Upper Limb Stroke Rehabilitation Using Surface Electromyography: A Systematic Review and Meta-Analysis

Abstract

BackgroundUpper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke.AimSynthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke.MethodsPubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols.ResultsTwenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI –0.18 to 0.46, I2 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI –0.34 to 1.18, I2 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline.ConclusionThis review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.

Performance in myoelectric pattern recognition improves with transcranial direct current stimulation

“…We undertake research in the field of prosthetic limbs 5 , 6 , rehabilitation of PLP 14 , 29 , and stroke 32 which would all benefit from validating the efficacy of tDCS to improve MPR. Here, we evaluated the hypothesis that tDCS improves MPR in the non-dominant hand of able-bodied individuals in a cross-over, sham-controlled study.…”

Surface-Electromyography-Based Co-Contraction Index for Monitoring Upper Limb Improvements in Post-Stroke Rehabilitation: A Pilot Randomized Controlled Trial Secondary Analysis

“…Surface electromyography (sEMG) records the electrical activity of muscles via electrodes placed over the skin, and it is a suitable tool for detecting antagonist muscle co-contraction, allowing to distinguish between physiological and pathological patterns [15][16][17][18][19][20][21].…”

“…In fact, for more than five decades, sEMG has been employed in the neurorehabilitation field as a tool to assess muscle activation and improve neuromuscular rehabilitation treatments [17,18]. For example, the EMG-based analysis has been used to investigate interlimb coordination, provide biofeedback, and track rehabilitation responses in subjects with neurological impairments [22].…”

“…Consequently, the development of easy-to-use methods for assessing motor control in a clinical setting could be valuable in tailoring the treatment of persons post-stroke. This is a topic of particular interest in the clinical field, but a recent review highlighted that sEMG is a promising tool to further improve functional recovery and stressed the need to develop specific sEMG-based interventions [17].…”

Performance in Myoelectric Pattern Recognition Improves with transcranial Direct Current Stimulation

“…Our group actively researches the elds of prosthetic limbs [5,6]and rehabilitation of PLP [14,29] and stroke [32] all of which would bene t from validating the e cacy of tDCS to improve MPR. Here, we evaluated the hypothesis that tDCS improves MPR in the nondominant hand of non-disabled individuals in a cross-over, sham-controlled study.…”