The effect of robot therapy assisted by surface EMG on hand recovery in post-stroke patients. A pilot study

Abstract

Background: Hemiparesis caused by a stroke negatively limits a patient’s motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension. Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG. Research project: Before-after study design. Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient. Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test. Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment.

Sensorimotor, Attentional, and Neuroanatomical Predictors of Upper Limb Motor Deficits and Rehabilitation Outcome after Stroke

“…Interestingly, the type of TB therapy did not enter into the model. This is in line with the fact that both TB methods are built on exercises of kinematic adaptation to continuous on-line feedback in ecological settings, as well as with the previous evidence that both methodologies boost upper limb motor recovery [17][18][19][20].…”

“…The exercises with virtual reality focus on the elbow and shoulder/proximal upper limb, with a 3D motion-tracking system (Polhemus 3Space Fas-Trak, Vermont, U.S.A.) as described by Piron and colleagues [2]. The AMADEO robot (Tyromotion GmbH Graz, Austria) treatment is based on detection and control of fingers' flexors and extensors through surface electromyography signals [19]. The choice of TB protocol was driven by clinical judgment and in particular by the residual abilities of the individual patient.…”

“…Recent innovative approaches for motor rehabilitation with technology-based (hereafter, TB) techniques aim to resemble the ecological environments, where behavior is demanding and cognitive abilities may be involved [2,14]. TB methods are based on interactive action-feedback simulation software, which engages patients into real-world-like scenarios [2,15,16] and supports motor recovery, as demonstrated for upper limb rehabilitation [17][18][19][20]. Nevertheless, a recent Cochrane review noted that most studies of TB rehabilitation (i.e., using virtual reality) usually exclude patients with severe cognitive deficits, thereby prompting for further investigations on cognitive abilities as covariate in motor training outcome [21].…”

The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb—Promising Results from a Pilot Study

“…An improvement in the activation of extensor digitorum communis and deltoid muscle was obtained; thus, these findings consolidate the improvement of the clinical parameters. Other studies used surface EMG to monitor muscle activity during RAT sessions and to control the amount of RAT given to each patient [ 42 ]. In the present study, we used conventional needle EMG to assess muscle activity before and after the intervention.…”