Electromyography-Triggered Constraint-Induced Movement Cycling Therapy for Enhancing Motor Function in Chronic Stroke Patients: A Randomized Controlled Trial

Abstract

This single-blind randomized controlled trial investigated the effectiveness of surface electromyography (sEMG)-triggered constraint-induced movement cycling therapy (CIMCT) in improving balance, lower extremity strength, and activities of daily living in patients with chronic stroke. The participants included patients with chronic stroke-induced hemiplegia who had been diagnosed for more than 6 months, with a minimum score of 24 points on the Mini-Mental State Examination and above level 3 on the Brunnstrom stages. The trial lasted 4 weeks and participants were divided into a CIMCT group and a general cycling training (GCT) group. The CIMCT group (n = 20) used an sEMG-triggered constrained-induced movement therapy device, whereas the GCT group (n = 19) used a standard stationary bicycle. The primary outcome measures showed a significant increase in muscle strength on the affected side in the CIMCT group, as assessed by a manual muscle tester (p < 0.05), with a large effect size (d = 1.86), while no meaningful improvement was observed in the GCT group. Both groups demonstrated significant improvements in dynamic balance, as measured by the Timed Up and Go (TUG) test (p < 0.05), with the CIMCT group showing superior results compared to the GCT group, reflected by a large effect size (d = 0.96). Additionally, both groups showed significant improvements in balance as assessed by the Berg Balance Scale (BBS) and the Functional Reach Test (FRT). The CIMCT group exhibited more pronounced improvements than the GCT group, with large effect sizes of 0.83 for the BBS and 1.25 for the FRT. The secondary outcome measures revealed significant improvements in activities of daily living in both groups, as assessed by the modified Barthel index (MBI), with the CIMCT group achieving a substantial improvement (p < 0.05), accompanied by a large effect size (d = 0.87). This study concludes that sEMG-triggered CIMCT effectively improved muscle strength, postural balance, and activities of daily living in patients with chronic stroke.

Keywords: bioengineering; electromyography; muscle strength; postural balance; stroke.

Figure 1

Flow chart.

Figure 2

sEMG-triggered CIMCT system.