[Ideomotor training combining the use with integrated application of electromyostimulation and a robotic...

Area of Science:

• Neuroscience and Rehabilitation Medicine
• Biomedical Engineering and Technology

Background:

• Upper limb (UL) dysfunction is a common and debilitating consequence of stroke, significantly impacting daily activities and environmental interaction.
• Existing sensorimotor biofeedback (BOS) therapies show varying degrees of effectiveness, highlighting the need for advanced rehabilitation strategies.
• The combination of electromyostimulation (EMS) and neurocomputer interface (NCI) technology presents a promising avenue for enhancing UL recovery post-stroke.

Purpose of the Study:

• To investigate the therapeutic effect of an integrated EMS and robotic NCI system on upper limb (UL) function in patients with spastic paresis following ischemic stroke (IS).
• To evaluate the efficacy of this combined approach during the early recovery period of IS.

Main Methods:

• A randomized controlled trial involving 120 patients with moderate to severe UL spastic paresis in the early IS recovery phase.
• Patients were allocated to four groups: a control group (basic rehabilitation), a main group (EMS + NCI with exoskeletons), comparison group 1 (NCI only), and comparison group 2 (EMS only).
• The intervention period lasted two weeks, with assessments at 5, 10, and 90 days post-intervention using standardized scales (MRCs, mAs, FMA-UE, ARAT).

Main Results:

• The main group (EMS + NCI) exhibited significant improvements in UL function, muscle strength, and scores on the Fugl-Meyer Assessment for upper extremity (FMA-UE) and Action Research Arm Test (ARAT).
• Clinically significant differences (Δ) in FMA-UE and ARAT scores were achieved by the main group, indicating substantial functional recovery.
• While NCI-only and EMS-only groups showed some improvement, the combined EMS and NCI approach yielded superior outcomes compared to basic rehabilitation and individual therapies.

Conclusions:

• The integrated approach combining ideomotor training with EMS and NCI effectively promotes the regression of sensorimotor disorders in the upper limb.
• This multimodal rehabilitation strategy enhances manipulative activity and restores UL function in patients recovering from ischemic stroke.
• The combination of stimulating visual, vestibular, and proprioceptive analyzers, alongside cognitive training, is crucial for optimizing recovery outcomes.