Robot-assisted assessment of muscle strength
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Robot-assisted assessment of muscle strength Marco Toigo1*, Martin Flück1, Robert Riener2,3 and Verena Klamroth-Marganska2,3*
Abstract Impairment of neuromuscular function in neurological disorders leads to reductions in muscle force, which may lower quality of life. Rehabilitation robots that are equipped with sensors are able to quantify the extent of muscle force impairment and to monitor a patient during the process of neurorehabilitation with sensitive and objective assessment methods. In this article, we provide an overview of fundamental aspects of muscle function and how the corresponding variables can be quantified by means of meaningful robotic assessments that are primarily oriented towards upper limb neurorehabilitation. We discuss new concepts for the assessment of muscle function, and present an overview of the currently available systems for upper limb measurements. These considerations culminate in practical recommendations and caveats for the rational quantification of force magnitude, force direction, moment of a force, impulse, critical force (neuromuscular fatigue threshold) and state and trait levels of fatigue. Keywords: Neuromuscular, Upper extremity, Robot, Assessment, Neurorehabilitation, Sensorimotor
Background This work was developed in the frame of the project “State of the Art Robot-Supported assessments (STARS)” as part of the COST Action TD1006 “European Network on Robotics for NeuroRehabilitation” [1]. STARS is intended to equally serve clinical practitioners and scientists working in the field of neurorehabilitation. The goal is to give recommendations for development, implementation, and administration of different indices of robotic assessments, grounded on the scientific literature available at this time. Intact neuromuscular function is indispensable for motor function, activities of daily living and social participation [2]. Neurological disorders can result in severe impairment of neuromuscular function. In stroke, the muscular weakness results from changes in muscle mass, length, muscle architecture (e.g., pennation angle) muscle composition (i.e., fiber type, fat content, connective tissue) and material properties [3]. Furthermore, an increase in stretch reflex excitability, antagonist muscle coactivation, and a decrease in motor unit firing rate are * Correspondence: [email protected]; [email protected] 1 Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland 2 Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland Full list of author information is available at the end of the article
observed [4]. Sufficient force in the upper limb is related to the ability to adequately perform many activities of daily living [2], and regaining muscle force is a major goal in upper extremity neurorehabilitation. Furthermore, grip strength is a major predictor of recovery and all-cause mortality [5, 6]. To provide optimal therapy, valid, reliable, sensitiv
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