scholarly journals Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial

2019 ◽  
Vol 33 (4) ◽  
pp. 284-295 ◽  
Author(s):  
Emily M. Mugler ◽  
Goran Tomic ◽  
Aparna Singh ◽  
Saad Hameed ◽  
Eric W. Lindberg ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Muscle Activation ◽  
Arm Movement ◽  
Chronic Stroke ◽  
Computer Interface ◽  
Stroke Survivors ◽  
Training Methods ◽  
Training Dose ◽  
Muscle Activation Patterns ◽  
Co Activation

Background. Abnormal muscle co-activation contributes to impairment after stroke. We developed a myoelectric computer interface (MyoCI) training paradigm to reduce abnormal co-activation. MyoCI provides intuitive feedback about muscle activation patterns, enabling decoupling of these muscles. Objective. To investigate tolerability and effects of MyoCI training of 3 muscle pairs on arm motor recovery after stroke, including effects of training dose and isometric versus movement-based training. Methods. We randomized chronic stroke survivors with moderate-to-severe arm impairment to 3 groups. Two groups tested different doses of isometric MyoCI (60 vs 90 minutes), and one group tested MyoCI without arm restraint (90 minutes), over 6 weeks. Primary outcome was arm impairment (Fugl-Meyer Assessment). Secondary outcomes included function, spasticity, and elbow range-of-motion at weeks 6 and 10. Results. Over all 32 subjects, MyoCI training of 3 muscle pairs significantly reduced impairment (Fugl-Meyer Assessment) by 3.3 ± 0.6 and 3.1 ± 0.7 ( P < 10−4) at weeks 6 and 10, respectively. Each group improved significantly from baseline; no significant differences were seen between groups. Participants’ lab-based and home-based function also improved at weeks 6 and 10 ( P ≤ .01). Spasticity also decreased over all subjects, and elbow range-of-motion improved. Both moderately and severely impaired patients showed significant improvement. No participants had training-related adverse events. MyoCI reduced abnormal co-activation, which appeared to transfer to reaching in the movement group. Conclusions. MyoCI is a well-tolerated, novel rehabilitation tool that enables stroke survivors to reduce abnormal co-activation. It may reduce impairment and spasticity and improve arm function, even in severely impaired patients.

Abstract P206: Wearable Myoelectric Interface Training for Improving Arm Movement in Chronic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Na-Teng Hung ◽  
Vivek Paul ◽  
Torin Kovach ◽  
Marc W Slutzky
Keyword(s):  
Computer Games ◽  
High Intensity ◽  
Arm Movement ◽  
Chronic Stroke ◽  
Control Group ◽  
High Dose ◽  
Stroke Survivors ◽  
Sham Control ◽  
Co Activation ◽  
Sham Control Group

Impaired arm movement after stroke is due not only to weakness and spasticity, but also to abnormal co-activation (a.k.a. abnormal synergies). Yet, few stroke therapies are aimed to reduce this co-activation. We designed a myoelectric computer interface (MyoCI) that provides feedback to stroke survivors to reduce this abnormal co-activation and associated arm impairment. Here, we describe a novel, wearable version of the MyoCI to control custom-designed computer games as a home-based therapy for chronic stroke survivors. This therapy, called the myoelectric interface for neurorehabilitation training (MINT), enables high-intensity, high-dose training using an inexpensive device at home. The MINT device records surface EMGs from 2-3 arm muscles and wirelessly controls games on a laptop or tablet. By mapping the muscle activities to orthogonal directions of cursor movements, the games operantly condition the participants to learn to reduce abnormal co-activation between the muscles. We are currently investigating this device in severely impaired stroke survivors (Fugl-Meyer score <30). Participants were asked to train 90 min per day, 6 days a week, for a total of 6 weeks, with different variants of the paradigm (2 or 3 muscles at a time) vs. a sham control group that trained on one muscle. We surveyed participants about their engagement with the game using a modified Intrinsic Motivation Inventory (IMI). Eighteen participants have completed the 6-week training to date. They averaged 75±19 min of daily training out of the 90 that were asked. Overall, 60% of participants surveyed enjoyed, and 90% were positively motivated by, the training. A few participants had significant difficulty with the laptops due to inexperience with computers. Participants’ performance on the game, measured by weighted time-to-target, improved steadily overall in the experimental group, while the sham control group stayed at high performance throughout. The MINT provides a motivating, enjoyable way to provide high-intensity therapy in the home to stroke survivors. This therapy is a new mechanism of action for stroke rehabilitation and we are evaluating its efficacy in an ongoing randomized controlled trial.

Development of an Apparatus for Bilateral Rhythmical Training of Arm Movement Via Linear and Elliptical Trajectories of Various Directions

2014 ◽  
Vol 8 (3) ◽  
Author(s):  
Zlatko Matjačić ◽  
Matjaž Zadravec ◽  
Jakob Oblak
Keyword(s):  
Muscle Activation ◽  
Arm Movement ◽  
Emg Activity ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Arm Cycling ◽  
Arm Reaching ◽  
Direction Of Movement ◽  
Muscle Groups ◽  
Neurologically Intact

Clinical rehabilitation of individuals with various neurological disorders requires a significant number of movement repetitions in order to improve coordination and restoration of appropriate muscle activation patterns. Arm reaching movement is frequently practiced via motorized arm cycling ergometers where the trajectory of movement is circular thus providing means for practicing a single and rather nonfunctional set of muscle activation patterns, which is a significant limitation. We have developed a novel mechanism that in the combination with an existing arm ergometer device enables nine different movement modalities/trajectories ranging from purely circular trajectory to four elliptical and four linear trajectories where the direction of movement may be varied. The main objective of this study was to test a hypothesis stating that different movement modalities facilitate differences in muscle activation patterns as a result of varying shape and direction of movement. Muscle activation patterns in all movement modalities were assessed in a group of neurologically intact individuals in the form of recording the electromyographic (EMG) activity of four selected muscle groups of the shoulder and the elbow. Statistical analysis of the root mean square (RMS) values of resulting EMG signals have shown that muscle activation patterns corresponding to each of the nine movement modalities significantly differ in order to accommodate to variation of the trajectories shape and direction. Further, we assessed muscle activation patterns following the same protocol in a selected clinical case of hemiparesis. These results have shown the ability of the selected case subject to produce different muscle activation patterns as a response to different movement modalities which show some resemblance to those assessed in the group of neurologically intact individuals. The results of the study indicate that the developed device may significantly extend the scope of strength and coordination training in stroke rehabilitation which is in current clinical rehabilitation practice done through arm cycling.

scholarly journals Alterations in upper limb muscle synergy structure in chronic stroke survivors

2013 ◽  
Vol 109 (3) ◽  
pp. 768-781 ◽  
Author(s):  
Jinsook Roh ◽  
William Z. Rymer ◽  
Eric J. Perreault ◽  
Seng Bum Yoo ◽  
Randall F. Beer
Keyword(s):  
Muscle Activation ◽  
Isometric Force ◽  
Muscle Synergy ◽  
Muscle Synergies ◽  
Stroke Survivors ◽  
Activation Patterns ◽  
Force Matching ◽  
Muscle Activation Patterns ◽  
Anterior Deltoid ◽  
Arm Function

Previous studies in neurologically intact subjects have shown that motor coordination can be described by task-dependent combinations of a few muscle synergies, defined here as a fixed pattern of activation across a set of muscles. Arm function in severely impaired stroke survivors is characterized by stereotypical postural and movement patterns involving the shoulder and elbow. Accordingly, we hypothesized that muscle synergy composition is altered in severely impaired stroke survivors. Using an isometric force matching protocol, we examined the spatial activation patterns of elbow and shoulder muscles in the affected arm of 10 stroke survivors (Fugl-Meyer <25/66) and in both arms of six age-matched controls. Underlying muscle synergies were identified using non-negative matrix factorization. In both groups, muscle activation patterns could be reconstructed by combinations of a few muscle synergies (typically 4). We did not find abnormal coupling of shoulder and elbow muscles within individual muscle synergies. In stroke survivors, as in controls, two of the synergies were comprised of isolated activation of the elbow flexors and extensors. However, muscle synergies involving proximal muscles exhibited consistent alterations following stroke. Unlike controls, the anterior deltoid was coactivated with medial and posterior deltoids within the shoulder abductor/extensor synergy and the shoulder adductor/flexor synergy in stroke was dominated by activation of pectoralis major, with limited anterior deltoid activation. Recruitment of the altered shoulder muscle synergies was strongly associated with abnormal task performance. Overall, our results suggest that an impaired control of the individual deltoid heads may contribute to poststroke deficits in arm function.

scholarly journals A Statistical Approach for the Assessment of Muscle Activation Patterns during Gait in Parkinson’s Disease

Electronics ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 1641
Author(s):  
Giulia Pacini Panebianco ◽  
Davide Ferrazzoli ◽  
Giuseppe Frazzitta ◽  
Margherita Fonsato ◽  
Maria Cristina Bisi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Tibialis Anterior ◽  
Muscle Activation ◽  
Statistical Approach ◽  
Healthy Adults ◽  
Activation Patterns ◽  
Gastrocnemius Medialis ◽  
Muscle Activation Patterns ◽  
Co Activation

Recently, the statistical analysis of muscle activation patterns highlighted that not only one, but several activation patterns can be identified in the gait of healthy adults, with different occurrence. Although its potential, the application of this approach in pathological populations is still limited and specific implementation issues need to be addressed. This study aims at applying a statistical approach to analyze muscle activation patterns of gait in Parkinson’s Disease, integrating gait symmetry and co-activation. Surface electromyographic signal of tibialis anterior and gastrocnemius medialis were recorded during a 6-min walking test in 20 patients. Symmetry between right and left stride time series was verified, different activation patterns identified, and their occurrence (number and timing) quantified, as well as the co-activation of antagonist muscles. Gastrocnemius medialis presented five activation patterns (mean occurrence ranging from 2% to 43%) showing, with respect to healthy adults, the presence of a first shorted and delayed activation (between flat foot contact and push off, and in the final swing) and highlighting a new second region of anticipated activation (during early/mid swing). Tibialis anterior presented five activation patterns (mean occurrence ranging from 3% to 40%) highlighting absent or delayed activity at the beginning of the gait cycle, and generally shorter and anticipated activations during the swing phase with respect to healthy adults. Three regions of co-contraction were identified: from heel strike to mid-stance, from the pre- to initial swing, and during late swing. This study provided a novel insight in the analysis of muscle activation patterns in Parkinson’s Disease patients with respect to the literature, where unique, at times conflicting, average patterns were reported. The proposed integrated methodology is meant to be generalized for the analysis of muscle activation patterns in pathologic subjects.

Influence of Gravity Compensation on Muscle Activation Patterns During Different Temporal Phases of Arm Movements of Stroke Patients

2009 ◽  
Vol 23 (5) ◽  
pp. 478-485 ◽  
Author(s):  
G.B. Prange ◽  
M.J.A. Jannink ◽  
A.H.A. Stienen ◽  
H. van der Kooij ◽  
M.J. IJzerman ◽  
...  
Keyword(s):  
Motor Control ◽  
Muscle Activation ◽  
Arm Movement ◽  
Quantitative Information ◽  
Gravity Compensation ◽  
Stroke Patients ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Arm Support ◽  
Control Objective

Background. Arm support to help compensate for the effects of gravity may improve functional use of the shoulder and elbow during therapy after stroke, but gravity compensation may alter motor control. Objective. To obtain quantitative information on how gravity compensation influences muscle activation patterns during functional, 3-dimensional reaching movements. Methods. Eight patients with mild hemiparesis performed 2 sets of repeated reach and retrieval movements, with and without unloading the arm, using a device that acted at the elbow and forearm to compensate for gravity. Electromyographic (EMG) patterns of 6 upper extremity muscles were compared during elbow and shoulder joint excursions with and without gravity compensation. Results. Movement performance was similar with and without gravity compensation. Smooth rectified EMG (SRE) values were decreased from 25% to 50% during movements with gravity compensation in 5 out of 6 muscles. The variation of SRE values across movement phases did not differ across conditions. Conclusions. Gravity compensation did not affect general patterns of muscle activation in this sample of stroke patients, probably since they had adequate function to complete the task without arm support. Gravity compensation did facilitate active arm movement excursions without impairing motor control. Gravity compensation may be a valuable modality in conventional or robot-aided therapy to increase the intensity of training for mildly impaired patients.

scholarly journals Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Chengpeng Hu ◽  
Tong Wang ◽  
Kenry W. C. Leung ◽  
Le Li ◽  
Raymond Kai-Yu Tong
Keyword(s):  
Electrical Stimulation ◽  
Lower Extremity ◽  
Functional Electrical Stimulation ◽  
Electrical Impedance ◽  
Muscle Activation ◽  
Chronic Stroke ◽  
Anisotropy Ratio ◽  
Stroke Survivors ◽  
Clinical Scales ◽  
Cycling Training

Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P &lt; 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training.Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).

scholarly journals Costs of position, velocity, and force requirements in optimal control induce triphasic muscle activation during reaching movement

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuki Ueyama
Keyword(s):  
Optimal Control ◽  
Nervous System ◽  
Muscle Activation ◽  
Arm Movement ◽  
The Body ◽  
Activation Patterns ◽  
Reaching Movement ◽  
Muscle Activation Patterns ◽  
Antagonist Muscles ◽  
Neural Input

AbstractThe nervous system activates a pair of agonist and antagonist muscles to determine the muscle activation pattern for a desired movement. Although there is a problem with redundancy, it is solved immediately, and movements are generated with characteristic muscle activation patterns in which antagonistic muscle pairs show alternate bursts with a triphasic shape. To investigate the requirements for deriving this pattern, this study simulated arm movement numerically by adopting a musculoskeletal arm model and an optimal control. The simulation reproduced the triphasic electromyogram (EMG) pattern observed in a reaching movement using a cost function that considered three terms: end-point position, velocity, and force required; the function minimised neural input. The first, second, and third bursts of muscle activity were generated by the cost terms of position, velocity, and force, respectively. Thus, we concluded that the costs of position, velocity, and force requirements in optimal control can induce triphasic EMG patterns. Therefore, we suggest that the nervous system may control the body by using an optimal control mechanism that adopts the costs of position, velocity, and force required; these costs serve to initiate, decelerate, and stabilise movement, respectively.

Voluntary activation failure contributes more to plantar flexor weakness than antagonist coactivation and muscle atrophy in chronic stroke survivors

2010 ◽  
Vol 109 (5) ◽  
pp. 1337-1346 ◽  
Author(s):  
Cliff S. Klein ◽  
Dina Brooks ◽  
Denyse Richardson ◽  
William E. McIlroy ◽  
Mark T. Bayley
Keyword(s):  
Muscle Atrophy ◽  
Muscle Activation ◽  
Voluntary Contraction ◽  
Chronic Stroke ◽  
Voluntary Activation ◽  
Stroke Survivors ◽  
Plantar Flexor ◽  
Plantar Flexors ◽  
Emg Amplitude ◽  
Magnetic Resonance Imaging Mri

The contributions of nervous system muscle activation and muscle atrophy to poststroke weakness have not been evaluated together in the same subject. Maximal voluntary contraction (MVC) torque, voluntary activation (twitch interpolation), and electromyographic (EMG) amplitude were determined bilaterally in the plantar flexors of seven chronic stroke survivors (40–63 yr, 24–51 mo poststroke). Volumes of the plantar flexor muscles were determined bilaterally with magnetic resonance imaging (MRI). The mean (±SD) contralesional (paretic) MVC torque was less than one-half of the ipsilesional leg: 56.7 ± 57.4 vs. 147 ± 35.7 Nm ( P = 0.006). Contralesional voluntary activation was only 48 ± 36.9%, but was near complete in the ipsilesional leg, 97 ± 1.9% ( P = 0.01). The contralesional MVC EMG amplitude (normalized to the maximum M-wave peak-to-peak amplitude) of the gastrocnemii and soleus were 36.0 ± 28.5 and 36.0 ± 31.0% of the ipsilesional leg. Tibialis anterior (TA) EMG coactivation was not different between the contralesional (23.2 ± 24.0% of TA MVC EMG) and ipsilesional side (12.3 ± 5.7%) ( P = 0.24). However, TA EMG coactivation was excessive (71%) in one subject and accounted for ∼8% of her weakness based on the estimated antagonist torque. Relative (%ipsilesional leg) plantar flexor and gastrocnemii volumes were 88 ± 6% ( P = 0.004) and 76 ± 15% ( P = 0.01), respectively. Interlimb volume differences of the soleus, deep plantar flexors, and peronei were not significant. Preferred walking speed (0.83 ± 0.33 m/s) was related to the contralesional MVC torque ( r2 = 0.57, P = 0.05, N = 7), but the two subjects with the greatest weakness walked faster than three others. Our findings suggest that plantar flexor weakness in mobile chronic stroke survivors reflects mostly voluntary activation failure, with smaller contributions from antagonist activity and atrophy.

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