title: Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke.
abstract: Post-stroke hemiparesis may manifest as asymmetric gait, poor balance, and inefficient movement patterns. We investigated improvements in lower-limb muscle activation and function during Wii-based Movement Therapy (WMT), a rehabilitation program specifically targeting upper-limb motor-function.
  
  
  
  Electromyography (EMG) was recorded bilaterally from tibialis anterior (TA) in 20 stroke patients during a 14-day WMT program. EMG amplitude and burst duration were analyzed during stereotypical movement sequences of WMT activities. Functional movement ability was assessed pre- and post-therapy including 6-min walk test (6MWT), stair-climbing speed, and Wolf Motor Function Test timed-tasks.
  
  
  
  TA EMG burst duration during Wii-golf increased by 30% on the more-affected side (p = 0.04) and decreased by 28% on the less-affected side. Patients who did not step during Wii-tennis had a 16% decrease in more-affected TA burst sum (p = 0.047) resulting in more symmetrical activation ratio at late-therapy, with the ratio changing from 3.24 ± 2.25 to 0.99 ± 0.11 (p = 0.047). Six-minute walk and stair-climbing speed improved (p = 0.005 and 0.03, respectively), as did upper-limb movement (p ≤ 0.001).
  
  
  
  This study provides physiological evidence for lower-limb improvements with WMT. Different patterns of muscle activation changes were evident across the WMT activities. Despite the relatively good pre-therapy lower-limb function, muscle activation and symmetry improved significantly with upper-limb WMT. Implications for rehabilitation WMT is an upper-limb neurorehabilitation program that also improves lower-limb motor-function. We report a shift towards more symmetrical muscle activation of tibialis anterior on the more- and less-affected sides that were reflected in increased distance walked during the 6MWT. The use of standing during therapy not only improves lower-limb function but also permits larger and more powerful upper-limb movements. Targeted upper-limb rehabilitation can also significantly improve mobility and balance, whether dynamic or static, that should reduce the risk of falls post-stroke.
authors.affiliation: a Neuroscience Research Australia , Sydney , NSW , Australia.|b Faculty of Medicine , School of Medical Sciences, University of New South Wales , Sydney , Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Trinh
authors.affiliation: a Neuroscience Research Australia , Sydney , NSW , Australia.|b Faculty of Medicine , School of Medical Sciences, University of New South Wales , Sydney , Australia.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Shiner
authors.affiliation: a Neuroscience Research Australia , Sydney , NSW , Australia.|b Faculty of Medicine , School of Medical Sciences, University of New South Wales , Sydney , Australia.
authors.forename: Angelica G
authors.initials: AG
authors.lastname: Thompson-Butel
authors.affiliation: a Neuroscience Research Australia , Sydney , NSW , Australia.|b Faculty of Medicine , School of Medical Sciences, University of New South Wales , Sydney , Australia.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: McNulty
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001315:Australia; D002908:Chronic Disease; D004576:Electromyography; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000534:rehabilitation*; D013177:Sports; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*; D018910:Video Games; D000070857:Walk Test; D055815:Young Adult
keywords: activities of daily living; balance; electromyography; muscle symmetry; walking