Effects of sensorimotor-integrated (SMI) wrist/hand rehabilitation assisted by a hybrid soft robot poststroke

Abstract

Sensorimotor integration (SMI) is essential for the intentional movement of the upper limb (UL). However, this process is often disrupted poststroke, hindering movement recovery. Previously, a wrist/hand exoneuromusculoskeleton (ENMS) driven by electromyography (EMG) was developed. This work integrated focal vibratory stimulation (FVS) with neuromuscular electrical stimulation (NMES) into the ENMS to achieve electro-vibro-feedback (i.e., ENMS-EVF) for SMI rehabilitation and investigated its functional and corticomuscular effects on chronic stroke participants after UL training. Nine participants with chronic stroke were recruited to attend a 20-session UL training assisted by the ENMS-EVF. The rehabilitative outcomes were evaluated before and after the training program using the Fugl–Meyer Assessment (FMA), monofilament test, EMG activation level, and directed corticomuscular coherence (dCMC). The results showed that the SMI rehabilitation training enhanced sensorimotor functions of the UL, as indicated by significant motor function improvement in the FMA (p < 0.05), significant elevation of distal sensitivity in the monofilament test (p < 0.05), significant enhancement of the proximal and distal muscle coordination in the EMG activation level (p < 0.01), and significant augmentation of ascending sensation feedback and reduction of required descending movement commands in the dCMC results (p < 0.05). This study unveils that the SMI rehabilitation assisted by ENMS-EVF is feasible and has neuroplastic effectiveness for benefiting the UL sensorimotor functions poststroke.