Feasibility of an Electromyography-Triggered Hand Robot for People After Chronic Stroke.

IMPORTANCE: Effective treatment of the affected hand after stroke is crucial for improved functional independence and recovery. OBJECTIVE: To determine the feasibility and clinical utility of an electromyography-triggered hand robot. DESIGN: Single-group repeated-measures design. Participants completed training 3×/wk for 6 wk. Feasibility data included participant feedback, adverse events, and compliance rates. Upper extremity outcomes were collected at baseline, discharge, and 6-wk follow-up. SETTING: Outpatient clinic. PARTICIPANTS: Twelve stroke survivors at least 6 mo poststroke living in the community. INTERVENTION: Eighteen sessions of intensive robotic hand therapy over 6 wk. Each 60-min treatment session was personalized to match the participant's ability. OUTCOMES AND MEASURES: Arm Motor Ability Test (AMAT), Stroke Impact Scale Hand subscale (SIS-H), Stroke Upper Limb Capacity Scale (SULCS), Fugl-Meyer Assessment, Box and Block Test, and dynamometer. RESULTS: All participants completed the training phase. Mild skin pinching or rubbing at dorsal proximal interphalangeal joint and proximal arm fatigue were the most common adverse events. Improvements in raw scores were achieved from baseline to discharge for all outcome measures, except the SULCS. Participants significantly improved from baseline to discharge on the AMAT and the SIS-H, and improvements were maintained at 6-wk follow-up. CONCLUSION AND RELEVANCE: Robotic hand training was feasible, safe, and well tolerated. Participants reported and demonstrated improvements in functional use of the affected arm. Thirty percent of participants achieved clinically significant improvements on the AMAT. We recommend further study of the device in a larger study using the AMAT as a primary outcome measure. WHAT THIS ARTICLE ADDS: It is feasible and safe to implement a robotic hand training protocol for people with moderate to severe arm impairment in an outpatient setting. Robotic training may provide a viable option for this group to actively participate in intensive training of the distal hand.

Ultrasound measures of muscle thickness may be superior to strength testing in adults with knee osteoarthritis: a cross-sectional study.

BACKGROUND: Evaluation of muscle strength as performed routinely with a dynamometer may be limited by important factors such as pain during muscle contraction. Few studies have compared formal strength testing with ultrasound to measure muscle bulk in adults with knee osteoarthritis (OA). METHODS: We investigated the muscle bulk of lower limb muscles in adults with knee OA using quantitative ultrasound. We analyzed the relationship between patient reported function and the muscle bulk of hip adductors, hip abductors, knee extensors and ankle plantarflexors. We further correlated muscle bulk measures with joint torques calculated with a hand held dynamometer. We hypothesized that ultrasound muscle bulk would have high levels of interrater reliability and correlate more strongly with pain and function than strength measured by a dynamometer. 23 subjects with unilateral symptomatic knee OA completed baseline questionnaires including the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Lower Extremity Activity Scale. Joint torque was measured with a dynamometer and muscle bulk was assessed with ultrasound. RESULTS: Higher ultrasound measured muscle bulk was correlated with less pain in all muscle groups. When comparing muscle bulk and torque measures, ultrasound-measured muscle bulk of the quadriceps was more strongly correlated with measures of pain and function than quadriceps isometric strength measured with a dynamometer. CONCLUSIONS: Ultrasound is a feasible method to assess muscle bulk of lower limb muscles in adults with knee OA, with high levels of interrater reliability, and correlates negatively with patient reported function. Compared with use of a hand held dynamometer to measure muscle function, ultrasound may be a superior modality.

Detection of Botulinum Toxin Muscle Effect in Humans Using Magnetic Resonance Imaging: A Qualitative Case Series.

BACKGROUND: Although important for dosing and dilution, there are few data describing botulinum toxin (BT) movement in human muscle. OBJECTIVE: To better understand BT movement within human muscle. DESIGN: Proof-of-concept study with descriptive case series. SETTING: Outpatient academic practice. PARTICIPANTS: Five subjects with stroke who were BT naive with a mean age of 60.4 ± 14 years and time poststroke of 4.6 ± 3.7 years. METHODS: Three standardized injections were given to the lateral gastrocnemius muscle (LGM): 2 contained 25 units (U) of onabotulinumtoxinA (Botox) in 0.25 mL of saline solution and the third 0.25 mL of saline solution only. The tibialis anterior muscle (TAM) was not injected in any subject. A leg magnetic resonance image was obtained at baseline, 2 months, and 3 months later with a 3.0 Tesla Siemens scanner. Three muscles, the LGM, lateral soleus muscle (LSM), and TAM, were manually outlined on the T2 mapping sequence at each time point. A histogram of T2 relaxation times (T2-RT) for all voxels at baseline was used to calculate a mean and standard deviation (SD) T2-RT for each muscle. Botulinum toxin muscle effect (BTME) at 2 months and 3 months was defined as a subject- and muscle-specific T2-RT voxel threshold ≥3 SD above the baseline mean at or near BT injection sites. MAIN OUTCOME MEASURES: BTME volume for each leg magnetic resonance imaging slice at 3 time points and 3 muscles for all subjects. RESULTS: One subject missed the 3-month scan, leaving 18 potential observations of BTME. Little to no BTME effect was seen in the noninjected TAM. A BTME was detected in the LGM in 13 of 18 possible observations, and no effect was detected in 5 observations. Possible BTME effect was seen in the LSM in 3 subjects due to either diffusion through fascia or needle misplacement. Volume of BTME, as defined here, appeared to be substantially greater than the 0.25-mL injection volume. CONCLUSIONS: This descriptive case series is among the first attempts to quantify BTME within human muscle. Our findings are preliminary and are limited by a few inconsistencies. However, we conclude that use of magnetic resonance imaging to detect the volume of BTME is feasible and may assist researchers in modeling the spread and diffusion of BT within human muscle. LEVEL OF EVIDENCE: IV.