The following is a summary of “Optimizing shoulder elevation assist rate in exoskeletal rehabilitation based on muscular activity indices: a clinical feasibility study,” published in the May 2024 issue of Neurology by Ito et al.
Researchers conducted a retrospective study assessing the effectiveness and safety of a new shoulder elevation exoskeleton robot incorporating a muscle synergy-derived optimization technique.
They conducted an intervention with 12 chronic stroke participants, involving 100 robot-assisted shoulder elevation exercises (10 sets of 10 repetitions each, lasting about 40 minutes) over 10 days (4 to 5 sessions per week). The optimal rate of robot assistance was determined by identifying change points using the co-contraction index, calculated from electromyogram (EMG) data collected from the anterior deltoid and biceps brachii muscles during initial shoulder elevation assessments. Key outcomes measured included the Fugl–Meyer assessment-upper extremity (FMA-UE) scores for shoulder/elbow/forearm, kinematic measures (maximum voluntary shoulder flexion angle and elbow flexion ratio during shoulder elevation), and shoulder pain indicators (pain-free passive shoulder flexion range of motion [ROM] and pain severity on a visual analog scale during shoulder flexion). The effectiveness and safety of robotic therapy were assessed using the Wilcoxon signed-rank sum test.
The results showed that all 12 patients completed the procedure without experiencing adverse events. The analysis excluded two participants due to the unavailability of EMG data for the biceps brachii. Ten participants, comprising five men and five women, with a mean age of 57.0 years (SD: 5.5) and a mean FMA-UE total score of 18.7 points (standard deviation: 10.5), demonstrated significant improvements in FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM, (P<0.05). Patients showed shoulder pain outcomes either remained stable or showed improvement in all patients.
Investigators concluded that a novel muscle synergy-derived optimization technique effectively determined optimal robotic assistance, enabling safe improvement of upper-extremity function in patients with chronic stroke during rehabilitation.
Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03651-x