Task-Oriented Training by a Personalized Electromyography-Driven Soft Robotic Hand in Chronic Stroke: A Randomized Controlled Trial.

BACKGROUND: Intensive task-oriented training has shown promise in enhancing distal motor function among patients with chronic stroke. A personalized electromyography (EMG)-driven soft robotic hand was developed to assist task-oriented object-manipulation training effectively. Objective. To compare the effectiveness of task-oriented training using the EMG-driven soft robotic hand. METHODS: A single-blinded, randomized controlled trial was conducted with 34 chronic stroke survivors. The subjects were randomly assigned to the Hand Task (HT) group (n = 17) or the control (CON) group (n = 17). The HT group received 45 minutes of task-oriented training by manipulating small objects with the robotic hand for 20 sessions, while the CON group received 45 minutes of hand-functional exercises without objects using the same robot. Fugl-Meyer assessment (FMA-UE), Action Research Arm Test (ARAT), Modified Ashworth Score (MAS), Box and Block test (BBT), Maximum Grip Strength, and active range of motion (AROM) of fingers were assessed at baseline, after intervention, and 3 months follow-up. The muscle co-contraction index (CI) was analyzed to evaluate the session-by-session variation of upper limb EMG patterns. RESULTS: The HT group showed more significant improvement in FMA-UE (wrist/hand, shoulder/elbow) compared to the CON group (P < .05). At 3-month follow-up, the HT group demonstrated significant improvements in FMA-UE, ARAT, BBT, MAS (finger), and AROMs (P < .05). The HT group exhibited a more significant decrease in muscle co-contractions compared to the CON group (P < .05). CONCLUSIONS: EMG-driven task-oriented training with the personalized soft robotic hand was a practical approach to improving motor function and muscle coordination. CLINICAL TRIAL REGISTRY NAME: Soft Robotic Hand System for Stroke Rehabilitation. CLINICAL TRIAL REGISTRATION-URL: https://clinicaltrials.gov/. UNIQUE IDENTIFIER: NCT03286309.

Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke Through EMG-Driven Robot Hand Training: Insights From Dynamic Causal Modeling.

EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement ( ß =3.56, [Formula: see text]). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 ( ß =0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.

A portable AFO solution for pneumatic actuator with cable tendon mechanism to assist ankle dorsiflexion.

The limited portability of pneumatic pumps presents a challenge for ankle-foot orthosis actuated by pneumatic actuators. The high-pressure requirements and time delay responses of pneumatic actuators necessitate a powerful and large pump, which renders the entire device heavy and inconvenient to carry. In this paper, we propose and validate a concept that enhances portability by employing a slack cable tendon mechanism. By managing slack tension properly, the time delay response problem of pneumatic actuators is eliminated through early triggering, and the system can be effectively controlled to generate the desired force for dorsiflexion assistance. The current portable integration of the system weighs approximately 1.6 kg, with distribution of 0.5 kg actuation part on the shank and 1.1 kg power system on the waist, excluding the battery. A mathematical model is developed to determine the proper triggering time and volumetric flow rate requirements for pump selection. To evaluate the performance of this actuation system and mathematical model, the artificial muscle's response time and real volumetric flow rate were preliminarily tested with different portable pumps on a healthy participant during treadmill walking at various speeds ranging from 0.5 m/s to 1.75 m/s. Two small pumps, specifically VN-C1 (5.36 L/min, 300 g) and VN-C4 (9.71L/min, 550 g), meet our design criteria, and then tested on three healthy subjects walking at normal speeds of 1 m/s and 1.5 m/s. The kinematic and electromyographic results demonstrate that the device can facilitate ankle dorsiflexion with a portable pump (300-500 g), generating sufficient force to lift up the foot segment, and reducing muscle activity responsible for ankle dorsiflexion during the swing phase by 8% and 10% at normal speeds of 1 m/s and 1.5 m/s respectively. This portable ankle robot, equipped with a compact pump weighing approximately 1.6 kg, holds significant potential for assisting individuals with lower limb weakness in walking, both within their homes and in clinical settings.

Immediate Effects of Functional Electrical Stimulation-Assisted Cycling on the Paretic Muscles of Patients With Hemiparesis After Stroke: Evidence From Electrical Impedance Myography.

Background: Electrical impedance myography (EIM) has been applied to assess muscle health conditions in neuromuscular disorders. This study aimed to detect immediate muscle electrical impedance property alterations in lower extremity of chronic stroke survivors immediately after functional electrical stimulation (FES)-assisted cycling training. Methods: Fourteen chronic stroke survivors were recruited for the current study. EIM measurements were conducted before and immediately after 40-min FES-assisted cycling training for each subject. Four interested muscle groups [rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and the medial head of gastrocnemius (MG)] were selected. Correlation analysis was performed to reveal a significant correlation between changes in EIM parameters and clinical scales [Fugl-Meyer Assessment of the lower extremity (FMA-LE); 6-min walking test (6MWT)]. Results: Immediately after training, reactance (X) and phase angle (θ) values significantly increased on the TA and MG muscles. Significant correlation was observed between X value and FMA-LE scores (r = 0.649, p = 0.012) at MG as well as X and FMA scores of the ankle joint (r = 0.612, p = 0.02). Resistance (R) and θ were significantly correlated with 6MWT score (R-6MWT: r = 0.651, p = 0.012; θ-6MWT: r = 0.621, p = 0.018). Conclusion: This brief report demonstrated that EIM can reveal the intrinsic property alteration in the paretic muscle of chronic stroke survivors immediately after FES-assisted cycling training. These alterations might be related to muscle hypertrophy (i.e., increases in muscle fiber size). This brief report might aid the understanding of the mechanism of electrical stimulation-assisted exercise in improving muscle function of stroke survivors.

Coaxial double-hole PEDOT: PSS electrodes achieving tunable terahertz zoomable convergence.

The local wavefront modulation technique in the terahertz band is an important basis for the development of terahertz modulation technology. Here, an electrically controlled convergent tunable device based on patterned transparent electrode poly (3, 4-ethylenedioxythiophene): poly (styrene sulfonate) (PEDOT: PSS) is realized to locally tune the terahertz wavefront. The device consists of two substrates with circular-hole electrodes and liquid crystal sandwiched between them. The refractive index gradient of liquid crystal in the device can be generated by the coaxial double-hole electrodes, which realize continuous control of significant focusing of the terahertz wave. The test results show that the focal length can be modulated in the range of 3-12 cm with varied external voltage; when it varies from 3 to 8 V, the 1/e2 radius of the spot decreases to 1.3 mm, 0.27 times the initial state, and the spot central intensity magnification increases gradually with the change, up to 3.31 times. The acquisition of the large tunable focal length range of the continuous terahertz zoom device shows that the construction of the gradient refractive index is an important method to regulate the terahertz wavefront by optical means, which greatly promotes the research of terahertz imaging devices.

Manganese-doping enhanced local heterogeneity and piezoelectric properties in potassium tantalate niobate single crystals.

Ion doping, an effective way to modify the nature of materials, is beneficial for the improvement of material properties. Mn doping exhibits gain of piezoelectric properties in KTa1-x Nb x O3 (KTN). However, the impact mechanism of Mn ions on properties remains unclear. Here, the effects of Mn doping on local heterogeneity and piezoelectric properties in KTN are studied. The electric field-induced strain of Mn-doped KTN is ∼0.25% at 10 kV cm-1, 118% higher than that of pristine KTN. Meanwhile, as a result of Mn doping, the dielectric permittivity was tripled and the ferroelectricity was modified. The changes in A1(2TO), B1 + E(3TO) and E(4TO) vibrations characterized by Raman spectra indicate increased local polarization, weak correlation of dipoles and distorted lattices in Mn-doped KTN, respectively. First-principles calculations demonstrate stronger local heterogeneity introduced by Mn dopants, which weakens the dipole correlations and reduces domain sizes. As a result, the decreased domain sizes, combined with the larger ratio of lattice parameters c and a of the Mn-contained portion, are responsible for the higher piezoelectricity. This work reveals the impact on properties of KTN from Mn dopants and the prominent role of local heterogeneity in improving piezoelectricity, being valuable for the optimization and design of material properties.

Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study.

Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3-5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = -0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training. Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).

Photovoltaic properties in an orthorhombic Fe doped KTN single crystal.

Since the domain wall photovoltaic effect (DW-PVE) is reported in BiFeO3 film, the investigations on photovoltaic properties in ferroelectrics have appealed more and more attention. In this work, we employed two Fe doped KTa1-xNbxO3 (Fe:KTN) single crystals in tetragonal phase and orthorhombic phase, respectively, possessing similar net polarization along [001]C direction, to quantize the contribution on photovoltaic properties from bulk photovoltaic effect (BPVE) and DW-PVE in Fe:KTN. The results show that there are significant enhancements of open-circuit voltages (VOC = -6.0 V, increases over 440%) and short-circuit current density (JSC = 18.5 nA cm-2, increases over 1580%) in orthorhombic Fe:KTN with engineer-domain structure after poled, corresponding to 14.2 mV and 2.2 mV for the single domain wall and bulk region under illumination of 405 nm light (100 mW). It reveals that DW-PVE plays a major role in KTN-based ferroelectrics, indicating an orthorhombic Fe:KTN single crystal is one of the potential photovoltaic materials.

Super terahertz phase shifter achieving high transmission and large modulation depth.

We propose an industrial-grade liquid-crystal-based terahertz (THz) 2π-phase shifter with predictable ultra-high amplitude transmittance. The phase retardation reaches 360.5° at 1.68 THz by analyzing the birefringence of liquid crystal (LC), and the amplitude transmittance in 0.3-1.5 THz is over 83%. More than 91.5% transmittance can be reached by decreasing the scattering of the THz wave in the dynamic deflection process of LC molecules, and that is close to the transmittance limit of quartz-based devices. This millimeter-thick phase shifter reaches full phase modulation and ultra-high transmittance in a broad THz band, is easy to be integrated in a quasi-optical system with a compact size and can be utilized as a wave plate, even an element in a THz phased array.

Ultra-large electric field-induced strain in potassium sodium niobate crystals.

Electromechanical coupling in piezoelectric materials allows direct conversion of electrical energy into mechanical energy and vice versa. Here, we demonstrate lead-free (K x Na1-x )NbO3 single crystals with an ultrahigh large-signal piezoelectric coefficient d 33* of 9000 pm V-1, which is superior to the highest value reported in state-of-the-art lead-based single crystals (~2500 pm V-1). The enhanced electromechanical properties in our crystals are realized by an engineered compositional gradient in the as-grown crystal, allowing notable reversible non-180° domain wall motion. Moreover, our crystals exhibit temperature-insensitive strain performance within the temperature range of 25°C to 125°C. The enhanced temperature stability of the response also allows the materials to be used in a wider range of applications that exceed the temperature limits of current lead-based piezoelectric crystals.

The Effects of Extracorporeal Shock Wave Therapy on Spastic Muscle of the Wrist Joint in Stroke Survivors: Evidence From Neuromechanical Analysis.

Background: This study combined neuromechanical modeling analysis, muscle tone measurement from mechanical indentation and electrical impedance myography to assess the neural and peripheral contribution to spasticity post stroke at wrist joint. It also investigated the training effects and explored the underlying mechanism of radial extracorporeal shock wave (rESW) on spasticity. Methods: People with first occurrence of stroke were randomly allocated to rESW intervention or control group. The intervention group received one session of rESW therapy, followed by routine therapy which was the same frequency and intensity as the control group. Outcome measures were: (1) NeuroFlexor method measured neural component (NC), elastic component (EC) and viscosity component (VC), and (2) myotonometer measured muscle tone (F) and stiffness (S), (3) electrical impedance myography measured resistance (R), reactance (X) and phase angle (θ); (4) modified Asworth scale; (5) Fugl Meyer Upper limb scale. All outcome measures were recorded at baseline, immediately post rESW and at 1-week follow-up. The differences between the paretic and non-paretic side were assessed by t-test. The effectiveness of rESW treatment were analyzed by repeated-measures one-way analysis of variance (ANOVA) at different time points. Results: Twenty-seven participants completed the study. NC, EC, and VC of the Neuroflexor method, F and S from myotonometer were all significantly higher on the paretic side than those from the non-paretic side. R, X, and θ from electrical impedance were significantly lower on the paretic side than the non-paretic side. Immediately after rESW intervention, VC, F, and S were significantly reduced, and X was significantly increased. The clinical scores showed improvements immediate post rESW and at 1-week follow-up. Conclusions: The observed changes in upper limb muscle properties adds further support to the theory that both the neural and peripheral components play a role in muscle spasticity. ESW intervention may be more effective in addressing the peripheral component of spasticity in terms of muscle mechanical properties changes. The clinical management of post stroke spasticity should take into consideration of both the neural and non-neural factors in order to identify optimal intervention regime.

Correlation Between Muscle Structures and Electrical Properties of the Tibialis Anterior in Subacute Stroke Survivors: A Pilot Study.

Electrical impedance myography (EIM) is a non-invasive diagnostic tool that assesses the muscle inherent properties, whereas ultrasonography can assess the alteration in muscle architecture. This study aimed to combine EIM with ultrasonography to assess the changes of the tibialis anterior (TA) muscle properties during passive plantar/dorsiflexion in stroke survivors. Fifteen patients with subacute stroke were recruited. The muscle structures were simultaneously assessed by EIM and ultrasonography at five different extension angles (-10°, 0°, 10°, 20°, and 30°) of the ankle joint. The EIM parameters measured were resistance (R), reactance (X), and phase angle (θ). The parameters recorded by ultrasonography were pennation angle (PA), muscle thickness (MT), and fascicle length (FL). Two-way repeated ANOVA was performed to compare the differences between the affected and unaffected sides as well as the parameters that changed with joint angle. Linear correlation analysis was conducted to assess the association between muscle parameters and clinical scores. The results showed that as the ankle was passively plantarflexed, the θ (P = 0.003) and PA (P < 0.001) values decreased, and the X (P < 0.001), R (P < 0.001), and FL (P < 0.001) values increased. Significant correlations were found between the FL and R values (r = 0.615, P = 0.015), MT and R values (r = 0.522, P = 0.046), and FL and θ values (r = 0.561, P = 0.03), as well as between the PA and the Fugl-Meyer Assessment of Lower Extremity score (r = 0.615, P = 0.015), the R and the Modified Ashworth Scale (MAS) score (r = 0.58, P = 0.023), and the PA and the manual muscle testing (MMT) score (r = -0.575, P = 0.025). This study demonstrated a correlation between the EIM and the ultrasonography parameters at different joint angles. Therefore, both methods could jointly be applied in patients with stroke to detect changes in the muscle inherent properties and muscle architecture. This could assist clinicians to quantitatively evaluate the muscle condition in people with subacute stroke. The study was registered on the Chinese Clinical Trial Registry (trial registration number: ChiCTR-IOR-17012299, http://www.chictr.org.cn/showprojen.aspx?proj=19818). Clinical Trial Registration Number: ChiCTR-IOR-17012299.

Lumbar muscles biomechanical characteristics in young people with chronic spinal pain.

BACKGROUND: The prevalence of low back pain is rising among the young adult population. Altered lumbar muscle tone was suggested to be associated with underlying pathologies and symptoms. To date, there is minimum information available on the repeatability of lumbar spine muscle mechanical properties in the young adults who experienced low back pain. This study aimed to assess the reproducibility of mechanical properties of lumbar spinal muscle in young adults with spinal pain by myotonometer and explored the difference in reproducibility when different number of indentations was used. METHODS: Participants who aged between 18 to 25 and reported chronic LBP were recruited. Lumbar muscle tone (Hz) and stiffness (N/m) were assessed by myotonometer on one occasion by two assessors. Parameters were recorded by triple scans and 5-scans mode. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Bland and Altman analysis were used to assess agreement between two measurements. The relationship between muscle mechanical properties and pain score and disability level were assessed by Spearman's rank correlation coefficient. RESULTS: The results of ICCs indicated excellent repeatability in triple scans and 5-scans mode for each lumbar level bilaterally (ICC > 0.75). SEM and SRD were smaller in triple scans than 5-scans mode for most levels. Bland and Altman analysis revealed no systematic bias. Spearman's rank correlation analysis indicated significant high correlations between muscle tone and disability level (r = 0.80, p < 0.05), and between muscle stiffness and disability level (r = 0.81, p < 0.05). CONCLUSIONS: This study found that lumbar spinal muscle tone and stiffness were repeatable parameters when measured by myotonometer. The reproducibility of muscle mechanical parameters did not appear to differ between the two scanning modes with different number of indentations. Muscle tone and stiffness measured by myotonometer may therefore be reliable as outcome measures to assess intervention induced changes. The lack of significant association between intensity of pain and mechanical properties of paraspinal muscles may suggest that muscle properties measured at rest might not be related to pain level at rest but more related to pain elicited during movement.

Impact of dipolar clusters on electro-optic effects in KTa1- xNbxO3 crystal.

Dipolar clusters are crucial structure factors in electro-optic (EO) effects. Here, the impacts of dipolar clusters on EO effects are investigated in KTa1-xNbxO3 using electric-field-dependent EO characteristics. The results indicate that the field-driven reorientation of dipolar clusters determines the orientational electric susceptibility, deeply contributing to the excellent quadratic EO effects. The controlled average size of correlated local dipoles and uniform orientation of ferroelectric domains efficiently suppress light scattering, being beneficial for the modulation of incident light. The understanding of dipolar cluster-triggered EO responses is valuable for exploring origins of large EO effects and optimizing EO properties of materials.

Origin of giant piezoelectric effect in lead-free K1-xNaxTa1-yNbyO3 single crystals.

A series of high-quality, large-sized (maximum size of 16 × 16 × 32 mm(3)) K1-xNaxTa1-yNbyO3 (x = 0.61, 0.64, and 0.70 and corresponding y = 0.58, 0.60, and 0.63) single crystals were grown using the top-seed solution growth method. The segregation of the crystals, which allowed for precise control of the individual components of the crystals during growth, was investigated. The obtained crystals exhibited excellent properties without being annealed, including a low dielectric loss (0.006), a saturated hysteresis loop, a giant piezoelectric coefficient d33 (d33 = 416 pC/N, determined by the resonance method and d33(*) = 480 pC/N, measured using a piezo-d33 meter), and a large electromechanical coupling factor, k33 (k33 = 83.6%), which was comparable to that of lead zirconate titanate. The reason the piezoelectric coefficient d33 of K0.39Na0.61Ta0.42Nb0.58O3 was larger than those of the other two crystals grown was elucidated through first-principles calculations. The obtained results indicated that K1-xNaxTa1-yNbyO3 crystals can be used as a high-quality, lead-free piezoelectric material.

Wavelength dependence of electro-optic effect in paraelectric potassium sodium tantalate niobate single crystal.

The refractive indices and quadratic electro-optic effect in terms of the coefficients (R11-R12) in a paraelectric K0.95Na0.05Ta0.58Nb0.42O3 single crystal were measured. The dispersion of the refractive index was described exactly by a single-term Sellmeier equation. We found an obvious dispersion of the electro-optic coefficients (R11-R12), and the coefficients decreased quickly with increasing wavelength above the Curie temperature. Following [J. Appl. Phys.40, 720 (1969)], we obtained a dispersion equation for the electro-optic effect in a paraelectric potassium sodium tantalate niobate single crystal. The experimental results agreed well with the dispersion model.