Lee, Yoseb
(Department of Physical Therapy, Health and Welfare Graduate School, Sahmyook University)
,
Cha, Yuri
(Department of Physical Therapy, Sunlin University)
,
Kim, Young
(Department of ICT Convergence Rehabilitation Engineering, Soon Chun Hyang University)
,
Hwang, Sujin
(Department of Physical Therapy, Division of Health Science, Baekseok University)
,
Chung, Yijung
(Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University)
Objective: The purpose of this study was to explore the effect of repetitive wrist extension task training with electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES) for wrist extensor muscle recovery in patients with stroke. Design: Randomized controlled trial. Methods: Fifte...
Objective: The purpose of this study was to explore the effect of repetitive wrist extension task training with electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES) for wrist extensor muscle recovery in patients with stroke. Design: Randomized controlled trial. Methods: Fifteen subjects who had suffered a stroke were randomly assigned to an EMG-triggered NMES group (n=8) or control group (n=7); subjects in both groups received conventional therapy as usual. Subjects in the experimental group received application of EMG-triggered NMES to the wrist extensor muscles for 20 minutes, twice per day, five days per week, for a period of four weeks, and were given a task to make a touch alarm go off by activity involving extension of their wrist. In the control group, subjects performed wrist self-exercises for the same duration and frequency as those in the experimental group. Outcome measures included muscle reaction time and spectrum analysis. Assessments were performed during the pre- and post-treatment periods. Results: In the EMG-triggered NMES group, faster muscle reaction time was observed, and median frequency also showed improvement, from 68.2 to 75.3 Hz, after training (p<0.05). Muscle reaction time was significantly faster, and median frequency was significantly higher in the experimental group than in the experimental group after training. Conclusions: EMG-triggered NMES is beneficial for patients with hemiparetic stroke in recovery of upper extremity function.
Objective: The purpose of this study was to explore the effect of repetitive wrist extension task training with electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES) for wrist extensor muscle recovery in patients with stroke. Design: Randomized controlled trial. Methods: Fifteen subjects who had suffered a stroke were randomly assigned to an EMG-triggered NMES group (n=8) or control group (n=7); subjects in both groups received conventional therapy as usual. Subjects in the experimental group received application of EMG-triggered NMES to the wrist extensor muscles for 20 minutes, twice per day, five days per week, for a period of four weeks, and were given a task to make a touch alarm go off by activity involving extension of their wrist. In the control group, subjects performed wrist self-exercises for the same duration and frequency as those in the experimental group. Outcome measures included muscle reaction time and spectrum analysis. Assessments were performed during the pre- and post-treatment periods. Results: In the EMG-triggered NMES group, faster muscle reaction time was observed, and median frequency also showed improvement, from 68.2 to 75.3 Hz, after training (p<0.05). Muscle reaction time was significantly faster, and median frequency was significantly higher in the experimental group than in the experimental group after training. Conclusions: EMG-triggered NMES is beneficial for patients with hemiparetic stroke in recovery of upper extremity function.
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문제 정의
Thus, this study combined EMG-triggered NMES and repetitive task training in order to determine its effect on muscular changes and wrist motor recovery of post-stroke patients. The purpose of this study was to investigate the effects of EMG-triggered NMES with repetitive task training on recovery of wrist extensor muscles in patients with stroke.
가설 설정
The hypothesis of this study was that EMG-triggered NMES with repetitive training will have a greater effect on motor recovery of upper extremity, compared with conventional treatment for patients with hemiparetic stroke.
제안 방법
Information of subject’s recruitment was informed at rehabilitation center’s announcement board for a week. After screening the volunteer under the inclusion criteria, eighteen subjects participated in the study after attaining a full understanding of the purpose and method of the research, and the signature consent form. Inclusion criteria were as follows: (1) first onset of an ischemic or hemorrhagic stroke confirmed by brain imaging; (2) below poor on manual muscle test of the less affected side; (3) able to perform volitional wrist extension greater than 10° from the neutral position; and (4) no cognitive deficits (mini mental status examination ≥24).
As mentioned previously, many researchers have studied the separate effects of EMG-triggered NMES and repetitive task training for stroke patients, however, only a few studies have focused on the combined effects of two experimental studies on stroke focusing on functional evaluations; not many of these have included study analysis of changes in muscle components or recruitment patterns by surface EMG. But it required that the study is composed of the physiological changes the muscle recruitment to use affordable training of active, repetitive, task-related training and EMGtriggered NMES. Thus, this study combined EMG-triggered NMES and repetitive task training in order to determine its effect on muscular changes and wrist motor recovery of post-stroke patients.
In addition to their conventional physical therapy, subjects in the EMG-triggered NMES group received wrist extensor training combined with EMG-triggered NMES and repetitive task training for 20 minutes twice per day, for a period of four weeks.
In addition to their conventional physical therapy, subjects in the control group performed self-exercise on the wrist joint, for 20 minutes, twice per day. The exercise method was explained to the subjects and their care-takers, and a marking card was given out.
The alarm went off randomly in order to prevent any anticipation reactions. Measurements were performed three times for each subject, and the mean values were used for statistical analysis. EMT signal was first processed with full wave rectification, followed by low pass filter at 50 Hz.
Subjects were randomly assigned to the EMG-triggered NMES group (n=9) or the control group (n=9) using a computer-generated randomization list based on demographic characteristics of the subjects. Subjects in both groups participated equally in a regular therapeutic program (physical therapy, occupational therapy, and simple exercises), five times per week, for a period of four weeks. Subjects in the experimental group received additional task-oriented EMG-triggered NMES for 20 minutes, twice per day, five times per week, for a period of four weeks.
Subjects in both groups participated equally in a regular therapeutic program (physical therapy, occupational therapy, and simple exercises), five times per week, for a period of four weeks. Subjects in the experimental group received additional task-oriented EMG-triggered NMES for 20 minutes, twice per day, five times per week, for a period of four weeks. Subjects in the control group were instructed to perform self-exercise of wrist extension during the same period.
The exercise method was explained to the subjects and their care-takers, and a marking card was given out. The exercise included wrist extension and flexion, ulnar and radial deviation, stretching, and simple joint movement exercises.
This study combined EMG-triggered NMES and repetitive task training, and determined its effects using surface EMG on motor recovery of the upper extremity in patients with stroke. Results of the study showed a significant decrease in muscle reaction time and a significant increase in median frequency in the EMG-triggered NMES group, compared to the control group.
This study had a single-blinded that the assessors were blinded about group assign, pretest-posttest control group design. Subjects were randomly assigned to the EMG-triggered NMES group (n=9) or the control group (n=9) using a computer-generated randomization list based on demographic characteristics of the subjects.
But it required that the study is composed of the physiological changes the muscle recruitment to use affordable training of active, repetitive, task-related training and EMGtriggered NMES. Thus, this study combined EMG-triggered NMES and repetitive task training in order to determine its effect on muscular changes and wrist motor recovery of post-stroke patients. The purpose of this study was to investigate the effects of EMG-triggered NMES with repetitive task training on recovery of wrist extensor muscles in patients with stroke.
데이터처리
For statistical analysis, Wilcoxon signed rank tests were used for within-group comparisons and Mann-Whitney U-tests were used for between-group comparisons. The level of statistical significance was set at 0.
성능/효과
Due to abnormal distribution, a few of these studies used fractionated components of the reaction time [1,21-23]. Results of the study demonstrated that treatments with EMG-triggered NMES have the potential to decrease muscle reaction time. Results of our present study also provide evidence for the possibility of improvement in muscle reaction time of wrist extensor muscles.
This study combined EMG-triggered NMES and repetitive task training, and determined its effects using surface EMG on motor recovery of the upper extremity in patients with stroke. Results of the study showed a significant decrease in muscle reaction time and a significant increase in median frequency in the EMG-triggered NMES group, compared to the control group. The results of this study were in agreement with to those of previous studies showing effective results of EMG-triggered NMES training in stroke patients [1,5,23,26].
Results of this study indicated significant effects of EMG-triggered NMES and repetitive task performance on upper limb rehabilitation of stroke patients. However, due to a small number of subjects, the results may not be easily generalized.
후속연구
Results of the study demonstrated that treatments with EMG-triggered NMES have the potential to decrease muscle reaction time. Results of our present study also provide evidence for the possibility of improvement in muscle reaction time of wrist extensor muscles.
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