Effects of electromyography-driven robot-aided hand training with neuromuscular electrical stimulation on hand control performance after chronic stroke

Purpose: An electromyography-driven robot system integrated with neuromuscular electrical stimulation (NMES) was developed to investigate its effectiveness on post-stroke rehabilitation. Methods: The performance of this system in assisting finger flexion/extension with different assistance combinations was evaluated in five stroke subjects. Then, a pilot study with 20-sessions training was conducted to evaluate the training’s effectiveness. Results: The results showed that combined assistance from the NMES–robot could improve finger movement accuracy, encourage muscle activation of the finger muscles and suppress excessive muscular activities in the elbow joint. When assistances from both NMES and the robot were 50% of their maximum assistances, finger-tracking performance had the best results, with the lowest root mean square error, greater range of motion, higher voluntary muscle activations of the finger joints and lower muscle co-contraction in the finger and elbow joints. Upper limb function improved after the 20-session training, indicated by the increased clinical scores of Fugl-Meyer Assessment, Action Research Arm Test and Wolf Motor Function Test. Muscle co-contraction was reduced in the finger and elbow joints reflected by the Modified Ashworth Scale. Conclusions: The findings demonstrated that an electromyography-driven NMES–robot used for chronic stroke improved hand function and tracking performance. Further research is warranted to validate the method on a larger scale.

• Implications for Rehabilitation

• The hand robotics and neuromuscular electrical stimulation (NMES) techniques are still separate systems in current post-stroke hand rehabilitation. This is the first study to investigate the combined effects of the NMES and robot on hand rehabilitation.

• The finger tracking performance was improved with the combined assistance from the EMG-driven NMES–robot hand system. The assistance from the robot could improve the finger movement accuracy and the assistance from the NMES could reduce the muscle co-contraction on finger and elbow joints.

• The upper limb functions were improved on chronic stroke patients after the pilot study of 20-session hand training with the combined assistance from the EMG-driven NMES–robot. The muscle spasticity on finger and elbow joints was reduced after the training.

     

两类功能性便秘患者行生物反馈治疗的疗效及随访比较

目的比较生物反馈治疗对两类功能性便秘（FC）的临床疗效及随访效果。方法选择2010年1月至2013年1月收治的72例FC患者,其中慢传输型便秘（STC）患者37例、出口梗阻型便秘（OOC）患者35例。所有患者均行生物反馈治疗,比较患者肛管静息压和肛管最大收缩压,并进行为期半年的随访。结果所有患者均完成2周生物反馈治疗,治疗后OOC组的肛管静息压与入院时同组和治疗后STC组相比,差异均无统计学意义;但治疗后OOC组肛管最大收缩压（146.73±24.51）mmHg明显高于入院时同组（112.51±22.5）mmHg及治疗后STC组（108.35±21.29）mmHg,P〈0.05。所有患者均随访半年。随访后OOC组的汉密尔顿焦虑量表（HAMA）评分（8.25±2.27）显著低于入院时同组（11.01±3.14）及随访后STC组（11.43±3.71）,P〈0.05。随访后OCC组的疾病不确定感量表（MUIS）评分（36.45±7.43）显著低于入院时同组（50.45±12.48）及随访后STC组（44.42±9.67）,P〈0.05。但随访后OCC组的Zung抑郁自评量表（SDS）评分与入院时同组及随访后STC组相比差异均无统计学意义。两组患者总体有效率相比,差异无统计学意义;但OOC组患者治愈率（48.57%）明显高于STC组（29.73%）,P〈0.05。结论生物反馈能有效治疗FC,对OOC的疗效更好。     

小针刀结合生物反馈疗法治疗耻骨直肠肌综合征所致便秘的临床观察

为探索小针刀结合生物反馈疗法治疗耻骨直肠肌综合征所致便秘的有效性,将耻骨直肠肌综合征所致便秘的患者70例分为研究组（37例）和对照组（33例）。研究组采用小针刀结合生物反馈疗法治疗,对照组采用单纯生物反馈疗法治疗,疗程均为20d。结果显示,研究组疗效（总有效率91．9％）显著优于对照组（总有效率66．7％）。结果表明,小针刀结合生物反馈疗法是治疗耻骨直肠肌综合征所致便秘的有效方法。     

直肠癌腹腔镜或开腹低位前切除术后生物反馈治疗的疗效分析

目的分析比较腹腔镜与开腹手术对直肠癌低位前切除病人术后生物反馈治疗的疗效。方法 2014年6月至2015年12月对61例直肠癌术后接受生物反馈治疗的病人相关信息进行回顾性分析,其中腹腔镜手术30例,开腹手术31例。以每日排便次数、Vaizey评分量表、Wexner评分量表、肛管最大静息压(MRP)、肛管最大收缩压(MSP)、直肠初始容量感觉阈、直肠最大耐受容量作为评价指标。结果腹腔镜组的治疗效果显著优于开腹手术组,其中:腹腔镜组每日排便次数平均减少了3.67次/d,而开腹手术组则减少了1.39次/d,P0.05;治疗前后肛管最大收缩压腹腔镜组增加了36.33 mmHg,而开腹手术组则增加了16.65 mmHg,P0.05;治疗前后直肠最大耐受容量腹腔镜组增加了34.90ml,而开腹手术组则增加了14.74 ml,P0.05。结论腹腔镜手术能够更好的保护神经,当接受生物反馈治疗时,病人由于神经完好,肛门功能能够得到更好的治疗效果。     

Controlling posture using a plantar pressure-based,tongue-placed tactile biofeedback system

The present paper introduces an original biofeedback system for improving human balance control, whose underlying principle consists in providing additional sensory information related to foot sole pressure distribution to the user through a tongue-placed tactile output device. To assess the effect of this biofeedback system on postural control during quiet standing, ten young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed reduced CoP displacements in the Biofeedback relative to the No-biofeedback condition. The present findings evidenced the ability of the central nervous system to efficiently integrate an artificial plantar-based, tongue-placed tactile biofeedback for controlling control posture during quiet standing.     

Inter-individual variability in sensory weighting of a plantar pressure-based, tongue-placed tactile biofeedback for controlling posture

The purpose of the present experiment was to investigate whether the sensory weighting of a plantar pressure-based, tongue-placed tactile biofeedback for controlling posture could be subject to inter-individual variability. To achieve this goal, 60 young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements were recorded using a force platform. Overall, results showed reduced CoP displacements in the Biofeedback relative to the No-biofeedback condition, evidencing the ability of the central nervous system to efficiently integrate an artificial plantar-based, tongue-placed tactile biofeedback for controlling posture during quiet standing. Results further showed a significant positive correlation between the CoP displacements measured in the No-biofeedback condition and the decrease in the CoP displacements induced by the use of the biofeedback. In other words, the degree of postural stabilization appeared to depend on each subject's balance control capabilities, the biofeedback yielding a greater stabilizing effect in subjects exhibiting the largest CoP displacements when standing in the No-biofeedback condition. On the whole, by evidencing a significant inter-individual variability in sensory weighting of an additional tactile information related to foot sole pressure distribution for controlling posture, the present findings underscore the need and the necessity to address the issue of inter-individual variability in the field of neuroscience.     

How a plantar pressure-based,tongue-placed tactile biofeedback modifies postural control mechanisms during quiet standing

The purpose of the present study was to determine the effects of a plantar pressure-based, tongue-placed tactile biofeedback on postural control mechanisms during quiet standing. To this aim, 16 young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements, recorded using a force platform, were used to compute the horizontal displacements of the vertical projection of the centre of gravity (CoG _v ) and those of the difference between the CoP and the vertical projection of the CoG (CoP-CoG _v ). Analysis of the CoP-CoG _v displacements showed larger root mean square (RMS) and mean power frequencies (MPF) in the Biofeedback than in the No-biofeedback condition. Stabilogram-diffusion analysis further showed a concomitant increased spatial and reduced temporal transition point co-ordinates at which the corrective processes were initiated and an increased persistent behaviour of the CoP-CoG _v displacements over the short-term region. Analysis of the CoG _v displacements showed decreased RMS and increased MPF in the Biofeedback relative to the No-biofeedback condition. Stabilogram-diffusion analysis further indicated that these effects mainly stem from reduced spatio-temporal transition point co-ordinates at which the corrective process involving CoG _v displacements is initiated and an increased anti-persistent behaviour of the CoG _v displacements over the long-term region. Altogether, the present findings suggest that the main way the plantar pressure-based, tongue-placed tactile biofeedback improves postural control during quiet standing is via both a reduction of the correction thresholds and an increased efficiency of the corrective mechanism involving the CoG _v displacements.     

生物反馈治疗原发性夜间遗尿症20例

目的 探讨生物反馈疗法对原发性夜间遗尿症(PNE)惠儿的疗效,为临床PNE惠儿治疗提供治疗选择.方法 2006年7月至2007年5月在本院确诊的PNE患儿20例,应用生物反馈治疗,观察疗效.结果 生物反馈治疗PNE的治愈率、改善率分别为50%和35%.结论 生物反馈治疗PNE患儿疗效较好,并且无明显不良反应,值得推广使用.