Abstract
BackgroundDifferent mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints.MethodsThirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions.ResultsSignificant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05).ConclusionsRobotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE.Clinical trial registrationClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089
Highlights
Stroke is one of the leading causes of long-term adult disabilities [1], with rapid growth worldwide [2]
This strategy resulted in the learned non-use in the distal joints and compensatory movements from the proximal in the upper extremity (UE) carried over to the chronic period when the distal practice was insufficient after the discharge [16]
The results suggested that direct support to the finger joints was more effective to achieve distal motor improvements than support to more proximal joints, and the improvement could continue in the three months after the training
Summary
Stroke is one of the leading causes of long-term adult disabilities [1], with rapid growth worldwide [2]. A pair of therapist-patient unit usually starts the training on the larger and more proximal joints and leaves the distal joints being less practiced in the early in-hospital UE rehabilitation, according to the spontaneous motor return after stroke. This strategy resulted in the learned non-use in the distal joints and compensatory movements from the proximal in the UE carried over to the chronic period when the distal practice was insufficient after the discharge [16]. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints
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