Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke

Purpose: Post-stroke hemiparesis may manifest as asymmetric gait, poor balance, and inefficient movement patterns. We investigated improvements in lower-limb muscle activation and function during Wii-based Movement Therapy (WMT), a rehabilitation program specifically targeting upper-limb motor-function.

Methods: Electromyography (EMG) was recorded bilaterally from tibialis anterior (TA) in 20 stroke patients during a 14-day WMT program. EMG amplitude and burst duration were analyzed during stereotypical movement sequences of WMT activities. Functional movement ability was assessed pre- and post-therapy including 6-min walk test (6MWT), stair-climbing speed, and Wolf Motor Function Test timed-tasks.

Results: TA EMG burst duration during Wii-golf increased by 30% on the more-affected side (p = 0.04) and decreased by 28% on the less-affected side. Patients who did not step during Wii-tennis had a 16% decrease in more-affected TA burst sum (p = 0.047) resulting in more symmetrical activation ratio at late-therapy, with the ratio changing from 3.24 ± 2.25 to 0.99 ± 0.11 (p = 0.047). Six-minute walk and stair-climbing speed improved (p = 0.005 and 0.03, respectively), as did upper-limb movement (p ≤ 0.001).

Conclusion: This study provides physiological evidence for lower-limb improvements with WMT. Different patterns of muscle activation changes were evident across the WMT activities. Despite the relatively good pre-therapy lower-limb function, muscle activation and symmetry improved significantly with upper-limb WMT. Implications for rehabilitation WMT is an upper-limb neurorehabilitation program that also improves lower-limb motor-function. We report a shift towards more symmetrical muscle activation of tibialis anterior on the more- and less-affected sides that were reflected in increased distance walked during the 6MWT. The use of standing during therapy not only improves lower-limb function but also permits larger and more powerful upper-limb movements. Targeted upper-limb rehabilitation can also significantly improve mobility and balance, whether dynamic or static, that should reduce the risk of falls post-stroke.