title: Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke.
abstract: BACKGROUND
  Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke.
  
  
  OBJECTIVE
  To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training.
  
  
  METHODS
  This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training.
  
  
  RESULTS
  The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05).
  
  
  CONCLUSIONS
  The NMES robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Hu
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR Department of Electronic Engineering, the Chinese University of Hong Kong, Hong Kong, SAR kytong@cuhk.edu.hk.
authors.forename: Raymond Kai-yu
authors.initials: RK
authors.lastname: Tong
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR.
authors.forename: Newmen S K
authors.initials: NS
authors.lastname: Ho
authors.affiliation: The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jing-jing
authors.initials: JJ
authors.lastname: Xue
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR.
authors.forename: Wei
authors.initials: W
authors.lastname: Rong
authors.affiliation: Tung Wah Hospital, the University of Hong Kong, Hong Kong, SAR.
authors.forename: Leonard S W
authors.initials: LS
authors.lastname: Li
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D002908:Chronic Disease; D004550:Elbow / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004576:Electromyography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D009119:Muscle Contraction / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012371:Robotics / Q000295:instrumentation*; D012720:Severity of Illness Index; D012782:Shoulder / Q000503:physiopathology; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014953:Wrist / Q000503:physiopathology*
keywords: neuromuscular electrical stimulation; rehabilitation; robot; stroke