Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial

Lee, Ya-Yun; Lin, Keh‐chung; Cheng, Hsiao-Ju; Wu, Ching‐yi; Hsieh, Yu-Chen; Chen, Chih‐Kuang

doi:10.1186/s12984-015-0088-3

Cited by 48 publications

(61 citation statements)

References 46 publications

(59 reference statements)

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“…Pure robot-assisted upper limb training also showed no superiority on motor improvements on chronic stroke in comparison with the traditional treatments in a reported randomized controlled trial ( 33 ). More recently, combined treatment with robot and NMES for the wrist by other research group also demonstrated more promising rehabilitation effectiveness in the upper limb motor recovery than pure robot training ( 34 ). However, most of the proposed devices are for single joint treatment, and the related trials were conducted on chronic stroke.…”

Section: Introductionmentioning

confidence: 99%

Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm

et al. 2017

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BackgroundEffective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was designed for the multi-joint physical training on the elbow, the wrist, and the fingers.ObjectivesTo investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments.MethodThis study was a pilot randomized controlled trial with a 3-month follow-up. Subacute stroke participants were randomly assigned into two groups, and then received 20-session upper limb training with the EMG-driven NMES-robotic arm (NMES-robot group, n = 14) or the time-matched traditional therapy (the control, n = 10). For the evaluation of the training effects, clinical assessments including Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), Action Research Arm Test (ARAT), and Function Independence Measurement (FIM) were conducted before, after the rehabilitation training, and 3 months later. Session-by-session EMG parameters in the NMES-robot group, including normalized co-contraction Indexes (CI) and EMG activation level of target muscles, were used to monitor the progress in muscular coordination patterns.ResultsSignificant improvements were obtained in FMA (full score and shoulder/elbow), ARAT, and FIM [P < 0.001, effect sizes (EFs) > 0.279] for both groups. Significant improvement in FMA wrist/hand was only observed in the NMES-robot group (P < 0.001, EFs = 0.435) after the treatments. Significant reduction in MAS wrist was observed in the NMES-robot group after the training (P < 0.05, EFs = 0.145) and the effects were maintained for 3 months. MAS scores in the control group were elevated following training (P < 0.05, EFs > 0.24), and remained at an elevated level when assessed 3 months later. The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii, as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group.ConclusionThe NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy. It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy.Clinical Trial Registration, identifier NCT02117089; date of registration: April 10, 2014.

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Section: Introductionmentioning

confidence: 99%

Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm

et al. 2017

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“…In addition, the combined system can reduce the compensatory muscular activities at the elbow and can improve muscle activation levels related to the wrist in patients with chronic stroke, which was not observed when robot-assisted therapy was used alone ( 23 ). A study on the wrist training in patients with chronic stroke by another research group also demonstrated higher rehabilitation effectiveness in the upper-limb motor recovery with the combination therapy than with robot-assisted therapy alone ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke

Nam

Wei

et al. 2017

Front. Neurol.

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BackgroundImpaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand was designed previously, whereas its rehabilitation effects were not investigated.ObjectivesThis study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke.MethodA clinical trial with single-group design was conducted on chronic stroke participants (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS). Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs) of the target muscles in the upper limb.ResultsSignificant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05), the ARAT (P < 0.05), and in the MAS (P < 0.05) were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD) and biceps brachii (P < 0.05), as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05).ConclusionThe upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later.Trial registration. NCT02117089; date of registration: April 10, 2014.

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“…In agreement with the theory that interventions can be merged in order to enhance functional recovery [26], the combined use of FES and robotic technologies, referred to as Hybrid Robotic Rehabilitation Systems, has gained increased interest for arm stroke rehabilitation [27]. A recent RCT involving chronic stroke survivors showed that the combined action of robot-assisted therapy and FES for wrist movements in case of bimanual tasks has a positive effect on hand movement quality and spasticity [28]. More recently, a pilot RCT on 24 subacute stroke patients compared the training effects of an EMG-triggered FES-robotic system supporting elbow, wrist and finger movements with traditional physical therapy, showing that the novel system was more effective [29].…”

Section: Introductionmentioning

confidence: 94%

A Hybrid Robotic System for Arm Training of Stroke Survivors: Concept and First Evaluation

Ambrosini

Russold

Gfoehler

et al. 2019

IEEE Trans. Biomed. Eng.

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To develop and evaluate a hybrid robotic system for arm recovery after stroke, combining EMG-triggered Functional Electrical Stimulation (FES) with a passive exoskeleton for upper limb suspension. Methods: The system was used in a structured exercise program resembling activities of daily life. Exercises execution was continuously controlled using angle sensor data and Radio-Frequency IDentification (RFID) technology. The training program consisted of 27 sessions lasting 30 minutes each. Seven post-acute stroke patients were recruited from two clinical sites. The efficacy of the system was evaluated in terms of Action Research Arm Test, Motricity Index, Motor Activity Log, and Box & Blocks tests. Furthermore, kinematicsbased and EMG-based outcome measures were derived directly from data collected during training sessions. Results: All patients showed an improvement of motor functions at the end of the training program. After training, the exercises were in most cases executed faster, smoother and with an increased range of motion. Subjects were able to trigger FES, but in some cases, they did not maintain the voluntary effort during task execution. All subjects but one considered the system usable. Conclusion: The preliminary results showed that the system can be used in a clinical environment with positive effects on arm functional recovery. However, only the final results of the currently ongoing clinical trial will unveil the system full potential. Significance: The presented hybrid robotic system is highly customizable, allows to monitor the daily performance, requires low supervision of the therapist and might have the potential to enhance arm recovery after stroke.

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Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial

Cited by 48 publications

References 46 publications

Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm

Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm

The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke

A Hybrid Robotic System for Arm Training of Stroke Survivors: Concept and First Evaluation

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