Most stroke survivors have sustained upper limb impairment in their distal joints. An electromyography (EMG)-driven wrist/hand exoneuromusculoskeleton (WH-ENMS) was developed previously. The present study investigated the feasibility of a home-based self-help telerehabilitation program assisted by the aforementioned EMG-driven WH-ENMS and its rehabilitation effects after stroke. Persons with chronic stroke (n = 11) were recruited in a single-group trial. The training progress, including the training frequency and duration, was telemonitored. The clinical outcomes were evaluated using the Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS). Improvement in muscle coordination was investigated in terms of the EMG activation level and the Co-contraction Index (CI) of the target muscles, including the abductor pollicis brevis (APB), flexor carpi radialis-flexor digitorum (FCR-FD), extensor carpi ulnaris-extensor digitorum (ECU-ED), biceps brachii (BIC), and triceps brachii (TRI). The movement smoothness and compensatory trunk movement were evaluated in terms of the following two kinematic parameters: number of movement units (NMUs) and maximal trunk displacement (MTD). The above evaluations were conducted before and after the training. All of the participants completed the home-based program with an intensity of 63.0 ± 1.90 (mean ± SD) min/session and 3.73 ± 0.75 (mean ± SD) sessions/week. After the training, motor improvements in the entire upper limb were found, as indicated by the significant improvements (P < 0.05) in the FMA, ARAT, WMFT, and MAS; significant decreases (P < 0.05) in the EMG activation levels of the APB and FCR-FD; significant decreases (P < 0.05) in the CI of the ECU–ED/FCR–FD, ECU–ED/BIC, FCR–FD/APB, FCR–FD/BIC, FCR–FD/TRI, APB/BIC and BIC/TRI muscle pairs; and significant reductions (P < 0.05) in the NMUs and MTD. The results suggested that the home-based self-help telerehabilitation program assisted by EMG-driven WH-ENMS is feasible and effective for improving the motor function of the paretic upper limb after stroke. Trial registration ClinicalTrials.gov. NCT03752775; Date of registration: November 20, 2018.

中文翻译：

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中风后肌电驱动腕/手外神经肌肉骨骼辅助上肢的家庭自助远程康复

大多数中风幸存者的远端关节都存在上肢损伤。之前开发了肌电图 (EMG) 驱动的腕/手外神经肌肉骨骼 (WH-ENMS)。本研究调查了由上述 EMG 驱动的 WH-ENMS 辅助的家庭自助远程康复计划的可行性及其中风后的康复效果。在单组试验中招募了慢性卒中患者（n = 11）。远程监控培训进度，包括培训频率和持续时间。使用 Fugl-Meyer 评估 (FMA)、Action Research Arm 测试 (ARAT)、Wolf 运动功能测试 (WMFT)、运动功能独立性测量 (FIM) 和改良 Ashworth 量表 (MAS) 评估临床结果。根据目标肌肉的 EMG 激活水平和共同收缩指数 (CI) 研究肌肉协调性的改善，包括拇短展肌 (APB)、桡侧腕屈肌-趾屈肌 (FCR-FD)、腕伸肌尺骨-趾伸肌 (ECU-ED)、肱二头肌 (BIC) 和肱三头肌 (TRI)。根据以下两个运动学参数评估运动平滑度和代偿性躯干运动：运动单位数 (NMU) 和最大躯干位移 (MTD)。以上评价分别在培训前后进行。所有参与者以 63.0 ± 1.90（平均值 ± SD）分钟/会话和 3.73 ± 0.75（平均值 ± SD）会话/周的强度完成了基于家庭的计划。训练后，发现整个上肢的运动都有改善，如 FMA、ARAT、WMFT 和 MAS 的显着改善（P < 0.05）所示；APB 和 FCR-FD 的 EMG 激活水平显着降低（P < 0.05）；ECU–ED/FCR–FD、ECU–ED/BIC、FCR–FD/APB、FCR–FD/BIC、FCR–FD/TRI、APB/BIC 和 BIC/的 CI 显着降低（P < 0.05） TRI 肌肉对；NMU 和 MTD 显着减少 (P < 0.05)。结果表明，EMG驱动的WH-ENMS辅助的家庭自助远程康复计划对于改善中风后瘫痪上肢的运动功能是可行且有效的。试验注册 ClinicalTrials.gov。NCT03752775；注册日期：2018年11月20日。ECU–ED/FCR–FD、ECU–ED/BIC、FCR–FD/APB、FCR–FD/BIC、FCR–FD/TRI、APB/BIC 和 BIC/的 CI 显着降低（P < 0.05） TRI 肌肉对；NMU 和 MTD 显着减少 (P < 0.05)。结果表明，EMG驱动的WH-ENMS辅助的家庭自助远程康复计划对于改善中风后瘫痪上肢的运动功能是可行且有效的。试验注册 ClinicalTrials.gov。NCT03752775；注册日期：2018年11月20日。ECU–ED/FCR–FD、ECU–ED/BIC、FCR–FD/APB、FCR–FD/BIC、FCR–FD/TRI、APB/BIC 和 BIC/的 CI 显着降低（P < 0.05） TRI 肌肉对；NMU 和 MTD 显着减少 (P < 0.05)。结果表明，EMG驱动的WH-ENMS辅助的家庭自助远程康复计划对于改善中风后瘫痪上肢的运动功能是可行且有效的。试验注册 ClinicalTrials.gov。NCT03752775；注册日期：2018年11月20日。结果表明，EMG驱动的WH-ENMS辅助的家庭自助远程康复计划对于改善中风后瘫痪上肢的运动功能是可行且有效的。试验注册 ClinicalTrials.gov。NCT03752775；注册日期：2018年11月20日。结果表明，EMG驱动的WH-ENMS辅助的家庭自助远程康复计划对于改善中风后瘫痪上肢的运动功能是可行且有效的。试验注册 ClinicalTrials.gov。NCT03752775；注册日期：2018年11月20日。