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J Electromyogr Kinesiol. 2014 Feb;24(1):11-7. doi: 10.1016/j.jelekin.2013.10.002. Epub 2013 Oct 21.

Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke.

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School of Mechanical and Aerospace Engineering, Seoul National University/IAMD, Seoul, Republic of Korea.
Department of Rehabilitation Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University of Medicine, Busan, Republic of Korea.
School of Mechanical and Aerospace Engineering, Seoul National University/IAMD, Seoul, Republic of Korea. Electronic address:


Although it has been reported that strengthening exercise in stroke patients is beneficial for their motor recovery, there is little evidence about which exercise method is the better option. The purpose of this study was to compare isotonic and isokinetic exercise by surface electromyography (EMG) analysis using standardized methods. Nine stroke patients performed three sets of isotonic elbow extensions at 30% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic elbow extensions with standardization of mean angular velocity and the total amount of work for each matched set in two strengthening modes. All exercises were done by using 1-DoF planner robot to regulate exact resistive torque and speed. Surface electromyographic activity of eight muscles in the hemiplegic shoulder and elbow was recorded. Normalized root mean square (RMS) values and co-contraction index (CCI) were used for the analysis. The isokinetic mode was shown to activate the agonists of elbow extension more efficiently than the isotonic mode (normalized RMS for pooled triceps: 96.0±17.0 (2nd), 87.8±14.4 (3rd) in isokinetic, 80.9±11.0 (2nd), 81.6±12.4 (3rd) in isotonic contraction, F[1,8]=11.168; P=0.010) without increasing the co-contraction of muscle pairs, implicating spasticity or synergy.


Co-contraction; Isokinetic contraction; Isotonic contraction; Muscle spasticity; Rehabilitation robotics; Stroke; Surface electromyography

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