A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke.
Wei Rong, Waiming Li, Mankit Pang and 6 others
PMID 28446181WHAT IT FOUND
After 20 sessions with a muscle-signal-controlled robot and electrical stimulation device, 11 people after chronic stroke improved upper-limb function scores and tracking accuracy.
No control group means the combined intervention cannot be attributed to one component.
Key findings
01During evaluation, robot support significantly reduced wrist tracking error compared with no robot support.
02Electrical stimulation, with or without robot support, significantly reduced co-contraction between tested elbow and wrist muscle pairs.
03After the training programme, elbow and wrist spasticity scores fell and upper-limb function test scores improved.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was a single-group pilot, so it did not compare the device with traditional physical or occupational training. Only 11 people were studied, and they had to be at least one year after stroke, have moderate to severe upper-limb impairment, enough passive wrist and elbow movement, and detectable voluntary muscle signals in target muscles, so people outside these criteria were not tested. The training combined robot assistance, electrical stimulation, muscle-signal-controlled task practice and repeated sessions, so the contribution of any single component cannot be separated. The device was a prototype that needed a hanging system to support the arm and 15 minutes of setup by a trained helper, and product optimization was still needed. Finger spasticity did not improve significantly, and finger flexion had no active assistance, so hand grasp and finger tone were not addressed.
The easy way to misread this
Do not conclude that this robot and electrical stimulation device is proven to improve stroke upper-limb function. The positive scores came from 20 sessions in 11 people with no control group, and the training mixed robot support, electrical stimulation, muscle-signal-controlled practice and repeated task training, so the effect of any one component cannot be separated.