This article presents a novel electromyography (EMG)-driven exoneuromusculoskeleton that integrates the neuromuscular electrical stimulation (NMES), soft pneumatic muscle, and exoskeleton techniques, for self-help upper limb training after stroke. The developed system can assist the elbow, wrist, and fingers to perform sequential arm reaching and withdrawing tasks under voluntary effort control through EMG, with a lightweight, compact, and low-power requirement design. The pressure/torque transmission properties of the designed musculoskeletons were quantified, and the assistive capability of the developed system was evaluated on patients with chronic stroke (n = 10). The designed musculoskeletons exerted sufficient mechanical torque to support joint extension for stroke survivors. Compared with the limb performance when no assistance was provided, the limb performance (measured as the range of motion in joint extension) significantly improved when mechanical torque and NMES were provided (p < 0.05). A pilot trial was conducted on patients with chronic stroke (n = 15) to investigate the feasibility of using the developed system in self-help training and the rehabilitation effects of the system. All the participants completed the self-help device-assisted training with minimal professional assistance. After a 20-session training, significant improvements were noted in the voluntary motor function and release of muscle spasticity at the elbow, wrist, and fingers, as indicated by the clinical scores (p < 0.05). The EMG parameters (p < 0.05) indicated that the muscular coordination of the entire upper limb improved significantly after training. The results suggested that the developed system can effectively support self-help upper limb rehabilitation after stroke. ClinicalTrials.gov Register Number NCT03752775.

中文翻译：

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一种用于中风后自助上肢康复的外神经肌肉骨骼

本文介绍了一种新型肌电图 (EMG) 驱动的外神经肌肉骨骼，它集成了神经肌肉电刺激 (NMES)、软气动肌肉和外骨骼技术，用于中风后的自助上肢训练。开发的系统可以通过 EMG 在自愿努力控制下辅助肘部、手腕和手指执行连续的手臂伸手和收回任务，具有轻巧、紧凑和低功耗的设计要求。量化设计的肌肉骨骼的压力/扭矩传递特性，并评估所开发系统的辅助能力对慢性中风患者（n = 10)。设计的肌肉骨骼施加足够的机械扭矩来支持中风幸存者的关节伸展。与不提供辅助时的肢体表现相比，提供机械扭矩和 NMES 时肢体表现（以关节伸展时的活动范围衡量）显着改善（p  < 0.05）。对慢性卒中患者进行了一项试点试验（n = 15) 研究开发的系统在自助培训中使用的可行性和系统的康复效果。所有参与者都在最少的专业协助下完​​成了自助设备辅助培训。临床评分表明，经过 20 次训练后，自主运动功能明显改善，肘部、腕部和手指肌肉痉挛状态得到缓解（p  < 0.05）。肌电参数（p  < 0.05）表明，训练后整个上肢的肌肉协调性显着提高。结果表明，所开发的系统可以有效地支持中风后的自助上肢康复。ClinicalTrials.gov 注册号 NCT03752775。