Distal versus proximal - an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial.
NMES-robot
Stroke rehabilitation
Supporting strategy
Upper extremity
Journal
Journal of neuroengineering and rehabilitation
ISSN: 1743-0003
Titre abrégé: J Neuroeng Rehabil
Pays: England
ID NLM: 101232233
Informations de publication
Date de publication:
03 06 2019
03 06 2019
Historique:
received:
21
09
2018
accepted:
16
05
2019
entrez:
5
6
2019
pubmed:
5
6
2019
medline:
12
2
2020
Statut:
epublish
Résumé
Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints. Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions. Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05). Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE. ClinicalTrials.gov , identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089.
Sections du résumé
BACKGROUND
Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints.
METHODS
Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions.
RESULTS
Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05).
CONCLUSIONS
Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov , identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089.
Identifiants
pubmed: 31159822
doi: 10.1186/s12984-019-0537-5
pii: 10.1186/s12984-019-0537-5
pmc: PMC6545723
doi:
Banques de données
ClinicalTrials.gov
['NCT02117089']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
64Subventions
Organisme : Innovation and Technology Commission - Hong Kong
ID : ITT/039/14GP
Pays : International
Organisme : Innovation and Technology Commission - Hong Kong
ID : ITS/033/12
Pays : International
Organisme : Hong Kong Polytechnic University
ID : 1-ZE4R
Pays : International
Références
Continuum (Minneap Minn). 2011 Jun;17(3 Neurorehabilitation):545-67
pubmed: 22810867
NeuroRehabilitation. 2008;23(3):231-7
pubmed: 18560139
J Neuroeng Rehabil. 2007 Feb 19;4:4
pubmed: 17309791
BMC Health Serv Res. 2008 Apr 17;8:86
pubmed: 18416858
Lancet Neurol. 2003 Jan;2(1):43-53
pubmed: 12849300
Neurorehabil Neural Repair. 2008 Mar-Apr;22(2):111-21
pubmed: 17876068
Circulation. 2014 Jan 21;129(3):e28-e292
pubmed: 24352519
Arch Phys Med Rehabil. 2006 May;87(5):671-9
pubmed: 16635630
Annu Rev Neurosci. 1986;9:147-70
pubmed: 3518585
J Neuroeng Rehabil. 2011 Nov 16;8:63
pubmed: 22087842
Lancet. 2011 May 14;377(9778):1693-702
pubmed: 21571152
J Psychiatr Res. 1975 Nov;12(3):189-98
pubmed: 1202204
Dtsch Arztebl Int. 2008 May;105(18):330-6
pubmed: 19629252
Neurorehabil Neural Repair. 2014 Nov-Dec;28(9):819-27
pubmed: 24642382
Br J Health Psychol. 2011 Sep;16(3):592-609
pubmed: 21199537
Stroke. 2013 Aug;44(8):2361-75
pubmed: 23697546
J Rehabil Res Dev. 2006 Mar-Apr;43(2):171-84
pubmed: 16847784
Neurorehabil Neural Repair. 2009 Oct;23(8):837-46
pubmed: 19531605
Neurorehabil Neural Repair. 2015 Sep;29(8):767-76
pubmed: 25549656
J Neuroeng Rehabil. 2016 Oct 29;13(1):95
pubmed: 27794362
Clin Rehabil. 2005 Sep;19(6):594-9
pubmed: 16180594
J Neurol Neurosurg Psychiatry. 2003 May;74(5):646-8
pubmed: 12700310
Stroke. 2003 Sep;34(9):2181-6
pubmed: 12907818
NeuroRehabilitation. 2011;28(2):105-11
pubmed: 21447911
N Engl J Med. 2005 Apr 21;352(16):1677-84
pubmed: 15843670
PM R. 2016 Aug;8(8):721-9
pubmed: 26805909
Phys Ther. 1987 Feb;67(2):206-7
pubmed: 3809245
Arch Phys Med Rehabil. 2004 Jul;85(7):1106-11
pubmed: 15241758
Lancet. 1999 Jul 17;354(9174):191-6
pubmed: 10421300
Neurorehabil Neural Repair. 2008 Jan-Feb;22(1):78-90
pubmed: 17704352
Arch Phys Med Rehabil. 2005 Dec;86(12 Suppl 2):S101-S114
pubmed: 16373145
IEEE Trans Neural Syst Rehabil Eng. 2007 Sep;15(3):327-35
pubmed: 17894265
Neurorehabil Neural Repair. 2009 Jun;23(5):505-14
pubmed: 19237734
BMC Musculoskelet Disord. 2008 Apr 10;9:44
pubmed: 18402701
J Electromyogr Kinesiol. 2004 Oct;14(5):577-89
pubmed: 15301776
J Electromyogr Kinesiol. 2009 Aug;19(4):639-50
pubmed: 18490177
BMJ. 2009 May 12;338:b1732
pubmed: 19435763
Cochrane Database Syst Rev. 2015 Nov 07;(11):CD006876
pubmed: 26559225
Exp Brain Res. 1999 Dec;129(3):441-50
pubmed: 10591915
IEEE Trans Neural Syst Rehabil Eng. 2005 Sep;13(3):325-34
pubmed: 16200756
Stroke. 2010 Jan;41(1):136-40
pubmed: 19940277
J Electromyogr Kinesiol. 2013 Oct;23(5):1065-74
pubmed: 23932795
Front Neurol. 2017 Dec 14;8:679
pubmed: 29312116
Stroke. 2015 Nov;46(11):3042-7
pubmed: 26443828
Restor Neurol Neurosci. 2004;22(3-5):281-99
pubmed: 15502272
Aust J Physiother. 2008;54(3):220
pubmed: 18833688
J Neuroeng Rehabil. 2017 Apr 26;14(1):34
pubmed: 28446181
Curr Atheroscler Rep. 2004 Jul;6(4):314-9
pubmed: 15191707
IEEE Trans Neural Syst Rehabil Eng. 2018 Aug 13;:
pubmed: 30106736
J Rehabil Med. 2009 Nov;41(12):955-60
pubmed: 19841823
Scand J Rehabil Med. 1975;7(1):13-31
pubmed: 1135616
Int J Rehabil Res. 2014 Mar;37(1):67-73
pubmed: 24126253
J Electromyogr Kinesiol. 2012 Jun;22(3):431-9
pubmed: 22277205
Front Psychol. 2016 Jul 21;7:1092
pubmed: 27493637
IEEE Int Conf Rehabil Robot. 2011;2011:5975424
pubmed: 22275625
Phys Med Rehabil Clin N Am. 2015 Nov;26(4):599-610
pubmed: 26522900
Neurorehabil Neural Repair. 2017 Jun;31(6):521-529
pubmed: 28506146
Front Neurol. 2017 Sep 04;8:447
pubmed: 28928706
J Stroke. 2013 Sep;15(3):174-81
pubmed: 24396811
J Neuroeng Rehabil. 2014 Jul 10;11:111
pubmed: 25012864
Disabil Rehabil Assist Technol. 2015 Mar;10(2):149-59
pubmed: 24377757
Top Stroke Rehabil. 2008 Sep-Oct;15(5):412-26
pubmed: 19008202
Neural Plast. 2012;2012:359728
pubmed: 22792492
Int J Rehabil Res. 2011 Dec;34(4):349-56
pubmed: 22044987
Arch Phys Med Rehabil. 2015 Oct;96(10):1820-7
pubmed: 26119465
Arch Phys Med Rehabil. 2007 Aug;88(8):1022-9
pubmed: 17678665