Functional and neuromuscular changes induced via a low-cost, muscle-computer interface for telerehabilitation: A feasibility study in chronic stroke

Abstract

Stroke is a leading cause of adult disability in the United States. High doses of repeated task-specific practice have shown promising results in restoring upper limb function in chronic stroke. However, it is currently challenging to provide such doses in clinical practice. At-home telerehabilitation supervised by a clinician is a potential solution to provide higher-dose interventions. However, telerehabilitation systems developed for repeated task-specific practice typically require a minimum level of active movement. Therefore, severely impaired people necessitate alternative therapeutic approaches. Measurement and feedback of electrical muscle activity via electromyography (EMG) have been previously implemented in the presence of minimal or no volitional movement to improve motor performance in people with stroke. Specifically, muscle neurofeedback training to reduce unintended co-contractions of the impaired hand may be a targeted intervention to improve motor control in severely impaired populations. Here, we present the preliminary results of a low-cost, portable EMG biofeedback system (Tele-REINVENT) for supervised and unsupervised upper limb telerehabilitation after stroke. We aimed to explore the feasibility of providing higher doses of repeated task-specific practice during at-home training. Therefore, we recruited 5 participants (age = 44–73 years) with chronic, severe impairment due to stroke (Fugl-Meyer = 19–40/66). They completed a 6-week home-based training program that reinforced activity of the wrist extensor muscles while avoiding coactivation of flexor muscles via computer games. We used EMG signals to quantify the contribution of two antagonistic muscles and provide biofeedback of individuated activity, defined as a ratio of extensor and flexor activity during movement attempt. Our data suggest that 30 1-h sessions over 6 weeks of at-home training with our Tele-REINVENT system is feasible and may improve individuated muscle activity as well as scores on standard clinical assessments (e.g., Fugl-Meyer Assessment, Action Research Arm Test, active wrist range of motion) for some individuals. Furthermore, tests of neuromuscular control suggest modest changes in the synchronization of electroencephalography (EEG) and EMG signals within the beta band (12–30 Hz). Finally, all participants showed high adherence to the training protocol and reported enjoying using the system. These preliminary results suggest that using low-cost technology for home-based telerehabilitation after severe chronic stroke is feasible and may be effective in improving motor control via feedback of individuated muscle activity.

Pre-Implementation Analysis of the Usability and Acceptability of a Poststroke Complex Telehealth Biofeedback Intervention

“…Here, we briefly describe the trial procedures to contextualize the usability and acceptability findings. See the Appendix for additional protocol details and Marin-Pardo et al. (2022) for the technical specifications and preliminary efficacy findings.…”

“…The remaining sessions were conducted independently by the participants, although members of the research team were typically available for ad hoc support via telephone. The training protocol is described in additional detail by Marin-Pardo et al. (2022) .…”

“…In this study, we evaluated the usability and acceptability of an electromyography (EMG) biofeedback telehealth intervention for poststroke upper extremity motor recovery (Tele-REINVENT; Marin-Pardo et al., 2022 ). This study builds on previous pilot work examining the acceptability of Tele-REINVENT through thematic analysis of interviews with stroke survivors ( N = 4; Donnelly et al., 2023 ) by using a mixed- methods approach, including validated measures of usability and acceptability, with a larger sample of users.…”

Acceptability of a Telerehabilitation Biofeedback System Among Stroke Survivors: A Qualitative Analysis

“…Here, we briefly describe the trial procedures to contextualize the qualitative data. See Marin-Pardo et al (2022) for the full protocol and quantitative findings. All study procedures were conducted observing the ethical standards of the University of Southern California Institutional Review Board and the revised (2013) Helsinki Declaration.…”

“…Half of the sessions were facilitated by a therapist or technician to offer feedback, provide technical support, and monitor EMG signal quality. In each session, participants donned EMG sensors, completed an EMG calibration, and chose which game(s) they wanted to play (Marin-Pardo et al, 2022). Additional intervention details are reported in the findings for context.…”