Combining electrical stimulation mediated by iterative learning control with movement practice using real objects and simulated tasks for post-stroke upper extremity rehabilitation.

Abstract

Objective: Task specific training and Electrical Stimulation (ES) are techniques used in rehabilitation of the upper extremity post stroke. This study describes the feasibility of using a rehabilitation system that combines personalised, precisely controlled levels of ES to the anterior deltoid, triceps and finger and wrist extensors during goal-oriented activity utilising real objects from daily life. Materials and Methods:Four chronic stroke participants undertook seventeen intervention sessions, each of one hour duration. During each session, particpants performed goal -orientated tasks while Iterative learning control (ILC) updated the ESsignal applied to each muscle group. The update was based on the difference between the ideal and actual movement in the previous attempt at the task, measured using Microsoft Kinect and PrimeSense sensors. The control system applied the minimum amount of ES required with a view to facilitating success at each given task while maximising voluntary effort. Results: Preliminary results demonstrate that ES mediated by ILC resulted in a statistically significant improvement in range of movement in all four joint angles studied (shoulder flexion; elbow, wrist and index finger extension) over 17 intervention sessions. Additionally, participants required signficantly less extrinsic support for each task. The tasks and system is described and initial intervention data are reported. Discussion: The feasibility of using this system for assisting upper limb movement has been demonstrated. A large scale pilot RCT is now required.