4. Discussion
upper extremity movements, post-stroke, chronic stroke, stroke, muscle contraction, upper limb paralysis, brain injury, muscle contractions
STROKE, SEQUELAE
This study investigated the effects of MT based on FES with the addition of a motion-recognition biofeedback device in patients with chronic stroke. The results showed that MT based on FES with the addition of a motion recognition biofeedback device significantly improved upper limb motor recovery, upper limb function, and active joint ROM compared to conventional MT.Surface EMG can detect weak muscle activation that cannot generate muscle contractions, making it applicable for detecting muscle contraction signals in patients with brain injury who have difficulty inducing movement. Biofeedback training using these signals can aid in the improvement of upper limb function in patients with stroke.The MT with biofeedback-based FES training conducted in this study and the existing MT share the common treatment goal of inducing activation of the affected side through the use of the unaffected side. However, in this study, a biofeedback-based FES device was used to make actual movement on the contralateral side. The result showed that activation of muscle contraction movements at the extremity such as FES activates neuroplasticity and affects the recovery of motor function, which was significantly different from the conventional mirror therapy group.This study examined the effectiveness of MT based on FES with real-time visual and tactile feedback by incorporating a motion recognition biofeedback device in patients with chronic stroke. While Kim and Lee reported significant improvement in elbow and wrist flexion and extension movements despite the use of only 2 channels of electrical signals by performing movements that included elbow and wrist flexion and extension in chronic stroke patients for 6 weeks, this study showed significant improvements in joint ROM through 6 movements using 8 channels of electromyographic signals from the Myo arm band in chronic stroke patients, which raises questions about the previous study’s results.Limitations in daily life are experienced by 70% of patients with stroke along with a decrease in quality of life due to functional impairment of the upper extremities.According to Joo et al,It has been reported that the range of active joint motion of the upper limb is closely related to the function of the upper limb.Despite various interventions, stroke rehabilitation is not sufficient to recover from post-stroke sequelae, and it affects the quality of life of patients with upper limb paralysis.There were limitations to this study. First, the intervention in this study involved simultaneously performing the same movement on the affected and unaffected sides, which is impractical for daily life applications. Second, the intervention was biased towards upper extremity movements rather than overall upper limb function, which made it difficult to control upper limb proximal muscle function. Third, FES is difficult to apply to a diverse range of movements because of the limited number of channels used. Fourth, the Myo armband has been discontinued and cannot be applied to additional participants. Fifth, the results cannot be generalized to patients with acute or subacute stroke, as this study only targeted patients with chronic stroke. Sixth, the long-term effects of the intervention could not be determined as there were no follow-up observations. Therefore, future studies need to address these limitations by considering the overall upper limb function and daily life activities in patients with chronic stroke and develop more practical interventions.