Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial

Abstract

Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS) have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted training within a virtual learning environment. Six MS patients with upper limb impairment (motricity index ranging from 50 to 91/100) and six healthy persons completed five training bouts of three minutes each performing lifting tasks, while EMG signals of anterior deltoid and lower trapezius muscles were measured and their subjective perceptions on muscle fatigue were registered. Decreased performance and higher subjective fatigue perception were present in the MS group. Increased mean EMG amplitudes and subjective perception levels on muscle fatigue were observed in both groups. Muscle fatigue development during 15′ training has been demonstrated in the arm of MS patients, which influences the sustainability of training intensity in MS patients. To optimize the training performance, adaptivity based on the detection of MS patient's muscle fatigue could be provided by means of training program adjustment.

A Survey of Assistive Technologies for Assessment and Rehabilitation of Motor Impairments in Multiple Sclerosis

“…Although several pharmacological treatments are available to control MS symptoms, assessments and rehabilitation using physical therapies have proven to help improve the quality of life [102]. Fatigue is an important factor to consider during rehabilitation and in designing rehabilitation plans [103], as studies have shown a decline in performance during rehabilitation tasks due to fatigue [104,105]. In this section, we discuss several techniques investigated by researchers for monitoring and detecting fatigue during rehabilitation.…”

“…Octavia et al evaluated muscle fatigue during robot-mediated upper limb rehabilitation as PwMS and healthy control subjects were performing five sessions of lifting and transporting exercises using a HapticMaster robot and an I-Travel system [104]. While performing the tasks EMG was recorded from the anterior deltoid and trapezius muscles, filtered using Infinite Impulse Response and Butterworth bandpass filters and then rectified using an RMS sliding window approach.…”

“…Many studies have directly or indirectly tried to account for fatigue. Octavia et al aimed to evaluate muscular fatigue during robot mediated upper limb rehabilitation [104]. Here, they found that during rehabilitation there was an increase in the subjective fatigue which was accompanied by a decrease in performance.…”

The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke and multiple sclerosis

“…In this prospective cohort study, pwMS attended 5 training sessions per 2 weeks, alternating 3 [32] whereas 8 weeks of training is often applied in MS [26][27][28]30]. In pwMS with overall high disability, a more extensive but more time-spread training program was required taking into account the occurrence of activity-related motor fatigue and higher risk for training overload [24].…”

“…However, it is still not clear whether (robot-mediated) upper limb training is successful in pwMS to the same extent as stroke patients, due to progressive neurodegeneration and presence of motor fatigue potentially interfering with feasible training intensity [24,25]. As in stroke, new training technologies, focusing on robotic and/or sensor-based technology, are being developed to improve upper limb movement in pwMS and indications for improvement were found in previous studies [26][27][28].…”