“It's All Sort of Cool and Interesting…but What Do I Do With It?” A Qualitative Study of Stroke Survivors' Perceptions of Surface Electromyography

Abstract

Background: Stroke is one of the most common neurologic injuries worldwide. Over decades, evidence-based neurorehabilitation research and advancements in wireless, wearable sensor design have supported the deployment of technologies to facilitate recovery after stroke. Surface electromyography (sEMG) is one such technology, however, clinical application remains limited. To understand this translational practice gap and improve clinical uptake, it is essential to include stakeholder voices in an analysis of neurorehabilitation practice, the acceptability of current sEMG technologies, and facilitators and barriers to sEMG use in the clinic and the community. The purpose of this study was to foreground the perspectives of stroke survivors to gain a better understanding of their experiences in neurorehabilitation, the technologies they have used during their recovery, and their opinions of lab-designed and commercially-available sEMG systems. Methods: A qualitative, phenomenological study was completed. In-depth, semi-structured interviews were conducted with eight stroke survivors (age range 49-78 years, 6 months to 12 years post-stroke) and two caregivers from a large metropolitan region. A demonstration of four sEMG systems was provided to gather perceptions of sensor design, features and function, and user interface. Interviews were audio-recorded, transcribed verbatim, and coded for analysis using constant comparison until data saturation was reached. Results: Three themes emerged from the data: (1) "Surface EMG has potential….but…" highlights the recognition of sEMG as a valuable tool but reveals a lack of understanding and need for clear meaning from the data; (2) "Tracking incremental progress over days or years is important" highlights the persistence of hope and potential benefit of sEMG in detecting small changes that may inform neurorehabilitation practice and policy; and (3) "Neurorehabilitation technology is cumbersome" highlights the tension between optimizing therapy time and trying new technologies, managing cost, logistics and setup , and desired technology features. Feldner et al. Stroke Survivor Perceptions of sEMG Conclusion: Further translation of sEMG technology for neurorehabilitation holds promise for stroke survivors, but sEMG system design and user interface needs refinement. The process of using sEMG technology and products must be simple and provide meaningful insight to recovery. Including stroke survivors directly in translational efforts is essential to improve uptake in clinical environments.

Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy

“…Nevertheless, the sample of responders was relatively large (n = 28) and included experts in pediatric rehabilitation: physical therapists, neuro-developmental disorders therapists, and medical doctors ( Figure 4A, left panel). It is also worth noting that many of the barriers for the sEMG use were acknowledged for other populations of patients as well [see, for instance, other articles in this research project: (140)(141)(142)(143)(144)(145)]. Therefore, a general need for this innovative technology suggests that "specific education should be part of the rehabilitation professionals' curriculum" (142).…”

Clinical Use of Surface Electromyography to Track Acute Upper Extremity Muscle Recovery after Stroke: A Descriptive Case Study of a Single Patient

“…The available data were reported and compared with sEMG output. Despite purposefully selecting the Biostamp sensors for their technical features among many other systems previously researched by this study team, there were also limitations in the sEMG sensors themselves, pointing to important needs for future development and research [28,29]. While the design of the sensors was comfortable and unobtrusive to the participant, the size of the sensors may have allowed for cross talk between muscles and decreased the quality of the signal.…”

“…Each sensor was 6.6 × 3.4 × 0.3 cm 3 in a housing made of a flexible, low-durometer silicone. These sensors were selected from many research lab-owned systems due to their low profile, flexibility, remote monitoring capabilities, and ability to sanitize in-hospital environments [28,29]. Prior to placement, the skin was prepared by washing with soap and water, and electroconductive gel was applied to each sensor.…”

“…Further, few studies have evaluated rehabilitation technologies, such as sEMG, during acute and subacute phases of stroke recovery, with the bulk of the literature engaging chronic stroke survivors [27]. Qualitative exploration of perceptions of wearable sensors in clinical settings has also been limited, aside from the previous work of this research group [28,29]. In the midst of conducting two larger studies, one that incorporated qualitative methods with stroke survivors in the community, and one that focused on quantitative sEMG tracking with a different group of hospitalized participants, the research team had the unique opportunity to perform both sets of research procedures with one participant who was able to be followed through acute hospitalization, subacute recovery in inpatient rehabilitation, and following discharge, due to remaining in the same medical system throughout recovery.…”

Development of a Low-Cost, Modular Muscle–Computer Interface for At-Home Telerehabilitation for Chronic Stroke

“…Recently, portable systems have been developed for at-home use to improve accessibility and training time with EMG biofeedback [ 13 , 14 ]. However, proper implementation of home-based EMG biofeedback is critical to prevent low participant adherence, avoid high costs, and account for limitations in terms of required physical space, time, and technical literacy [ 14 , 15 , 16 , 17 , 18 ]. Specifically, it has been suggested that the ability to track patient progress in real-time and the continued involvement of a clinician in the intervention are key factors that could improve patient motivation and adherence to at-home rehabilitation programs [ 9 , 17 ].…”