Coupling Robot-aided assessment and surface electromyography to evaluate wrist and forearm muscles activity, muscle fatigue and its effect on proprioception

Sensorimotor functions and an intact neural control of muscles are essential for the effective execution of movements during daily living tasks. However, despite the ability of human sensorimotor system to cope with a great diversity of internal and external demands and constraints, these mechanisms can be altered as a consequence of neurological disorders, injuries or just due to excessive effort leading to muscle fatigue. A precise assessment of both motor and sensory impairment is thus needed in order to provide useful cues to monitor the progression of the disease in pathological populations or to prevent injuries in case of workers. In particular, considering muscle fatigue, an objective assessment of its manifestation may be crucial when dealing with subjects with neuromuscular disorders for understanding how specific disease features evolve over time or for testing the efficacy of a potential therapeutic strategy. Indeed, muscle fatigue accounts for a significant portion of the disease burden in populations with neuromuscular diseases but, despite its importance, a standardized, reliable and objective method for fatigue measurement is lacking in clinical practice. The work presented in this thesis investigates a practical solution through the use of a robotic task and parameters extracted by surface electromyography signals. Moreover, a similar approach that combines robot-mediated proprioception test and muscle fatigue assessment has been developed and used in this thesis to objectively investigate the influence of muscle fatigue on position sense. Finally, the effect of posture on muscle activity, from a perspective of injuries prevention, has been examined. Data on adults and children have been collected and quantitative and objective information about muscle activity, muscle fatigue and joint sensitivity were obtained gaining useful insight both in the clinical context and in the prevention of workplace injuries. A novel method to assess muscle fatigue has been proposed together with the definition of an easy readable indicator that can help clinicians in the assessment of the patient. As for the impact of fatigue on the sensorimotor system, results obtained showed a decrease in wrist proprioceptive acuity which led also to a decline in the performance of a simple tracing task. Regarding the adoption of different muscle strategies depending on postures, results showed that muscle activity of forearm muscles was overall similar regardless from the postures.