Posts Tagged neuromuscular

[ARTICLE] Music meets robotics: a prospective randomized study on motivation during robot aided therapy – Full Text



Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C–), each in a condition with (V+) and without (V–) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation.


In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V–). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece.


Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C–) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found.


Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders.



Following a stroke, 80-90% of patients suffer from arm paresis, which remains chronic in about 30-40% of all cases [123]. Task-oriented, intensive, and motivational training is important to increase arm function post-stroke [245678].

Intensity is recognized as a key feature of successful rehabilitation therapy [9]. Robots in neurorehabilitation allow for highly-intensive, task-oriented training and have the potential to be superior to conventional therapies (i.e., physical or occupational therapy) in improving motor function post-stroke [10]. Robotic therapy may embed functional training tasks into computer games to facilitate motor learning and to stimulate motivation [11].

Autonomy, competence, and relatedness can be regarded as the main components of intrinsic motivation [1213]. While extrinsic motivation can be described as a goal-directed drive towards an externally provided reward (e.g., a score in a game), intrinsic motivation is a process oriented and internally provided reward due to a satisfying, interesting, meaningful or enjoyable activity [1415]. The knowledge regarding the meaningfulness of an activity is a positive determinant of patient motivation [7]. Thus, for patients, an activity should not only be enjoyable, but also lead to a rehabilitation progress. Furthermore, patient engagement is related to the expected reduction of impairment during game-based therapy in stroke [16].

Activities with a close relation to intrinsic motivation are frequently associated with activities promoting creativity [171819]. This might be because activities promoting creativity involve one’s own accord, active decision making, and a resulting product, thus satisfying the need of autonomy, competence, and relatedness [12202122].

In addition to encouraging creativity, music is a promising stimulator for intrinsic motivation in the context of rehabilitation [2324]. Music effectively promotes post-stroke recovery in motor and cognitive functions, and furthermore in emotional and social domains [25262728293031]. Studies that compared conventional therapy forms to therapy tasks embedded in active music making revealed that music-associated training increases the level of motivation significantly [2432].

Auditory displays have already been determined to be effective for navigation within complex systems [33]. Accordingly, sound is an audible source for navigation through the execution of a task in virtual scenarios without the need for a visual display unit, the advantage being that the visual focus can be on the trained limb rather than a graphical display, thus promoting visuo-motor control [3435].

We developed tasks for robot-assisted training of the arm that aim to increase intrinsic motivation with a focussed stimulation of the two aspects: creativity and music. To investigate whether a music condition promoting creativity influences motivation differently than a music condition not promoting creativity, we compared motivational effects of both versions. We investigated the effect of the presence or absence of a visual display for both conditions regarding promotion of creativity. As the training goal of the presented gamified task is to induce high intensity during exercise, the game is operated by repetitive horizontal movements.

For this current study, we designed audio-haptic tasks in a way that they can be performed either with visual display (i.e., a monitor presenting the game workspace) as an audio-visuo-haptic environment or without a visual display as an audio-haptic environment only. To reduce the cognitive load of the participants and have more cognitive resources for creation and decision making processes, we designed the visual display and the haptic environment such that they both presented the same game workspace [36]. Accordingly, the visuals were not essential to complete the audio-haptic task.

Given these related works, the primary hypothesis was that a gamified task promoting creativity embedded in a task for motor therapy increases intrinsic motivation more than a gamified task not promoting creativity. Our second hypothesis was that a gamified task in motor therapy without visual display increases intrinsic motivation more than a gamified task with visual display. Moreover, we hypothesized that promoting creativity and omitting a visual display would increase total training time, free movement time and perceived product value. We further hypothesized that promoting creativity and omitting a visual display would reduce energy expenditure, relative perceived training time and perceived effort.[…]


Fig. 1

Fig. 1ARMin arm rehabilitation robot. Additionally for this study, a keyboard was placed close to the participant’s left hand so that the space bar could be used as input device

Continue —>  Music meets robotics: a prospective randomized study on motivation during robot aided therapy | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke – Full Text



The peripheral sensory system is critical to regulating motor plasticity and motor recovery. Peripheral electrical stimulation (ES) can generate constant and adequate sensory input to influence the excitability of the motor cortex. The aim of this proof of concept study was to assess whether ES prior to each hand function training session for eight weeks can better improve neuromuscular control and hand function in chronic stroke individuals and change electroencephalography-electromyography (EEG-EMG) coherence, as compared to the control (sham ES). We recruited twelve subjects and randomly assigned them into ES and control groups. Both groups received 20-minute hand function training twice a week, and the ES group received 40-minute ES on the median nerve of the affected side before each training session. The control group received sham ES. EEG, EMG and Fugl-Meyer Assessment (FMA) were collected at four different time points. The corticomuscular coherence (CMC) in the ES group at fourth weeks was significantly higher (p = 0.004) as compared to the control group. The notable increment of FMA at eight weeks and follow-up was found only in the ES group. The eight-week rehabilitation program that implemented peripheral ES sessions prior to function training has a potential to improve neuromuscular control and hand function in chronic stroke individuals.


Stroke is one of the leading contributing factors to the loss of functional abilities and independence in daily life in adults1. The most common and widely observed impairment following stroke is motor impairment, which can be regarded as a loss or limitation of function in muscle control or movement2,3,4,5. Most stroke survivors later regain the ability to walk independently, but only fewer than 50% of them will have fully recovered upper extremity functions6,7. From a review focusing on motor recovery after stroke, it has been indicated that the recovery of both arm and hand function among subacute and chronic stroke survivors is limited in current neural rehabilitation settings4; therefore, additional management with activating plasticity before or during performing motor training is necessary for better motor recovery.

The fundamental principle of stroke rehabilitation is inducing brain plasticity by sensory or proprioceptive input in order to facilitate motor functions8,9. It has been demonstrated that strong sensory input can induce plastic changes in the motor cortex via direct or indirect pathways10,11,12,13,14,15,16,17. In this case, electrical stimulation (ES) that provides steady and adequate somatosensory input can be an ideal method of stimulating the motor cortex.

Recent studies using functional magnetic resonance imaging (fMRI) or transcranial magnetic stimulation (TMS) suggest that ES on peripheral nerves can increase motor-evoked potential (MEP)18,19,20, increase the active voxel count in the corresponding motor cortex13, and increase blood-oxygen-level dependent (BOLD) signals in fMRI, suggesting peripheral ES induced higher excitability and activation level of cortical neurons21. Since the expansion of the motor cortical area or increase in the excitability of neural circuits is associated with learning new motor skills22,23,24,25,26, clinicians should take advantage and assist patients with stroke on motor tasks training during this period of time. Celnik and colleagues27 found that the hand function of chronic stroke subjects improved immediately after two-hour peripheral nerve stimulation combined with functional training, and the effect lasted for one day. Based on previous studies, the ES that increases corticomuscular excitability may turn out to be an ideal intervention added prior to traditional motor training to “activate” the neural circuit, so that patients may get the most out of the training. According to a recent study that applied single session peripheral ES on post-stroke individuals, the corticomuscular coherence (CMC), which is the synchronization level between EEG and EMG, increased significantly and was accompanied by improvement in the steadiness of force output28.

To our knowledge, however, there is no study investigating the long-term effect of ES combined with functional training on both motor performance and cortical excitability. We targeted the median nerve because its distribution covered the dorsal side of index, middle, and half of ring finger and the palmar side of the first three fingers and half of the ring finger. Besides, median nerve is in charge of the flexion of the first three fingers, which combined they accounts for most of the functional tasks of hand. Therefore, the purpose of this pilot study was to preliminarily evaluate the effect of eight-week ES-combined hand functional training among chronic stroke patients based on CMC and motor performance. We followed up for four weeks after the intervention ceased and examined the lasting effect. We hypothesized that those who received intervention with ES would have better hand function and higher CMC than those who received intervention with sham ES. We also hypothesized that the effect would last for at least four weeks during our follow-up.[…]

Continue —> Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke | Scientific Reports

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[Abstract] sEMG Bias-driven Functional Electrical Stimulation System for Upper Limb Stroke Rehabilitation


It is evident that the dominant therapy of functional electrical stimulation (FES) for stroke rehabilitation suffers from heavy dependency on therapists experience and lack of feedback from patients status, which decrease the patients’ voluntary participation, reducing the rehabilitation efficacy. This paper proposes a closed loop FES system using surface electromyography (sEMG) bias feedback from bilateral arms for enhancing upper-limb stroke rehabilitation. This wireless portable system consists of sEMG data acquisition and FES modules, the former is used to measure and analyze the subject’s bilateral arm motion intention and neuromuscular states in terms of their sEMG, the latter of multi-channel FES output is controlled via the sEMG bias of the bilateral arms. The system has been evaluated with experiments proving that the system can achieve 39.9 dB signal-to-noise ratio (SNR) in the lab environment, outperforming existing similar systems. The results also show that voluntary and active participation can be effectively employed to achieve different FES intensity for FES-assisted hand motions, demonstrating the potential for active stroke rehabilitation.
Published in: IEEE Sensors Journal ( Early Access ) Date of Publication: 18 June 2018

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via sEMG Bias-driven Functional Electrical Stimulation System for Upper-Limb Stroke Rehabilitation – IEEE Journals & Magazine

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[Abstract] An adaptive self-organizing fuzzy logic controller in a serious game for motor impairment rehabilitation


Rehabiliation robotics combined with video game technology provides a means of assisting in the rehabilitation of patients with neuromuscular disorders by performing various facilitation movements. The current work presents ReHabGame, a serious game using a fusion of implemented technologies that can be easily used by patients and therapists to assess and enhance sensorimotor performance and also increase the activities in the daily lives of patients. The game allows a player to control avatar movements through a Kinect Xbox, Myo armband and rudder foot pedal, and involves a series of reach-grasp-collect tasks whose difficulty levels are learnt by a fuzzy interface. The orientation, angular velocity, head and spine tilts and other data generated by the player are monitored and saved, whilst the task completion is calculated by solving an inverse kinematics algorithm which orientates the upper limb joints of the avatar. The different values in upper body quantities of movement provide fuzzy input from which crisp output is determined and used to generate an appropriate subsequent rehabilitation game level. The system can thus provide personalised, autonomously-learnt rehabilitation programmes for patients with neuromuscular disorders with superior predictions to guide the development of improved clinical protocols compared to traditional theraputic activities.

Source: An adaptive self-organizing fuzzy logic controller in a serious game for motor impairment rehabilitation – IEEE Xplore Document

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[WEB SITE] Restorative Therapies’ Xcite FES System Receives CE Mark – Rehab Managment

Baltimore-based Restorative Therapies Inc announces that its new Xcite Functional Electrical Stimulation (FES) rehabilitation system has received a CE mark and has been approved for marketing in Canada.

The system delivers up to 12 channels of electrical stimulation to nerves that activate core, leg, and arm muscles and help enable them to move.

“Xcite system inherits many of the popular RT300 FES cycle’s great features including personalized muscle selection, secure Internet connectivity and physical therapy clinic ease of use.” says Andrew Barriskill, CEO of Restorative Therapies, in a media release from the company. “We are excited to have obtained CE marking and Canadian approval for this product, which will allow us to market the system in Canada and many other international markets.”

“Xcite is a physical and occupational therapy system which provides a library of coordinated multichannel FES therapies for people with neurological impairments,” states Prof David Ditor of Brock University, in Ontario, Canada. “After being involved in the development trials, we are excited to see the system obtain the CE mark and Canadian approval making the system more widely available.”

“In addition to combining several valuable neuro-rehabilitation interventions, functional electrical stimulation, mass practice, and neuromuscular re-education, Xcite is portable and easy enough to use that it could be used in the patient’s home,” adds Prof Susan Harkema of the Kentucky Spinal Cord Injury Research Center, University of Louisville, according to the release.

[Source(s): Restorative Therapies Inc, PRWeb]

Source: Restorative Therapies’ Xcite FES System Receives CE Mark – Rehab Managment

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[WEB SITE] MyoPro – customized lightweight and fully functional arm brace for patients with neuromuscular damage.

The MyoPro® myoelectric limb orthosis is a powered brace that supports a weakened and deformed arm for functional use. In addition, the MyoPro can reinitiate movement of a partially paralyzed arm to enhance function and quality of life. It is designed for individuals with stroke, MS, ALS, brain & spinal cord injury and other neuromuscular disorders.

via MyoPro – customized lightweight and fully functional arm brace for patients with neuromuscular damage..

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