Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial

• Published in: Neurorehabilitation and neural repair Vol. 33; no. 4; p. 284
• Main Authors: Mugler, Emily M, Tomic, Goran, Singh, Aparna, Hameed, Saad, Lindberg, Eric W, Gaide, Jon, Alqadi, Murad, Robinson, Elizabeth, Dalzotto, Katherine, Limoli, Camila, Jacobson, Tyler, Lee, Jungwha, Slutzky, Marc W
• Format: Journal Article
• Language: English
• Published: United States 01.04.2019
• Subjects: Adult; Aged; Arm - physiopathology; Biofeedback, Psychology - methods; Biomechanical Phenomena; Chronic Disease; Computers; Electromyography; Female; Humans; Male; Middle Aged; Movement; Muscle Spasticity; Muscle, Skeletal - physiopathology; Range of Motion, Articular; Recovery of Function; Stroke - physiopathology; Stroke Rehabilitation - methods; Treatment Outcome; User-Computer Interface; Video Games; feedback; stroke rehabilitation; impairment; co-activation; function; EMG; upper extremity
• ISSN: 1552-6844
• DOI: 10.1177/1545968319834903

Abnormal muscle co-activation contributes to impairment after stroke. We developed a myoelectric computer interface (MyoCI) training paradigm to reduce abnormal co-activation. MyoCI provides intuitive feedback about muscle activation patterns, enabling decoupling of these muscles. To investigate tolerability and effects of MyoCI training of 3 muscle pairs on arm motor recovery after stroke, including effects of training dose and isometric versus movement-based training. We randomized chronic stroke survivors with moderate-to-severe arm impairment to 3 groups. Two groups tested different doses of isometric MyoCI (60 vs 90 minutes), and one group tested MyoCI without arm restraint (90 minutes), over 6 weeks. Primary outcome was arm impairment (Fugl-Meyer Assessment). Secondary outcomes included function, spasticity, and elbow range-of-motion at weeks 6 and 10. Over all 32 subjects, MyoCI training of 3 muscle pairs significantly reduced impairment (Fugl-Meyer Assessment) by 3.3 ± 0.6 and 3.1 ± 0.7 ( P < 10 ) at weeks 6 and 10, respectively. Each group improved significantly from baseline; no significant differences were seen between groups. Participants' lab-based and home-based function also improved at weeks 6 and 10 ( P ≤ .01). Spasticity also decreased over all subjects, and elbow range-of-motion improved. Both moderately and severely impaired patients showed significant improvement. No participants had training-related adverse events. MyoCI reduced abnormal co-activation, which appeared to transfer to reaching in the movement group. MyoCI is a well-tolerated, novel rehabilitation tool that enables stroke survivors to reduce abnormal co-activation. It may reduce impairment and spasticity and improve arm function, even in severely impaired patients.