Electromyography Recordings Detect Muscle Activity Before Observable Contractions in Acute Stroke Care

Abstract

Objective To evaluate muscle activity in the arms of adult stroke survivors with limited or no arm movement during acute care. Design Prospective observational study. Setting Acute care regional stroke center. Participants We recruited adults (N=21) who had a stroke within the previous 5 days who were admitted to a level 1 trauma hospital and had a National Institutes of Health Stroke Scale score >1 for arm function at the time of recruitment. A total of 21 adults (13 men, 8 women) with an average age of 60±15 years were recruited an average of 3±1 days after their stroke. Eleven (7 men, 4 women; age, 56±11y) had no observable or palpable arm muscle activity (Manual Muscle Test [MMT]=0) and 10 (6 men, 4 women; age, 64±1y) had detectable activity (MMT>0). Interventions Dual mode sensors (electromyography and accelerometry) were placed on the anterior deltoid, biceps, triceps, wrist extensors, and wrist flexors of the impaired arm. Main Outcome Measures The number of muscle contractions, as well as average duration, amplitude, and co-contraction patterns were evaluated for each participant. Results Muscle contractions were observed in all 5 muscles for all participants using electromyography (EMG) recordings. Contractions were easily identified from 30 minutes of monitoring for participants with an MMT >0, but up to 3 hours of monitoring was required for participants with an MMT=0 to detect contractions in all 5 muscles during standard care. Only the wrist extensors demonstrated significantly larger amplitude contractions for participants with an MMT>0 than those with an MMT=0. Co-contraction was rare, involving less than 10% of contractions. Co-contraction of 2 muscles most commonly aligned with the flexor synergy pattern commonly observed after stroke. For participants with an MMT=0, the number of contractions and maximum amplitude were moderately correlated with MMT scores at follow-up. Conclusions Muscle activity was detected with surface EMG recordings during standard acute care, even for individuals with no observable activity by clinical examination. Wearable sensors may be useful for monitoring early muscle activity and movement after stroke.

Clinical Features to Predict the Use of a sEMG Wearable Device (REMO®) for Hand Motor Training of Stroke Patients: A Cross-Sectional Cohort Study

“…Our results reflected the difficulty of muscle activation in patients with a higher level of upper limb motor impairment. Papazian et al affirmed that in severely impaired patients, there were upper limb muscle contractions without visible movements, but they reflected random and uncontrolled muscle activity [ 29 ]. However, sEMG-driven interventions should be feasible to this type of patient when considering the limited rehabilitation options available for people with severe upper limb impairments [ 29 ].…”

“…Papazian et al affirmed that in severely impaired patients, there were upper limb muscle contractions without visible movements, but they reflected random and uncontrolled muscle activity [ 29 ]. However, sEMG-driven interventions should be feasible to this type of patient when considering the limited rehabilitation options available for people with severe upper limb impairments [ 29 ]. These data suggested that more investigation of sEMG-driven intervention of patients with severe motor impairment is needed.…”

“…To determine the sample size, we considered recent evidence on the possibility of detecting muscle activity at the forearm, meant as voluntary control of sEMG amplitude since the first week after stroke, also in those patients not expressing any active voluntary movement [ 29 ]. Moreover, for these impaired patients, more than 90% of contractions involved at least one muscle.…”

“…Among the options offered by TBR, devices providing biofeedback from surface electromyography (sEMG) represent a reliable solution to enhance motor recovery in stroke rehabilitation [ 28 , 29 ]. Indeed, sEMG-based solutions trigger an interaction with the external environment (e.g., a computer interface) and provide the patients with real-time auditory or visual information on the timing and amplitude of their muscle activation [ 29 , 30 ].…”

Rehabilitation of motor function after stroke: A bibliometric analysis of global research from 2004 to 2022

“…Electromyography can quantitatively and qualitatively analyze the neuromuscular function of target muscles by collecting surface signals during muscle activity and speculating on the damage extent and nature of target muscles, thereby offering noninvasive and real-time measurements ( Cè et al, 2020 ; Feldner et al, 2021 ; Fujita et al, 2021 ; Papazian et al, 2021 ). Liu et al (2022) combined sEMG devices and video games to develop a biofeedback-based therapeutic play system, which could improve patient training initiative and compliance.…”