Deans' stroke musings: Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography (EMG)-Driven Neuromuscular Electrical Stimulation (NMES)-Robotic arm

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, August 29, 2017

Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography (EMG)-Driven Neuromuscular Electrical Stimulation (NMES)-Robotic arm

Weasel words used, could achieve. Useless research then since more followup needed to create a protocol out of this.
http://journal.frontiersin.org/article/10.3389/fneur.2017.00447/full

Qiuyang Qian¹,

Xiaoling Hu^1*, Qian Lai¹, Stephanie Ng², Yongping Zheng¹ and Waisang Poon²

¹Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong
²Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

Background: Effective post-stroke motor rehabilitation depends on repeated limb practice with voluntary efforts. An electromyography (EMG) driven neuromuscular electrical stimulation (NMES)-Robot arm was designed for the multi-joint physical training on the elbow, the wrist and the fingers.
Objectives: To investigate the training effects of the device assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments.
Method: This study was a pilot randomized controlled trial with a 3-month follow-up. Subacute stroke participants were randomly assigned into two groups, and then received 20-session upper limb training with the EMG-driven NMES-robotic arm (NMES-robot group, n=14) or the time-matched traditional therapy (the control, n=10). For the evaluation of the training effects, clinical assessments including Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), Action Research Arm Test(ARAT) and Function Independence Measurement(FIM) were conducted before, after the rehabilitation training, and 3 months later. Session-by-session EMG parameters in the NMES-robot group, including normalized co-contraction Indexes (CI) and EMG activation level of target muscles, were used to monitor the progress in muscular coordination patterns.
Results: Significant improvements were obtained in FMA(full score and shoulder/elbow), ARAT and FIM(P<0.001, effect sizes>0.279) for both groups. Significant improvement in FMA wrist/hand was only observed in the NMES-robot group (P<0.001, effect size=0.435) after the treatments. Significant reduction in MAS wrist was observed in the NMES-robot group after the training (P<0.05, effect sizes=0.145) and the effects were maintained for 3 months. MAS scores in the control group were elevated following training (P<0.05, effect sizes>0.24), and remained at an elevated level when assessed three months later. The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii, as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group.
Conclusions: The NMES-robot assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy. It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy.