Upper extremity intervention for stroke combining virtual reality, robotics and electrical stimulation

Approximately 80% of individuals with chronic stroke present with long lasting upper extremity (UE) impairments. We propose the perSonalized UPper Extremity Rehabilitation (SUPER) intervention, which combines robotics, virtual reality activities, and neuromuscular electrical stimulation (NMES). The objectives of our study were to determine the feasibility of the SUPER intervention in individuals with moderate/severe stroke. Stroke participants received a 4-week intervention (3x per week), based on their functional level. Their level of corticospinal tract recovery was assessed using the Predict Recovery Potential algorithm, involving measurements of motor evoked potentials and manual muscle testing. Those with low potential for hand recovery (shoulder group) received an intervention focusing on elbow and shoulder movements. Those with a good potential for hand recovery (hand group) also received EMG-triggered NMES. Outcomes included the Fugl-Meyer UE assessment, the Motor Activity Log and the Stroke Impact Scale. Approximately 40% of participants in either the hand or shoulder group showed changes in the Fugl-Meyer UE assessment superior to its minimum clinically important difference. This indicates that our personalized approach may be effective in improving UE function in specific individuals with moderate and severe impairments due to stroke.