Muscle synergy analysis for clinical characterization of upper limb motor recovery after stroke.

IF 3.6 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2025-06-06 DOI:10.1016/j.apmr.2025.05.019

Giorgia Pregnolato, Giacomo Severini, Lorenza Maistrello, Daniele Rimini, Tiziana Lencioni, Ilaria Carpinella, Maurizio Ferrarin, Johanna Jonsdottir, Vincent C K Cheung, Andrea Turolla

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引用次数: 0

Abstract

Objective: To characterize individuals with stroke who responded or did not respond to upper limb motor treatment by analyzing muscle synergy patterns (similarity, merging and fractionation).

Design: This study is a secondary analysis of a multicentre randomized controlled trial.

Setting: Inpatients of two specialised neurorehabilitation hospitals.

Participants: We enrolled 62 individuals with a unilateral first-event ischemic or haemorrhagic stroke and severe-to-mild upper limb motor impairment (Fugl-Meyer Assessment Upper Extremity score of 5 to 61, out of 66). We excluded people with untreated seizure, severe cognitive or verbal comprehension impairment.

Interventions: After randomization, individuals were allocated to conventional, virtual reality or robot-assisted treatment groups (20 sessions, 1h/day, 5d/week, 4 weeks).

Main outcome measures: A blinded assessor performed assessments both before and after the intervention. Surface electromyography recordings from 16 muscles during reaching tasks were collected pre- and post-treatment. We extracted muscle synergy patterns (similarity, merging, and fractionation) of the stroke-affected and unaffected upper limb of each subject.

Results: Overall, individuals improved upper limb motor function (Fugl-Meyer Assessment Upper Extremity change score = 7.14 ± 7.46, p< 0.001). We identified 34 responders to treatment showing clinically significant improvement (over the Minimal Clinically Important Difference of 5 points on the Fugl-Meyer Assessment-Upper Extremity). The responders showed decreased merging of synergies (p=0.016) as compared with the non-responders (p=0.025), who conversely showed improved similarity of synergies (p=0.006).

Conclusions: In individuals with stroke undergoing upper limb motor rehabilitation, changes in the synergy merging pattern may serve as a potential marker to distinguish responders from non-responders.

Trial registration: The trial is registered in ClinicalTrial.gov, identifier number NCT03530358 (https://clinicaltrials.gov/study/NCT03530358).

查看原文本刊更多论文

脑卒中后上肢运动恢复临床特征的肌肉协同分析。

目的：通过分析肌肉协同模式（相似、合并和分离）来描述对上肢运动治疗有反应或无反应的中风患者。设计：本研究是一项多中心随机对照试验的二次分析。环境：两家神经康复专科医院的住院病人。参与者：我们招募了62名单侧首发缺血性或出血性中风和重度至轻度上肢运动障碍的患者（Fugl-Meyer上肢评分为5至61分，共66名）。我们排除了未经治疗的癫痫发作、严重认知或语言理解障碍的患者。干预措施：随机化后，个体被分配到传统、虚拟现实或机器人辅助治疗组（20次，1小时/天，5天/周，4周）。主要结果测量：一名盲法评估者在干预前后进行了评估。在到达任务期间收集了16块肌肉的表面肌电记录。我们提取了每个受试者受中风影响和未受中风影响的上肢的肌肉协同模式（相似、合并和分离）。结果：总体而言，个体上肢运动功能得到改善（Fugl-Meyer上肢改变评分 = 7.14±7.46,p< 0.001）。我们确定了34名对治疗有反应的患者，显示出临床显着改善（超过Fugl-Meyer评估上肢的最小临床重要差异5分）。与无反应者（p=0.025）相比，有反应者的协同效应合并率降低（p=0.016），相反，无反应者的协同效应相似度提高（p=0.006）。结论：在接受上肢运动康复的脑卒中患者中，协同合并模式的变化可能是区分有反应者和无反应者的潜在标志。试验注册：该试验在ClinicalTrial.gov上注册，识别码NCT03530358 （https://clinicaltrials.gov/study/NCT03530358）。

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.