What percentage of severely impaired stroke survivors retain residual voluntary EMG?

Back-ground. Beneficial rehabilitation interventions for severely impaired stroke patients are limited. Owing to practical constraints in the routine clinical use of electroencephalogram (EEG)-based brain-computer interfaces, this study investigates the feasibility of using a more practical electromyography (EMG) to detect movement intention in severe stroke subjects without visible movement. Currently, no large-scale studies provide strong evidence in favour of EMG-based human-machine interaction for closed-loop control of robotic assistance for severe stroke. Objective. To screen severely impaired stroke subjects without active wrist extension for the presence of residual EMG activity. Methods. High-density surface EMG was recorded from the wrist extensor muscles of 100 severely impaired stroke survivors while they repeatedly attempted wrist extension. EMG activity during "Rest" and "Move" states was compared, and subjects showing statistically greater muscle activity during Move than Rest were classified as having residual EMG. A modified Hodges detector combined with the probability difference-sum ratio (PDSR) was used for classification, with a threshold of 0.73 identifying subjects with residual EMG. Results. Of the 100 subjects without active wrist extension (Muscle power: MRC < 2), 64 exhibited residual EMG activity, supporting the feasibility of EMG for movement intention detection. Among these, 35 demonstrated consistent muscle activity (Detection probability > 0.2); representing suitable candidates for EMG-driven robot-assisted therapy. Conclusions. A substantial proportion of severely impaired stroke subjects without active movement could benefit from a simpler EMG-based interface for robot-assisted therapy. Distinct neural mechanisms (intact voluntary drive or abnormal co-activation) may contribute to the residual muscle activity, which should be considered while designing control strategies.