The re-education of upper limb movement post stroke using iterative learning control mediated by electrical stimulation

Abstract

An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and electrical stimulation (ES) to reduce upper limb impairments following stroke, but current systems may not encourage maximal voluntary contribution from the participant. This study developed and tested iterative learning control (ILC) algorithms mediated by ES, using a purpose designed robotic workstation, for upper limb rehabilitation post stroke. Surface electromyography (EMG) which may be related to impaired performance and function was used to investigate seven shoulder and elbow muscle activation patterns in eight neurologically intact and five chronic stroke participants during nine tracking tasks. The participants’ forearm was supported using a hinged arm-holder, which constrained their hand to move in a two dimensional horizontal plane.
Outcome measures taken prior to and after an intervention consisted of the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), isometric force and error tracking. The intervention for stroke participants consisted of eighteen sessions in which a similar range of tracking tasks were performed with the addition of responsive electrical stimulation to their triceps muscle. A question set was developed to understand participants’ perceptions of the ILC system. Statistically significant improvements were measured (p?0.05) in: FMA motor score, unassisted tracking, and in isometric force. Statistically significant differences in muscle activation patterns were observed between stroke and neurologically intact participants for timing, amplitude and coactivation patterns. After the intervention significant changes were observed in many of these towards neurologically intact ranges. The robot–assisted therapy was well accepted and tolerated by the stroke participants. This study has demonstrated the feasibility of using ILC mediated by ES for upper limb stroke rehabilitation in the treatment of stroke patients with upper limb hemiplegia.

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Identifiers

ORCID for Ann-Marie Hughes: orcid.org/0000-0002-3958-8206

ORCID for Eric Rogers: orcid.org/0000-0003-0179-9398

ORCID for Jane Burridge: orcid.org/0000-0003-3497-6725

ORCID for Paul Lewin: orcid.org/0000-0002-3299-2556

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