Myoelectric Arm Orthosis in Motor Learning-Based Therapy for Chronic Deficits After Stroke and Traumatic Brain Injury

Svetlana Pundik; Jessica McCabe; Margaret Skelly; Ahlam Salameh; Jonathan Naft; Zhengyi Chen; Curtis Tatsuoka; Stefania Fatone

doi:10.3389/fneur.2022.791144

Myoelectric Arm Orthosis in Motor Learning-Based Therapy for Chronic Deficits After Stroke and Traumatic Brain Injury

Front Neurol. 2022 Feb 8:13:791144. doi: 10.3389/fneur.2022.791144. eCollection 2022.

Authors

Svetlana Pundik^{1

2}, Jessica McCabe¹, Margaret Skelly¹, Ahlam Salameh^{1

2}, Jonathan Naft³, Zhengyi Chen⁴, Curtis Tatsuoka⁴, Stefania Fatone⁵

Affiliations

¹ Brain Plasticity and NeuroRecovery Laboratory, Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.
² Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
³ Geauga Rehabilitation Engineering, Cleveland, OH, United States.
⁴ Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States.
⁵ Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

Abstract

Background: Technologies that enhance motor learning-based therapy and are clinically deployable may improve outcome for those with neurological deficits. The MyoPro™ is a customized myoelectric upper extremity orthosis that utilizes volitionally generated weak electromyographic signals from paretic muscles to assist movement of an impaired arm. Our purpose was to evaluate MyoPro as a tool for motor learning-based therapy for individuals with chronic upper limb weakness.

Methods: This was a pilot study of thirteen individuals with chronic moderate/severe arm weakness due to either stroke (n = 7) or TBI (n = 6) who participated in a single group interventional study consisting of 2 phases. The in-clinic phase included 18 sessions (2x per week, 27hrs of face-to-face therapy) plus a home exercise program. The home phase included practice of the home exercise program. The study did not include a control group. Outcomes were collected at baseline and at weeks 3, 5, 7, 9, 12, 15, and 18. Statistics included mixed model regression analysis.

Results: Statistically significant and clinically meaningful improvements were observed on Fugl-Meyer (+7.5 points). Gains were seen at week 3, increased further through the in-clinic phase and were maintained during the home phase. Statistically significant changes in Modified Ashworth Scale, Range of Motion, and Chedoke Arm and Hand Activity Inventory were seen early during the in-clinic phase. Orthotic and Prosthetic User's Survey demonstrated satisfaction with the device throughout study participation. Both stroke and TBI participants responded to the intervention.

Conclusions: Use of MyoPro in motor learning-based therapy resulted in clinically significant gains with a relatively short duration of in-person treatment. Further studies are warranted.

Clinical trial registration: www.ClinicalTrials.gov, identifier: NCT03215771.

Keywords: exoskeleton device; orthotics; rehabilitation; robotics; stroke; traumatic brain injury; upper extremity.

Associated data

ClinicalTrials.gov/NCT03215771