Khorasani Abed, Gorski Cynthia M, Hung Na-Teng, Hulsizer Joel, Paul Vivek, Tomic Goran, Prakash Prashanth R, Park Sangsoo, Seo Gang, Houskamp Ethan J, Lanis Jessica, Hunzeker Megan, King Erin, Chappel Anya, Jampol Alix, Patel Pooja, Gallagher Catherine, Galant Rachel, Rucker Grace, Lee Jungwha, Harvey Richard, Roh Jinsook, Slutzky Marc W
Department of Neurology, Northwestern University, Chicago, IL, USA.
Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA.
medRxiv. 2025 Jun 25:2025.06.24.25330240. doi: 10.1101/2025.06.24.25330240.
Abnormal muscle co-activation contributes to arm impairment after stroke. This single-blind, randomized, sham-controlled trial evaluated the feasibility and efficacy of home-based, personalized myoelectric interface for neurorehabilitation (MINT) conditioning to reduce abnormal co-activation and enhance arm function and determine the optimal number of abnormally co-activating muscles to target during training.
Moderately to severely impaired chronic stroke survivors were randomized to one of three MINT groups (who played customized games requiring independent activation of 2 or 3 abnormally co-activating muscles) or a sham control group (played using one muscle). All groups trained 90 minutes/day, 5 days/week at home and 1 day/week in lab, for 6 weeks, and changed trained muscle sets every 2-3 weeks. The primary outcome was the Wolf Motor Function Test (WMFT) at 6 weeks.
Fifty-nine participants completed the training. Participants performed 315 ± 85 (mean ± SD) repetitions daily. At week 6, participants in all MINT groups combined improved by 4 s on WMFT (p=0.0008), exceeding the minimal clinically important difference (1.5 s). Participants who trained 3 muscles simultaneously improved by 6.8 s (p=0.001), while the 2-muscle and sham groups did not change significantly. In per-protocol analysis, the 3-muscle group, but not 2-muscle groups, improved significantly more than sham (p=0.046), though not in intention-to-treat analysis. All MINT groups continued improving at 4 weeks post-training. Importantly, severely impaired participants in combined MINT groups improved more than those in sham (p=0.02). Importantly, combined MINT groups also improved their reaching range of motion significantly more than sham. Co-activation decreased by 76% in MINT groups during training. Notably, reduction in co-activation during reaching correlated significantly with improved arm function and range of motion. Other secondary outcomes did not show clinically important improvement. Stroke involving the posterior limb of the internal capsule negatively predicted response to MINT.
Home-based MINT conditioning, especially the 3-muscle variant, is feasible, reduces co-activation, and improves arm movement and function.
CLINICAL TRIAL REGISTRATION―: ClinicalTrials.gov (NCT03401762).
异常的肌肉共同激活会导致中风后手臂功能受损。这项单盲、随机、假对照试验评估了基于家庭的个性化肌电接口神经康复（MINT）训练的可行性和疗效，以减少异常共同激活并增强手臂功能，并确定训练期间应针对的异常共同激活肌肉的最佳数量。
将中度至重度慢性中风幸存者随机分为三个MINT组之一（玩需要独立激活2或3块异常共同激活肌肉的定制游戏）或假对照组（使用一块肌肉进行游戏）。所有组每周在家训练5天，每天训练90分钟，每周在实验室训练1天，共训练6周，每2-3周更换训练的肌肉组。主要结局是6周时的Wolf运动功能测试（WMFT）。
59名参与者完成了训练。参与者每天进行315±85（平均值±标准差）次重复训练。在第6周时，所有MINT组的参与者在WMFT上总共提高了4秒（p=0.0008），超过了最小临床重要差异（1.5秒）。同时训练3块肌肉的参与者提高了6.8秒（p=0.001），而训练2块肌肉的组和假对照组没有显著变化。在符合方案分析中，训练3块肌肉的组比假对照组改善更显著（p=0.046），但在意向性分析中并非如此。所有MINT组在训练后4周仍持续改善。重要的是，合并MINT组中严重受损的参与者比假对照组改善更多（p=0.02）。重要的是，合并MINT组的伸手运动范围也比假对照组改善更显著。MINT组在训练期间共同激活减少了76%。值得注意的是，伸手时共同激活的减少与手臂功能和运动范围的改善显著相关。其他次要结局未显示出具有临床意义的改善。涉及内囊后肢的中风对MINT治疗反应呈负向预测。
基于家庭的MINT训练，尤其是3块肌肉变体的训练，是可行的，可减少共同激活，并改善手臂运动和功能。
临床试验注册—：ClinicalTrials.gov（NCT03401762）
