A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke

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

Evidence of Neuroplasticity: A Robotic Hand Exoskeleton Study for Post-Stroke Rehabilitation

“…MAS score of 1, 1+, 2, 3, 4 was mapped as 1, 1.5, 2, 3, 4 for all statistical calculation purpose, respectively as by Rong et. al (13).…”

“…Although rehabilitation with neuro-rehabilitation robots has shown encouraging clinical-results (5,6,15,(7)(8)(9)(10)(11)(12)(13)(14), it is currently limited to a very few hospitals and not widely used because of associated high-cost and an infrastructural-requirement to station, size, complexity, set-up time, safety and usability restricting its success (16), (17), (18). Rehabilitation-strategies need to take into account the multifaceted nature of disability, which itself changes with time elapsed post-stroke and address with a multimodal-approach.…”

Upper-Limb Exoskeletons for Stroke Rehabilitation

“…When FES is combined with the patient's residual voluntary effort [1], cortical plasticity seems to be enhanced, having therefore the potential to improve the therapeutic effects of FES [6]. The combined action of robotassisted therapy supporting elbow and wrist motion and EMG-triggered FES has shown positive effects on muscle coordination in subacute [24] and chronic stroke survivors [25]. FES has been combined also with passive anti-gravity exoskeletons, e.g.…”

Principles and global experience of applying robotic rehabilitation technologies in patients after stroke

“…Да и мышечная сила может оказаться недостаточной для выполнения полноценного двигательного акта, а интенсивная стимуляция вызывает мышечную усталость. ЭМГ-управляемая NMES-роботизированная система позволяет контролировать движения и доказанно улучшает моторную функцию верхней конечности за счет снижения спастического мышечного тонуса и увеличения объема движений в лучезапястном суставе и пальцах кисти, координирования работы мышц проксимальных и дистальных отделов руки [42].…”