni post hoc test) when the assistive schemes were R100N100 and R0N100
Summary
It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. 70 to 80% stroke survivors experienced impairments in their upper extremity, which greatly affects the independency of their daily living [2, 3]. In the upper limb rehabilitation, it has been found that the recovery of the proximal joints, e.g., the shoulder and the elbow, is much better than the distal, e.g., the wrist and fingers [4, 5]. The main possible reasons are: 1) The spontaneous motor recovery in early stage after stroke is from the proximal to the distal; and 2) the proximal joints experienced more effective physical practices than the distal joints throughout the whole rehabilitation process, since the proximal joints are easier to be handled by a human therapist and are more voluntarily controllable by most of stroke survivors [2]. More effective rehabilitation methods which may benefit the functional restoration at both the proximal and the distal are desired for post-stroke upper limb rehabilitation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
