Author: Nam, Ching Yi
Title: Electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) and robot hybrid system for upper limb rehabilitation after stroke
Advisors: Hu, Xiaoling (BME)
Degree: Ph.D.
Year: 2021
Subject: Cerebrovascular disease -- Patients -- Rehabilitation
Arm -- Diseases
Electrotherapeutics
Robotics in medicine
Hong Kong Polytechnic University -- Dissertations
Department: Department of Biomedical Engineering
Pages: xviii, 168 pages : color illustrations
Language: English
Abstract: Upper limb motor deficits are noted in more than 80% of stroke survivors. Restoration of limb function requires repeated-and-intensive practice of the paralyzed limb with maximized voluntary motor effort and minimized compensatory motions in close-to¬≠normal muscular coordination. While electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robot assisted therapy has been suggested for repeated¬≠and-intensive upper limb training with maximized voluntary motor effort, and minimized the compensatory motions, it remains challenging. The main difficulties are as follows: (1) EMG-driven NMES-robot assisted therapy for hand function recovery was under investigation although impaired hand dexterity is a major disability of the upper limb after stroke; (2) long-term rehabilitation methods with potential for self-help training by stroke survivors are urgently required to improve the independency of stroke survivors and decrease the burden on the healthcare system because of the expanding stroke population and insufficiency of professional staff worldwide. However, suitable technologies for these methods are currently lacking; and (3) most outpatients with chronic stroke experienced upper limb impairments, especially in the distal joints. However, they have limited access to the treatment in public healthcare system because of resource constraints. The objectives of this study were: (1) investigation of the rehabilitation effectiveness of an EMG-driven NMES-robotic hand assisted upper limb training, (2) development of a novel EMG-driven NMES-robot (i.e., exoneuromusculoskeleton) for self-help upper limb rehabilitation, and (3) investigation of the feasibility and rehabilitation effectiveness of home-based self-help training assisted by an EMG-driven wrist/hand exoneuromusculoskeleton. This study was divided into the following three parts: In the first part, a clinical trial with single-group design was conducted on participants with chronic stroke (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand assisted upper limb training. The results suggested that device-assisted upper limb training was effective for improving voluntary motor functions and muscle coordination in the paretic upper limb. Furthermore, these improvements were maintained after 3 months.
In the second part, a novel EMG-driven exoneuromusculoskeleton was developed. The system integrated the NMES, soft pneumatic muscle, and exoskeleton techniques, for self-help upper limb training after stroke. The developed system could assist the elbow, wrist, and fingers to perform sequential limb task under voluntary effort control through EMG, with a lightweight, compact, and low power-requirement design. The pressure-torque transmission properties of the designed musculoskeletons were quantified, and the assistive capability of the system was evaluated on patients with chronic stroke (n =10). The feasibility of the developed system for self-help operation and rehabilitation effects were also investigated in a pilot single-group trial (n =15). The results suggested that the developed system could effectively support self-help upper limb rehabilitation after stroke. In the third part, the feasibility of using the EMG-driven wrist/hand exoneuromusculoskeleton for home-based self-help upper limb training, and its rehabilitation effects were investigated on participants with chronic stroke(n =11) in a clinical trial with single-group design. The EMG-driven wrist/hand exoneuromusculoskeleton could assist self-help upper limb training in a home setting, and was effective in improving motor functions of the paretic upper limb. In conclusion, repeated-and-intensive upper limb training with coordinated hand movements assisted by the EMG-driven NMES-robotic hand could facilitate hand function recovery and improve muscular coordination in the paretic limb. A novel EMG-driven exoneuromusculoskeleton was developed for self-help upper limb rehabilitation, which could assist the physical practice of the paretic upper limb. The system could assist self-help upper limb training in both laboratory and home settings, and was effective for improving voluntary motor control, muscular coordination, and reducing muscle spasticity of the paretic upper limb.
Rights: All rights reserved
Access: open access

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