Effects of the novel elbow joint torque measurement device assessing elbow joint movements in healthy subjects and stroke patients: a randomized crossover trial

Effects of the novel elbow joint torque measurement device assessing elbow joint movements in healthy subjects and stroke patients: a randomized crossover trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effects of the novel elbow joint torque measurement device assessing elbow joint movements in healthy subjects and stroke patients: a randomized crossover trial Qingqin Xu, Mengxuan Hu, Lei Li, Shi Chen, Bo Liu, Jianwei Lu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4945340/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Apr, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Current clinical practice lacks quantitative assessment methods for elbow joint movements. In response to existing research limitations, this study introduces the innovative elbow joint torque measurement device (EJTMD), which concurrently measures muscle strength and active range of motion (AROM) using multi-source sensing detection technology. Healthy subjects (n=22) and stroke patients (n=22) were recruited in this randomized crossover study. Each participant underwent two measurement methods: EJTMD or traditional tools like a protractor and muscle strength tester. Participants were randomly allocated to EJTMD first or traditional tools first. The efficacy of EJTMD was assessed by comparing muscle strength and AROM with traditional tools. Integrated EMG (iEMG) and root mean square (RMS) were utilized to analyze outcomes during elbow movements. The peak torque (PT) and peak torque/body weight (PT/BW) were examined to explore the differences in mechanical characteristics of bilateral elbow joints. Motor evoked potentials (MEP) and central motor conduction time (CMCT) were employed to investigate potential mechanisms of underlying motor discrepancies post-stroke. EJTMD demonstrates superior muscle strength, AROM, iEMS, and RMS during elbow movements compared to traditional tools ( P <0.05). Repeated EJTMD measurement outcomes have a good correlation on the same day (r≥0.999, P <0.001). EJTMD exhibits a statistic difference in measurement outcomes pre- and post-treatment among stroke patients than traditional tools ( P <0.05). Stroke patients reveal weaker PT and PT/BW on the lesion side during low-speed testing ( P <0.05). Stroke patients show decreased iEMS and RMS on the affected side during elbow movements ( P <0.05), with prolonged MEP latency and CMCT ( P <0.001), and reduced MEP amplitude ( P <0.001). Based on the results, EJTMD demonstrates reliability and effectiveness in elbow movements for healthy subjects and stroke patients, showing sensitivity to minor joint changes. Stroke patients have decreased flexor and extensor function on the lesion side, potentially due to blocked corticospinal tract conduction. Biological sciences/Neuroscience Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Physical sciences/Engineering Elbow joint healthy subjects motor evoked potentials stroke surface electromyography Figures Figure 1 Figure 2 Figure 3 1 Introduction Despite ongoing advancements in medical technology leading to a decrease in the mortality rate among stroke patients, the prevalence of high disability persists. Researchers discovered that upper limb injuries in stroke patients are often more severe than those in lower limbs, making the recovery process more challenging due to the intricate nature of upper limb movements 1 . The elbow joint, acting as a pivotal component of the upper limb, connects the upper arm to the forearm and controls a diverse range of upper limb movements. Due to its unique structure, critical role, and complex functionality, the elbow joint has attracted considerable scholarly attention. The decline in muscle strength and limited joint mobility commonly contributes to post-stroke disability. Precise quantitative assessment of muscle strength and joint range of motion (ROM) is essential for rehabilitation physicians to promptly develop and adjust the rehabilitation regimen. Nevertheless, in current clinical practice, the evaluation of muscle strength primarily relies on a muscle strength tester. Despite its simplicity and user-friendliness, this approach is impeded by subjectivity, imprecision, and challenges in quantification 2 . Joint ROM is commonly assessed using a protractor. While this method is simple and economical, it is burdened by limitations such as limited accuracy, noticeable measurement errors, and significant subjectivity in the outcomes 3 . To address the limitations of current measurement techniques, our research team developed an innovative elbow joint torque measurement device (EJTMD, Patent No: 202211075457. X). The device possesses the ability to concurrently measure muscle strength and active range of motion (AROM) through the integration of sophisticated multi-source sensing detection technology. This study aims to investigate the effects of EJTMD on assessing elbow joint movements in both healthy subjects and stroke patients via a randomized crossover trial. Moreover, the research seeks to delve deeper into the mechanical characteristics of the post-stroke elbow joint through this device. The motor discrepancies in the bilateral upper limbs post-stroke reveal a complex pathological process, potentially associated with factors like neuroplasticity and compensatory mechanisms. To gain a deeper understanding of the mechanisms underlying these disparities, surface electromyography (sEMG) and motor evoked potentials (MEP) were utilized in this research. sEMG enables quantitative analysis of muscle activation levels and coordinated movements of various muscle groups by capturing bioelectrical signals generated during muscle contractions 4 . MEP and central motor conduction time (CMCT) can be employed to evaluate corticospinal tract (CST) conduction, assisting in deducing potential causes for variations in bilateral upper limb movements 5 . The novelties of this research are highlighted as follows: (1) This paper introduces an innovative EJTMD capable of simultaneously and precisely measuring muscle strength and AROM, offering a quantitative approach for assessing elbow joint mobility. (2) This study demonstrates the application of this device on both healthy subjects and stroke patients, thereby establishing a comprehensive validation of its clinical utility. (3) This work pioneers research into the mechanical characteristics of elbow joint through a novel tool. Furthermore, the potential mechanisms underlying disparities are further investigated via electrophysiological techniques. 2 Methods 2.1 Study design This study was conducted as a single-blinded randomized crossover trial. This design was selected to reduce the impact of confounding variables that could arise when comparing distinct groups 6 . The sample size estimation was based on sample size formulas for comparing multiple groups 7 , 8 . A sample size of twenty cases per group was calculated. Taking into account a 10% attrition rate, the minimum required sample size was set at twenty-two cases per group. 2.2 Participants Healthy subjects (n = 22) and stroke patients (n = 22) were recruited from the rehabilitation department of a Tertiary Hospital between March and June 2024. The trial adhered to the reporting guidelines outlined in the Consolidated Standards of Reporting Trials (CONSORT), approved by the Hospital Ethics Committee (application number: PJ2024-06-18), and was approved on 28/02/2023 by the Chinese Clinical Trial Registry (registration number: ChiCTR2300068710). All participants provided written informed consent before this research. The inclusion criteria were (1) diagnosed with a stroke leading to unilateral hemiplegia 9 ; (2) aged between 30 and 65 years; (3) Mini-Mental State Examination score ≥ 22, Brunnstrom scale ≥Ⅱ, and Modified Ashworth Scale < 3; and (4) capable of performing and maintaining elbow flexion and extension movements for 6 seconds. The exclusion criteria were (1) brainstem or thalamic stroke; (2) pacemakers or intracranial metal implants; (3) severe cardiopulmonary, hypertension, epilepsy, or peripheral neuropathic diseases; and (4) serious visual, auditory, balance, speech, or cognitive impairments. 2.3 Interventions Each participant underwent two measurement methods: EJTMD or traditional tools like a protractor (Navai, Germany) and muscle strength tester (LANDTEK, China). All participants were randomly assigned to traditional tools first or EJTMD first. According to Fig. 1 (a), this device, the EJTMD, uniquely assesses muscle strength and AROM concurrently through advanced multi-source sensing detection technology. Figure 1 (b) illustrates the fundamental principle of the EJTMD, maintaining the device's rotation center perpendicular to the upper arm consistently during elbow joint measurements via a sophisticated control system. This device has exceptional measurement accuracy by automatically aligning the elbow joint's rotation center with the device's rotation center. In Fig. 1 (c), all participants were seated with their upper limbs relaxed. Before the formal trial, subjects executed two submaximal elbow movements as preparatory activities. During the formal test, the device's angular velocity was set at low speed (60 degrees/s), medium speed (120 degrees/s), and high speed (180 degrees/s) respectively. Participants exerted their best effort in elbow flexion and extension, repeating each movement three times with a 60-second interval between repetitions. The peak torque (PT), peak torque/body weight (PT/BW), and PT values of elbow extension and flexion were recorded. 2.4 Outcome measures 2.4.1 sEMG testing A multi-channel wireless sEMG acquisition and analysis equipment (Ultium-EMG, America) was employed for collecting sEMG data in this study. According to Pan et al.'s research, the sEMG parameters were set as a sampling frequency of 1000Hz and a filtering pass range of 20 to 500Hz 10 . Based on Fig. 2 (a), each channel of sEMG sensors included two dry electrodes positioned 10mm apart in parallel to establish a differential measurement mode. The recording electrodes were positioned on the most prominent belly portions of the brachioradialis (BRD), biceps brachii (BB), long head of triceps brachii (LOTB), and lateral head of triceps brachii (LATB), aligned parallel to the muscle fibers. Reference electrodes were placed on bones or tendons. The iEMG and RMS values during elbow flexion and extension were each recorded three times. Figure 2 (b) to 2(d) presented the sEMG signals of the aforementioned muscles in healthy subjects and stroke patients during elbow movements. 2.4.2 Neuro-electrophysiological testing In the neuro-electrophysiological testing conducted by Liao et al. 11 , the MagTD40 transcranial magnetic stimulator (Yiruide Corp., China) was utilized. According to Du et al.'s research 12 , MEP could be measured by stimulating the contralateral primary motor cortex (M1) with a transient high-flux magnetic field. As shown in Fig. 3 (a), the location of M1 motor cortex stimulation site was determined based on the positioning cap and anatomical map 13 . In Fig. 3 (b), the recording electrodes were situated on the abductor pollicis brevis (APB), the reference electrodes on the APB tendon, and the ground electrodes on the wrist. MEPs elicited during APB contraction were used as a consistent standard for outcome assessment. The cortical latency and amplitude of MEPs were recorded thrice. Identical intensity was applied to the ipsilateral 7th cervical spinous process, and the spinal latency of MEPs was recorded. The CMCT was calculated as the disparity between the latency of MEPs at the cortical and spinal cord 14 . Figure 3 (c) to 3(g) displayed the results of bilateral MEPs comparison in stroke patients. 2.4.3 Elbow Joint Functional Assessment Scales This study exclusively focuses on evaluating the function of the upper limb, specifically assessing aspects related to the elbow joint. Assessment scales such as the elbow joint section of the Fugl-Meyer Assessment (FMA), the Wolf Motor Function Test (WMFT), upper limb section of the Motor Assessment Scale (MAS), the shoulder and elbow section of the Motor Status Scale (MSS), and the Lindmark Assessment demonstrate exceptional reliability and validity, establishing them as widely recognized approaches for assessing motor function post-stroke 15 – 18 . 2.5 Statistical analysis This research used SPSS26.0 (IBM Corp., America) for statistical analysis. Count data were analyzed by χ 2 test and described by frequency. The measurement data were first tested for normality, and the two groups of data conforming to normal distribution were compared by t test and expressed as mean ± standard deviation. Mann-Whitney rank sum test was utilized for comparing skewed data between two groups, with results expressed as M (P 25 , P 75 ). Pearson correlation analysis was conducted to investigate the correlation between sEMG indexes and clinical scales. Intraclass correlation coefficients (ICCs) were employed to assess the correlation and reliability of repeated measures 19 . A P -value less than 0.05 was considered statistically significant. 3 Results 3.1 Participants No patients withdrew from the experiment, and no adverse events occurred during the research. Table 1 demonstrates no statistical differences in gender, age, height, and weight between healthy subjects and stroke patients ( P > 0.05). Table 1 General data comparison ( \(\bar {x} \pm s\) /M (P 25 , P 75 ), n = 22) Healthy subjects Stroke patients P values Gender (male/female, n) 11/11 12/10 1.000* Age ( \(\bar {x} \pm s\) , years) 52.64 ± 9.42 53.59 ± 10.00 0.746 # Height ( \(\bar {x} \pm s\) , cm) 167.82 ± 6.34 164.59 ± 6.78 0.111 # Weight ( \(\bar {x} \pm s\) , kg) 62.27 ± 9.69 65.86 ± 11.89 0.279 # Disease duration [M (P 25 , P 75 ), d] - 54 (40, 84) - Dominant side (left/right, n) 0/22 0/22 1.000* Hemiplegia side (left/right, n) - 11/11 - Note: * indicates a χ 2 test, and # denotes a t test. 3.2 Results of the effects of the novel EJTMD assessing elbow joint movements in both healthy subjects and stroke patients In Table 2 , EJTMD exhibits significantly superior AROM and muscle strength compared to traditional tools in both healthy subjects and stroke patients ( P < 0.05). Moreover, iEMG and RMS values increase during elbow movements when using the EJTMD ( P < 0.05). These outcomes may be attributed to the utilization of the EJTMD, potentially activating more muscles to generate strength. In Table 3 , repeated EJTMD measurement outcomes have a good correlation on the same day (r ≥ 0.999, P < 0.001). EJTMD exhibits a statistic difference in measurement outcomes pre- and post-treatment among stroke patients than traditional tools in Table 4 ( P < 0.05). In Table 5 , the changes in iEMG and RMS values observed when using EJTMD show correlations with the Fugl-Meyer, WMFT, MAS, MSS, and Lindmark assessments in stroke patients ( P < 0.05). The data demonstrate the reliability and clinical utility of the EJTMD, showing its sensitivity to minor elbow joint changes in stroke patients. Table 2 Results of two measurement methods and sEMG in both healthy subjects and stroke patients ( \(\bar {x} \pm s\) , n = 22) Healthy subjects P values Stroke patients P values Traditional tools EJTMD Traditional tools EJTMD AROM (°) 136.36 ± 4.92 140.45 ± 3.05 b 0.002 109.55 ± 19.08 114.09 ± 19.20 a 0.035 BRD muscle strength (N) 20.66 ± 6.21 25.48 ± 8.34 a 0.036 9.25 ± 4.91 13.64 ± 8.74 a 0.048 BB muscle strength (N) 26.64 ± 5.23 30.81 ± 7.23 a 0.035 10.63 ± 5.93 15.82 ± 9.63 a 0.038 TB muscle strength (N) 19.91 ± 4.94 24.27 ± 7.58 a 0.030 10.35 ± 6.14 15.88 ± 10.55 a 0.041 Elbow flexion iEMG (V) 3.53 ± 1.77 4.96 ± 2.47 a 0.032 1.00 ± 1.23 2.01 ± 1.95 a 0.044 Elbow flexion RMS (µV) 259.17 ± 109.02 350.92 ± 154.97 a 0.028 48.38 ± 24.22 87.15 ± 83.60 a 0.043 Elbow extension iEMG (V) 2.30 ± 1.38 3.30 ± 1.79 a 0.045 1.00 ± 0.88 1.68 ± 1.25 a 0.032 Elbow extension RMS (µV) 168.05 ± 104.48 267.83 ± 169.59 a 0.024 46.23 ± 31.13 85.83 ± 76.81 a 0.033 Note: compared with traditional tools, a: P < 0.05, b: P < 0.01, c: P < 0.001. Table 3 Results of repeated EJTMD measurement outcomes and sEMG in all participants on the same day ( \(\bar {x} \pm s\) , n = 22) Healthy subjects Stroke patients First assessment Second assessment r values P values First assessment Second assessment r values P values AROM (°) 140.45 ± 3.05 140.45 ± 2.63 c 0.999 < 0.001 114.09 ± 19.20 114.55 ± 19.08 c 1.000 < 0.001 BRD muscle strength (N) 25.48 ± 8.34 25.53 ± 8.28 c 0.999 < 0.001 13.64 ± 8.74 13.66 ± 8.75 c 1.000 < 0.001 BB muscle strength (N) 30.81 ± 7.23 30.78 ± 7.22 c 0.999 < 0.001 15.82 ± 9.63 15.87 ± 9.61 c 1.000 < 0.001 TB muscle strength (N) 24.27 ± 7.58 24.41 ± 7.49 c 0.999 < 0.001 15.88 ± 10.55 15.94 ± 10.57 c 1.000 < 0.001 Elbow flexion iEMG (V) 4.96 ± 2.47 4.98 ± 2.47 c 1.000 < 0.001 2.01 ± 1.95 2.02 ± 1.95 c 1.000 < 0.001 Elbow flexion RMS (µV) 350.92 ± 154.97 351.06 ± 155.03 c 1.000 < 0.001 87.15 ± 83.60 87.26 ± 83.32 c 1.000 < 0.001 Elbow extension iEMG (V) 3.30 ± 1.79 3.30 ± 1.79 c 1.000 < 0.001 1.68 ± 1.25 1.68 ± 1.25 c 1.000 < 0.001 Elbow extension RMS (µV) 267.83 ± 169.59 267.79 ± 169.58 c 1.000 < 0.001 85.83 ± 76.81 85.91 ± 76.94 c 1.000 < 0.001 Note: compared with the first assessment, a: P < 0.05, b: P < 0.01, c: P < 0.001. The r values range from − 1 to 1. Values approaching ± 1 indicates a strong positive (negative) correlation, while values near 0 suggest no significant correlation. Table 4 Discrepancies in two measurement methods pre/post-treatment and sEMG in stroke patients ( \(\bar {x} \pm s\) , n = 22) Traditional tools EJTMD Pre-treatment Post-treatment d values Pre-treatment Post-treatment d values P values AROM (°) 109.55 ± 19.08 111.59 ± 17.62 1.82 ± 2.46 114.09 ± 19.20 118.18 ± 16.94 3.64 ± 2.82 a 0.028 BRD muscle strength (N) 9.25 ± 4.91 9.37 ± 4.95 0.12 ± 0.11 13.64 ± 8.74 14.23 ± 8.86 0.60 ± 0.40 c < 0.001 BB muscle strength (N) 10.63 ± 5.93 10.71 ± 5.91 0.08 ± 0.08 15.82 ± 9.63 16.39 ± 9.81 0.57 ± 0.37 c < 0.001 TB muscle strength (N) 10.35 ± 6.14 10.45 ± 6.15 0.10 ± 0.06 15.88 ± 10.55 16.40 ± 10.92 0.52 ± 0.71 a 0.013 Elbow flexion iEMG (V) 1.00 ± 1.23 1.00 ± 1.23 0.00 ± 0.00 2.01 ± 1.95 2.06 ± 1.95 0.04 ± 0.03 c < 0.001 Elbow flexion RMS (µV) 48.38 ± 24.22 48.61 ± 24.21 0.23 ± 0.20 87.15 ± 83.60 88.23 ± 83.87 1.08 ± 0.68 c < 0.001 Elbow extension iEMG (V) 0.95 ± 0.88 0.96 ± 0.88 0.00 ± 0.00 1.68 ± 1.25 1.70 ± 1.26 0.01 ± 0.01 a 0.022 Elbow extension RMS (µV) 46.23 ± 31.13 46.38 ± 31.11 0.15 ± 0.15 85.83 ± 76.81 87.43 ± 77.59 1.59 ± 1.30 c < 0.001 Note: compared with traditional tools, a: P < 0.05, b: P < 0.01, c: P < 0.001. Table 5 Correlation analysis between sEMG characteristics and elbow joint functional assessment scales (n = 22) Elbow flexion Elbow extension iEMG (V) RMS (µV) iEMG (V) RMS (µV) Fugl-Meyer r values 0.630 0.600 0.487 0.448 P values 0.002 0.003 0.021 0.037 WMFT r values 0.508 0.513 0.460 0.484 P values 0.016 0.015 0.031 0.023 MAS r values 0.584 0.463 0.506 0.441 P values 0.004 0.03 0.016 0.040 MSS r values 0.580 0.567 0.536 0.521 P values 0.005 0.006 0.01 0.013 Lindmark r values 0.598 0.476 0.490 0.477 P values 0.003 0.025 0.021 0.025 Note: the r values range between − 1 and 1. Values near ± 1 indicate strong positive (negative) associations, while those near 0 suggest no correlation. 3.3 Results of mechanical characteristics of bilateral upper limbs and neuro-electrophysiological testing in stroke patients Table 6 shows that PT and PT/BW are weaker on the lesion side compared to the healthy side in low, medium, and high-speed tests ( P < 0.05), especially in the low-speed test ( P < 0.001). In Table 7 , PT values of elbow extension and flexion on lesion side exceed those on the healthy side during the low-speed test ( P 0.05). The data indicate that stroke patients exhibit lower flexor and extensor muscular strength on the lesion side, with a more pronounced decline in extensor muscle strength observed during low-speed testing. As shown in Fig. 3 (c) to 3(g) and Table 8 , compared with the healthy side, the MEP latency and CMCT of the lesion side of stroke patients are prolonged ( P < 0.001), while the MEP amplitude is reduced ( P < 0.001). Table 9 illustrates that iEMG and RMS values of BRD, BB, and TB on the affected side are significantly lower than those on the unaffected side during elbow movements ( P < 0.05). The findings suggest that a conduction block, which leads to decreased muscle activity on the lesion side, may be a potential cause of the diminished motor function observed in stroke patients. Table 6 Results of bilateral PT and PT/BW in stroke patients ( \(\bar {x} \pm s\) , n = 22) Muscles Speed PT (Nm) PT/BW (Nm/kg) (°/s) Healthy side Lesion side P values Healthy side Lesion side P values Flexor muscles 60 26.58 ± 7.99 14.73 ± 9.02 c < 0.001 0.41 ± 0.11 0.23 ± 0.14 c < 0.001 120 19.81 ± 6.93 14.30 ± 8.61 a 0.024 0.30 ± 0.10 0.22 ± 0.13 a 0.023 180 18.17 ± 6.33 13.25 ± 7.89 a 0.028 0.28 ± 0.09 0.20 ± 0.12 b 0.006 Extensor muscles 60 29.84 ± 9.53 15.88 ± 10.55 c < 0.001 0.46 ± 0.15 0.24 ± 0.16 c < 0.001 120 22.06 ± 6.91 14.70 ± 9.34 b 0.005 0.34 ± 0.11 0.22 ± 0.14 b 0.003 180 20.11 ± 6.47 13.59 ± 8.42 a 0.027 0.31 ± 0.10 0.21 ± 0.13 b 0.004 Note: compared with the healthy side, a: P < 0.05, b: P < 0.01, c: P < 0.001. Table 7 Results of PT values of elbow extension and flexion in stroke patients ( \(\bar {x} \pm s\) , n = 22) Speed (°/s) Healthy side Lesion side t values P values 60 0.91 ± 0.20 1.03 ± 0.18 a -2.120 0.040 120 0.91 ± 0.21 1.03 ± 0.19 -1.921 0.062 180 0.92 ± 0.26 1.02 ± 0.20 -1.295 0.203 Note: compared with the healthy side, a: P < 0.05, b: P < 0.01, c: P < 0.001. Table 8 Comparison of neuro-electrophysiological results in stroke patients ( \(\bar {x} \pm s\) , n = 22) Healthy side Lesion side t values P values MEP latency (ms) 20.50 ± 2.24 74.73 ± 18.07 c -13.965 < 0.001 MEP amplitude (µV) 219.55 ± 25.54 148.18 ± 26.84 c 9.035 < 0.001 CMCT (ms) 8.73 ± 2.57 23.09 ± 18.30 b -3.646 0.001 Note: compared with the healthy side, a: P < 0.05, b: P < 0.01, c: P < 0.001. Table 9 Comparison of iEMG and RMS during elbow movements in stroke patients ( \(\bar {x} \pm s\) , n = 22) iEMS (V) RMS (µV) Healthy side Lesion side P values Healthy side Lesion side P values Elbow flexion BRD 2.23 ± 1.56 1.20 ± 1.09 b 0.008 133.65 ± 97.50 72.70 ± 70.06 a 0.022 BB 2.94 ± 2.17 1.78 ± 1.06 a 0.031 173.26 ± 129.81 104.14 ± 84.72 a 0.044 LOTB 0.64 ± 0.38 0.34 ± 0.45 a 0.022 36.49 ± 24.06 23.15 ± 10.82 a 0.024 LATB 0.65 ± 0.41 0.34 ± 0.45 a 0.020 36.68 ± 23.73 23.81 ± 10.44 a 0.027 Elbow extension BRD 1.01 ± 1.39 0.29 ± 0.23 a 0.027 60.92 ± 75.82 21.46 ± 19.00 a 0.026 BB 0.99 ± 2.00 0.12 ± 0.03 a 0.046 30.31 ± 13.19 9.98 ± 2.20 c < 0.001 LOTB 2.53 ± 1.93 0.89 ± 0.47 b 0.001 150.32 ± 120.20 71.00 ± 39.43 b 0.007 LATB 2.55 ± 1.92 0.89 ± 0.47 b 0.001 194.26 ± 237.85 72.05 ± 39.55 a 0.026 Note: compared with the healthy side, a: P < 0.05, b: P < 0.01, c: P < 0.001. 4 Discussion This work is one of the first crossover trials to explore the effects of EJTMD evaluating elbow joint movements in both healthy subjects and stroke patients. Furthermore, this study explores the mechanical characteristics of the elbow joint using EJTMD and investigates the underlying mechanisms of differences in bilateral upper limb movements post-stroke. Results show that EJTMD exhibits superior muscle strength, AROM, iEMG, and RMS compared to traditional tools ( P < 0.05). The data suggest that stroke patients demonstrate reduced flexor and extensor muscular strength on the lesion side, with a more pronounced decline observed in the extensor muscles during low-speed testing ( P < 0.05). The reduction in iEMG, RMS, and MEP amplitude, along with the prolongation of MEP latency and CMCT, may elucidate the decline in motor function on the lesion side post-stroke. This study discovers that EJTMD shows larger muscle strength and AROM in both healthy subjects and stroke patients. This improvement may be attributed to the participants' direct interaction with the device, resulting in increased attention towards the device itself rather than the muscles engaged in elbow flexion and extension. By independently planning the anticipated movement trajectory and rapidly activating the muscles, participants attain superior muscle strength and AROM. This phenomenon may be associated with the focus of attention theory. Extensive research on attentional focus consistently shows that directing attention externally (towards the anticipated movement trajectory) leads to superior motor performance compared to an internal focus (on body movement) 20 – 22 . Marchant et al. found that during the maximal isometric contraction of BB, healthy subjects who directed their attention to the bent rod of the device (external focus) achieved greater PT in the elbow flexor muscle compared to when they focused on the arm muscles (internal focus) 21 . Moreover, Wulf et al. observed that participants who focused on an external focus could generate more power, resulting in a higher vertical jump 23 . While the underlying mechanism of the focus of attention theory remains elusive, recent studies suggest a potential link to corticospinal excitability and activation of the default mode network 20 . The data indicate a notable decline in the strength of both flexor and extensor muscles on the lesion side in stroke patients during low-speed testing, with a more pronounced decrease observed in the extensor muscles. This observation could be associated with the emergence of a speed-dependent spasm pattern in the upper limb post-stroke. Limb spasticity following a stroke is a common motor sensory dysfunction arising from upper motor neuron injury, characterized by a speed-dependent myotatic reflex that often affects the elbow joint 24 . Previous studies have demonstrated a significant negative correlation between spasticity scores and movement speed 25 , 26 . Additionally, the spinal anterior horn cells of the flexor muscles exhibit greater excitability and recovery following upper motor neuron damage compared to the extensor muscles, potentially leading to an earlier recovery of the flexor muscles in the upper limb 27 , 28 . Hence, this study recommends that during upper limb strength training, stroke patients should prioritize low-speed training for the extensor muscle group. The data demonstrate a decline in iEMS, RMS, and MEP amplitude, alongside an increase in MEP latency and CMCT on the affected side post-stroke. iEMG refers to the total discharge of motor units involved in muscle activity in a specific time and reflecting the muscle contraction characteristics over time 29 . RMS is the square root of the squared mean of the instantaneous EMG amplitude over a duration, serves as a measure of muscle activity level 30 . MEP can reflect the integrity of the conduction path of motor information from the brain through the spinal cord to the muscles 31 . CMCT stands as a crucial indicator for assessing CST integrity 32 . It is inferred that post-stroke damage to the CST prolongs CMCT, reduces motor unit recruitment, diminishes the descending driving force from the corticospinal pathway to the motor neuron pool, and weakens muscle contraction intensity, ultimately leading to decreased muscle strength. 5 Conclusions This paper introduces a novel EJTMD capable of concurrently measuring muscle strength and AROM in the elbow joint, providing a quantitative assessment approach. To demonstrate the clinical utility and reliability of EJTMD, experiments were done in the elbow joint of healthy subjects and stroke patients. The device exhibits greater sensitivity to subtle changes in the elbow joint ( P < 0.05). In addition, the function of the flexor and extensor muscles on the affected side of stroke patients may be decreased due to the conduction block of the CST, and the extensor muscles decline is more obvious during low-speed testing. Declarations Data Availability Statement: Data supporting the current study are available from the corresponding authors on reasonable request. Ethical approval: The study was approved by the Hospital Ethics Committee (application number: PJ2024-06-18), and adhered to the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. Acknowledgments: This work was supported by the Anhui Provincial Department of Education (grant number: 2022AH051160). The authors declare that they have no conflict of interest. Author contributions statement: Qingqin Xu, Mengxuan Hu and Lei Li conceived and designed research; Shi Chen and Bo Liu performed experiments; Qingqin Xu and Jianwei Lu analyzed data; Qingqin Xu, Mengxuan Hu and Hemu Chen drafted and revised the manuscript. All authors read and approved the manuscript. Competing interests: The authors declare no competing interests. References Hayward, K. S. et al. Timing and dose of upper limb motor intervention after stroke: a systematic review. Stroke 52 , 3706-3717, doi:10.1161/strokeaha.121.034348 (2021). Gregory, W. J. & Saygin, D. Assessment of physical activity and muscle function in adult inflammatory myopathies. Current Rheumatology Reports 24 , 54-63, doi:10.1007/s11926-022-01059-5 (2022). Wang, J. et al. Advanced rehabilitation in ischaemic stroke research. Stroke and Vascular Neurology , doi:10.1136/svn-2022-002285 (2023). Juan, C., Xiang, C. & Minfen, S. A framework for daily activity monitoring and fall detection based on surface electromyography and accelerometer signals. IEEE Journal of Biomedical and Health Informatics 17 , 38-45, doi:10.1109/titb.2012.2226905 (2013). Campos, B. et al. Rethinking remapping: circuit mechanisms of recovery after stroke. The Journal of Neuroscience 43 , 7489-7500, doi:10.1523/jneurosci.1425-23.2023 (2023). Pandis, N., Chung, B., Scherer, R. W., Elbourne, D. & Altman, D. G. CONSORT 2010 statement: extension checklist for reporting within person randomised trials. BMJ 357 , j2835, doi:10.1136/bmj.j2835 (2017). Bhalerao, S. & Kadam, P. Sample size calculation. International Journal of Ayurveda Research 1 , doi:10.4103/0974-7788.59946 (2010). Huang, M., Miller, T., Ying, M. & Pang, M. Y. C. Whole-body vibration modulates leg muscle reflex and blood perfusion among people with chronic stroke: a randomized controlled crossover trial. Sci Rep 10 , 1473, doi:10.1038/s41598-020-58479-5 (2020). Liu, L. et al. Chinese stroke association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases. Stroke and vascular neurology 5 , 159-176, doi:10.1136/svn-2020-000378 (2020). Pan, B. et al. Motor function assessment of upper limb in stroke patients. Journal of Healthcare Engineering 2021 , 1-11, doi:10.1155/2021/6621950 (2021). Liao, L. Y. et al. Intermittent theta-burst stimulation for stroke: primary motor cortex versus cerebellar stimulation: a randomized sham-controlled trial. Stroke , doi:10.1161/strokeaha.123.044892 (2023). Du, J. et al. Aberrances of cortex excitability and connectivity underlying motor deficit in acute stroke. Neural Plasticity 2018 , 1-10, doi:10.1155/2018/1318093 (2018). Buetefisch, C. M. et al. Stroke lesion volume and injury to motor cortex output determines extent of contralesional motor cortex reorganization. Neurorehabilitation and Neural Repair 37 , 119-130, doi:10.1177/15459683231152816 (2023). Li, J. et al. Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction. Neural Regen Res 11 , 1584-1590, doi:10.4103/1673-5374.193236 (2016). Gladstone, D. J., Danells, C. J. & Black, S. E. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. The American Society of Neurorehabilitation 16 , 232-240, doi:10.1177/154596802401105171 (2002). Wolf, S. L. et al. Assessing wolf motor function test as outcome measure for research in patients after stroke. Stroke 32 , 1635-1639, doi:10.1161/01.STR.32.7.1635 (2001). Ferraro, M. et al. Assessing the motor status score: a scale for the evaluation of upper limb motor outcomes in patients after stroke. The American Society of Neurorehabilitation 16 , 283-289, doi:10.1177/154596830201600306 (2002). Gong, X., Jin, S., Zhou, Y., Lai, L. H. & Wang, W. Y. Curative effect of medicine cake sticking ultrasound drug penetration combined with body training on hemiplegia after stroke: an in vitro ultrasound targeted drug controlled release technology. Preventive Medicine 173 , doi:10.1016/j.ypmed.2023.107600 (2023). Subramanian, S. K., Baniña, M. C., Turolla, A. & Levin, M. F. Reaching performance scale for stroke test‐retest reliability, measurement error, concurrent and discriminant validity. Pm&R 14 , 337-347, doi:10.1002/pmrj.12584 (2021). Kuhn, Y. A., Keller, M., Ruffieux, J. & Taube, W. Adopting an external focus of attention alters intracortical inhibition within the primary motor cortex. Acta Physiologica 220 , 289-299, doi:10.1111/apha.12807 (2016). Marchant, D. C., Greig, M. & Scott, C. Attentional focusing instructions influence force production and muscular activity during isokinetic elbow flexions. Journal of Strength and Conditioning Research 23 , 2358-2366, doi:10.1519/JSC.0b013e3181b8d1e5 (2009). Wulf, G. Attentional focus and motor learning: a review of 15 years. International Review of Sport and Exercise Psychology 6 , 77-104, doi:10.1080/1750984x.2012.723728 (2013). Wulf, G. & Dufek, J. Increased jump height with an external focus due to enhanced lower extremity joint kinetics. Journal of Motor Behavior 41 , 401-409, doi:10.1080/00222890903228421 (2009). Wissel, J. et al. Early development of spasticity following stroke: a prospective, observational trial. Journal of Neurology 257 , 1067-1072, doi:10.1007/s00415-010-5463-1 (2010). Lindberg, P. G. et al. Validation of a new biomechanical model to measure muscle tone in spastic muscles. Neurorehabilitation and Neural Repair 25 , 617-625, doi:10.1177/1545968311403494 (2011). Sorinola, I. O., White, C. M., Rushton, D. N. & Newham, D. J. Electromyographic response to manual passive stretch of the hemiplegic wrist: accuracy, reliability, and correlation with clinical spasticity assessment and function. Neurorehabilitation and Neural Repair 23 , 287-294, doi:10.1177/1545968308321778 (2009). Dashtipour, K., Chen, J. J., Walker, H. W. & Lee, M. Y. Systematic literature review of abobotulinumtoxina in clinical trials for adult upper limb spasticity. American Journal of Physical Medicine & Rehabilitation 94 , 229-238, doi:10.1097/phm.0000000000000208 (2015). Jin, Y. & Zhao, Y. Post-stroke upper limb spasticity incidence for different cerebral infarction site. Open Medicine 13 , 227-231, doi:10.1515/med-2018-0035 (2018). Onishi, H. et al. Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes. Journal of Electromyography and Kinesiology 10 , 59-67, doi:10.1016/S1050-6411(99)00020-6 (2000). Ashraf, H. et al. Evaluation of windowing techniques for intramuscular EMG-based diagnostic, rehabilitative and assistive devices. Journal of Neural Engineering 18 , doi:10.1088/1741-2552/abcc7f (2021). Hallett, M. Transcranial magnetic stimulation: a primer. Neuron 55 , 187-199, doi:10.1016/j.neuron.2007.06.026 (2007). Groppa, S. et al. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee. Clinical Neurophysiology 123 , 858-882, doi:10.1016/j.clinph.2012.01.010 (2012). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Apr, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 29 Jan, 2025 Reviews received at journal 28 Jan, 2025 Reviewers agreed at journal 02 Jan, 2025 Reviews received at journal 20 Nov, 2024 Reviewers agreed at journal 06 Nov, 2024 Reviewers agreed at journal 05 Nov, 2024 Reviewers invited by journal 16 Oct, 2024 Editor assigned by journal 11 Oct, 2024 Editor invited by journal 03 Sep, 2024 Submission checks completed at journal 03 Sep, 2024 First submitted to journal 20 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4945340","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":361182195,"identity":"501be9ab-d87c-460f-a1e7-26c985f6173c","order_by":0,"name":"Qingqin Xu","email":"","orcid":"","institution":"Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qingqin","middleName":"","lastName":"Xu","suffix":""},{"id":361182196,"identity":"af9c27c5-d316-4df2-a211-cc9c3e836a94","order_by":1,"name":"Mengxuan Hu","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mengxuan","middleName":"","lastName":"Hu","suffix":""},{"id":361182198,"identity":"2a78cbf8-7a77-46a7-ac3f-b9429eecc447","order_by":2,"name":"Lei Li","email":"","orcid":"","institution":"Chinese Academy of Sciences","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Li","suffix":""},{"id":361182199,"identity":"d57bc38b-bf24-4e33-89ab-6cfb5c78c260","order_by":3,"name":"Shi Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shi","middleName":"","lastName":"Chen","suffix":""},{"id":361182200,"identity":"899be7f4-5e3b-46b0-b28d-75a13612c0bb","order_by":4,"name":"Bo Liu","email":"","orcid":"","institution":"Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Liu","suffix":""},{"id":361182201,"identity":"ef2b7cb0-e6ea-474c-b24d-44fb0b9afe3e","order_by":5,"name":"Jianwei Lu","email":"","orcid":"","institution":"Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jianwei","middleName":"","lastName":"Lu","suffix":""},{"id":361182202,"identity":"2c41ea07-8f56-4a05-9851-c845f65ed22c","order_by":6,"name":"Hemu Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYDACCQYGZhDNz8AD5jM2EK1FsoFkLQYHiNXCP7v52OOCim2Jm4+fPbqZh8FGdsMB5mcP8Fpy51i68YwztxO3nclLu83DkGa84QCbuQE+LQYSOWbSvG1ALQdyzIBaDiduOMDDJoFfS/43ad5/txM3978BaflPjJYcNmnehtuJGyTAthwgrEXiRpqZNM+x28YzbrwxuznHINl45mE2M7xa+GckP5Pmqbkt29+fY3bjTYWdbN/x5md4taC7kwEaTaNgFIyCUTAKKAIAWfFJ6IAWX8UAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hemu","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-08-20 13:27:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4945340/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4945340/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-97953-w","type":"published","date":"2025-04-13T16:05:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67088547,"identity":"cfa3f4a9-3b2a-4592-89fe-f945623262f1","added_by":"auto","created_at":"2024-10-21 06:31:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4586680,"visible":true,"origin":"","legend":"\u003cp\u003e(a) A novel Elbow Joint Torque Measurement Device. (b) The mechanical structure diagram of the device. (c) Data collection using EJTMD in healthy subjects.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4945340/v1/7895c293babe774f457517dd.png"},{"id":67088545,"identity":"599b020d-0dc7-4586-8587-e29f11e70848","added_by":"auto","created_at":"2024-10-21 06:31:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6791294,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Electrodes positioning during sEMG testing. (b)sEMG signals during elbow flexion and extension in healthy subjects. (c) sEMG signals during elbow flexion and extension on the healthy side of stroke patients. (d) sEMG signals during elbow flexion and extension on the lesion side of stroke patients.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4945340/v1/15d0d9fcd51a46033be32287.png"},{"id":67090127,"identity":"68be4aaa-558d-4c00-9d87-329ef056d0c6","added_by":"auto","created_at":"2024-10-21 06:39:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2035387,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Localization of the primary motor cortex (M1). (b) Neuro-electrophysiological testing. (c) Contralesional MEP of M1 and C7 in the stroke patient. (d) Ipsilesional MEP of M1 and C7 in the stroke patient. (e) Comparison of bilateral MEP latency results in stroke patients. (f) Comparison of bilateral MEP amplitude results in stroke patients. (g) Comparison of bilateral CMCT results in stroke patients.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4945340/v1/a62f9a879a836d0d1cb941cb.png"},{"id":80558741,"identity":"a77fc0ae-11a0-4340-ae2d-6266ccf2f1da","added_by":"auto","created_at":"2025-04-14 16:16:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":18874004,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4945340/v1/57463499-3e55-4bc0-a1a9-f1d06ecde234.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of the novel elbow joint torque measurement device assessing elbow joint movements in healthy subjects and stroke patients: a randomized crossover trial","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eDespite ongoing advancements in medical technology leading to a decrease in the mortality rate among stroke patients, the prevalence of high disability persists. Researchers discovered that upper limb injuries in stroke patients are often more severe than those in lower limbs, making the recovery process more challenging due to the intricate nature of upper limb movements \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The elbow joint, acting as a pivotal component of the upper limb, connects the upper arm to the forearm and controls a diverse range of upper limb movements. Due to its unique structure, critical role, and complex functionality, the elbow joint has attracted considerable scholarly attention.\u003c/p\u003e \u003cp\u003eThe decline in muscle strength and limited joint mobility commonly contributes to post-stroke disability. Precise quantitative assessment of muscle strength and joint range of motion (ROM) is essential for rehabilitation physicians to promptly develop and adjust the rehabilitation regimen. Nevertheless, in current clinical practice, the evaluation of muscle strength primarily relies on a muscle strength tester. Despite its simplicity and user-friendliness, this approach is impeded by subjectivity, imprecision, and challenges in quantification \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Joint ROM is commonly assessed using a protractor. While this method is simple and economical, it is burdened by limitations such as limited accuracy, noticeable measurement errors, and significant subjectivity in the outcomes \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. To address the limitations of current measurement techniques, our research team developed an innovative elbow joint torque measurement device (EJTMD, Patent No: 202211075457. X). The device possesses the ability to concurrently measure muscle strength and active range of motion (AROM) through the integration of sophisticated multi-source sensing detection technology.\u003c/p\u003e \u003cp\u003eThis study aims to investigate the effects of EJTMD on assessing elbow joint movements in both healthy subjects and stroke patients via a randomized crossover trial. Moreover, the research seeks to delve deeper into the mechanical characteristics of the post-stroke elbow joint through this device. The motor discrepancies in the bilateral upper limbs post-stroke reveal a complex pathological process, potentially associated with factors like neuroplasticity and compensatory mechanisms. To gain a deeper understanding of the mechanisms underlying these disparities, surface electromyography (sEMG) and motor evoked potentials (MEP) were utilized in this research. sEMG enables quantitative analysis of muscle activation levels and coordinated movements of various muscle groups by capturing bioelectrical signals generated during muscle contractions \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. MEP and central motor conduction time (CMCT) can be employed to evaluate corticospinal tract (CST) conduction, assisting in deducing potential causes for variations in bilateral upper limb movements \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe novelties of this research are highlighted as follows: (1) This paper introduces an innovative EJTMD capable of simultaneously and precisely measuring muscle strength and AROM, offering a quantitative approach for assessing elbow joint mobility. (2) This study demonstrates the application of this device on both healthy subjects and stroke patients, thereby establishing a comprehensive validation of its clinical utility. (3) This work pioneers research into the mechanical characteristics of elbow joint through a novel tool. Furthermore, the potential mechanisms underlying disparities are further investigated via electrophysiological techniques.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis study was conducted as a single-blinded randomized crossover trial. This design was selected to reduce the impact of confounding variables that could arise when comparing distinct groups \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The sample size estimation was based on sample size formulas for comparing multiple groups \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. A sample size of twenty cases per group was calculated. Taking into account a 10% attrition rate, the minimum required sample size was set at twenty-two cases per group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003eHealthy subjects (n\u0026thinsp;=\u0026thinsp;22) and stroke patients (n\u0026thinsp;=\u0026thinsp;22) were recruited from the rehabilitation department of a Tertiary Hospital between March and June 2024. The trial adhered to the reporting guidelines outlined in the Consolidated Standards of Reporting Trials (CONSORT), approved by the Hospital Ethics Committee (application number: PJ2024-06-18), and was approved on 28/02/2023 by the Chinese Clinical Trial Registry (registration number: ChiCTR2300068710). All participants provided written informed consent before this research. The inclusion criteria were (1) diagnosed with a stroke leading to unilateral hemiplegia \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e; (2) aged between 30 and 65 years; (3) Mini-Mental State Examination score\u0026thinsp;\u0026ge;\u0026thinsp;22, Brunnstrom scale \u0026ge;Ⅱ, and Modified Ashworth Scale\u0026thinsp;\u0026lt;\u0026thinsp;3; and (4) capable of performing and maintaining elbow flexion and extension movements for 6 seconds. The exclusion criteria were (1) brainstem or thalamic stroke; (2) pacemakers or intracranial metal implants; (3) severe cardiopulmonary, hypertension, epilepsy, or peripheral neuropathic diseases; and (4) serious visual, auditory, balance, speech, or cognitive impairments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Interventions\u003c/h2\u003e \u003cp\u003eEach participant underwent two measurement methods: EJTMD or traditional tools like a protractor (Navai, Germany) and muscle strength tester (LANDTEK, China). All participants were randomly assigned to traditional tools first or EJTMD first. According to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e(a), this device, the EJTMD, uniquely assesses muscle strength and AROM concurrently through advanced multi-source sensing detection technology. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e(b) illustrates the fundamental principle of the EJTMD, maintaining the device's rotation center perpendicular to the upper arm consistently during elbow joint measurements via a sophisticated control system. This device has exceptional measurement accuracy by automatically aligning the elbow joint's rotation center with the device's rotation center. In Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e(c), all participants were seated with their upper limbs relaxed. Before the formal trial, subjects executed two submaximal elbow movements as preparatory activities. During the formal test, the device's angular velocity was set at low speed (60 degrees/s), medium speed (120 degrees/s), and high speed (180 degrees/s) respectively. Participants exerted their best effort in elbow flexion and extension, repeating each movement three times with a 60-second interval between repetitions. The peak torque (PT), peak torque/body weight (PT/BW), and PT values of elbow extension and flexion were recorded.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Outcome measures\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 sEMG testing\u003c/h2\u003e \u003cp\u003eA multi-channel wireless sEMG acquisition and analysis equipment (Ultium-EMG, America) was employed for collecting sEMG data in this study. According to Pan et al.'s research, the sEMG parameters were set as a sampling frequency of 1000Hz and a filtering pass range of 20 to 500Hz \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Based on Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(a), each channel of sEMG sensors included two dry electrodes positioned 10mm apart in parallel to establish a differential measurement mode. The recording electrodes were positioned on the most prominent belly portions of the brachioradialis (BRD), biceps brachii (BB), long head of triceps brachii (LOTB), and lateral head of triceps brachii (LATB), aligned parallel to the muscle fibers. Reference electrodes were placed on bones or tendons. The iEMG and RMS values during elbow flexion and extension were each recorded three times. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(b) to 2(d) presented the sEMG signals of the aforementioned muscles in healthy subjects and stroke patients during elbow movements.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Neuro-electrophysiological testing\u003c/h2\u003e \u003cp\u003eIn the neuro-electrophysiological testing conducted by Liao et al. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, the MagTD40 transcranial magnetic stimulator (Yiruide Corp., China) was utilized. According to Du et al.'s research \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, MEP could be measured by stimulating the contralateral primary motor cortex (M1) with a transient high-flux magnetic field. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e(a), the location of M1 motor cortex stimulation site was determined based on the positioning cap and anatomical map \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e(b), the recording electrodes were situated on the abductor pollicis brevis (APB), the reference electrodes on the APB tendon, and the ground electrodes on the wrist. MEPs elicited during APB contraction were used as a consistent standard for outcome assessment. The cortical latency and amplitude of MEPs were recorded thrice. Identical intensity was applied to the ipsilateral 7th cervical spinous process, and the spinal latency of MEPs was recorded. The CMCT was calculated as the disparity between the latency of MEPs at the cortical and spinal cord \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e(c) to 3(g) displayed the results of bilateral MEPs comparison in stroke patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Elbow Joint Functional Assessment Scales\u003c/h2\u003e \u003cp\u003eThis study exclusively focuses on evaluating the function of the upper limb, specifically assessing aspects related to the elbow joint. Assessment scales such as the elbow joint section of the Fugl-Meyer Assessment (FMA), the Wolf Motor Function Test (WMFT), upper limb section of the Motor Assessment Scale (MAS), the shoulder and elbow section of the Motor Status Scale (MSS), and the Lindmark Assessment demonstrate exceptional reliability and validity, establishing them as widely recognized approaches for assessing motor function post-stroke \u003csup\u003e\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eThis research used SPSS26.0 (IBM Corp., America) for statistical analysis. Count data were analyzed by \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/em\u003e\u003c/sup\u003e test and described by frequency. The measurement data were first tested for normality, and the two groups of data conforming to normal distribution were compared by \u003cem\u003et\u003c/em\u003e test and expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Mann-Whitney rank sum test was utilized for comparing skewed data between two groups, with results expressed as M (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e). Pearson correlation analysis was conducted to investigate the correlation between sEMG indexes and clinical scales. Intraclass correlation coefficients (ICCs) were employed to assess the correlation and reliability of repeated measures \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. A \u003cem\u003eP\u003c/em\u003e-value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participants\u003c/h2\u003e \u003cp\u003eNo patients withdrew from the experiment, and no adverse events occurred during the research. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates no statistical differences in gender, age, height, and weight between healthy subjects and stroke patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral data comparison (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e/M (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e), n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy subjects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStroke patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (male/female, n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.59\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.746\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.27\u0026thinsp;\u0026plusmn;\u0026thinsp;9.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.86\u0026thinsp;\u0026plusmn;\u0026thinsp;11.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.279\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease duration [M (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e), d]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (40, 84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant side (left/right, n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemiplegia side (left/right, n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: * indicates a \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/em\u003e\u003c/sup\u003e test, and \u003csup\u003e#\u003c/sup\u003e denotes a \u003cem\u003et\u003c/em\u003e test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Results of the effects of the novel EJTMD assessing elbow joint movements in both healthy subjects and stroke patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, EJTMD exhibits significantly superior AROM and muscle strength compared to traditional tools in both healthy subjects and stroke patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, iEMG and RMS values increase during elbow movements when using the EJTMD (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These outcomes may be attributed to the utilization of the EJTMD, potentially activating more muscles to generate strength. In Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, repeated EJTMD measurement outcomes have a good correlation on the same day (r\u0026thinsp;\u0026ge;\u0026thinsp;0.999, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). EJTMD exhibits a statistic difference in measurement outcomes pre- and post-treatment among stroke patients than traditional tools in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the changes in iEMG and RMS values observed when using EJTMD show correlations with the Fugl-Meyer, WMFT, MAS, MSS, and Lindmark assessments in stroke patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The data demonstrate the reliability and clinical utility of the EJTMD, showing its sensitivity to minor elbow joint changes in stroke patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of two measurement methods and sEMG in both healthy subjects and stroke patients (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealthy subjects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eStroke patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional tools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEJTMD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTraditional tools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEJTMD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAROM (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e136.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e109.55\u0026thinsp;\u0026plusmn;\u0026thinsp;19.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114.09\u0026thinsp;\u0026plusmn;\u0026thinsp;19.20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRD muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.66\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.48\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBB muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.81\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e10.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTB muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e10.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion iEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion RMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e259.17\u0026thinsp;\u0026plusmn;\u0026thinsp;109.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e350.92\u0026thinsp;\u0026plusmn;\u0026thinsp;154.97\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e48.38\u0026thinsp;\u0026plusmn;\u0026thinsp;24.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.15\u0026thinsp;\u0026plusmn;\u0026thinsp;83.60\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension iEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension RMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e168.05\u0026thinsp;\u0026plusmn;\u0026thinsp;104.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267.83\u0026thinsp;\u0026plusmn;\u0026thinsp;169.59\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e46.23\u0026thinsp;\u0026plusmn;\u0026thinsp;31.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.83\u0026thinsp;\u0026plusmn;\u0026thinsp;76.81\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: compared with traditional tools, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of repeated EJTMD measurement outcomes and sEMG in all participants on the same day (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealthy subjects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eStroke patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003cp\u003eassessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSecond assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003cp\u003evalues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFirst assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSecond assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003er\u003c/p\u003e \u003cp\u003evalues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalues\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAROM (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114.09\u0026thinsp;\u0026plusmn;\u0026thinsp;19.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e114.55\u0026thinsp;\u0026plusmn;\u0026thinsp;19.08\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRD muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.48\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.53\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.75\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBB muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.81\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.87\u0026thinsp;\u0026plusmn;\u0026thinsp;9.61\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTB muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;7.49\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.94\u0026thinsp;\u0026plusmn;\u0026thinsp;10.57\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion iEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion RMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e350.92\u0026thinsp;\u0026plusmn;\u0026thinsp;154.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351.06\u0026thinsp;\u0026plusmn;\u0026thinsp;155.03\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.15\u0026thinsp;\u0026plusmn;\u0026thinsp;83.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.26\u0026thinsp;\u0026plusmn;\u0026thinsp;83.32\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension iEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension RMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e267.83\u0026thinsp;\u0026plusmn;\u0026thinsp;169.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267.79\u0026thinsp;\u0026plusmn;\u0026thinsp;169.58\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.83\u0026thinsp;\u0026plusmn;\u0026thinsp;76.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e85.91\u0026thinsp;\u0026plusmn;\u0026thinsp;76.94\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: compared with the first assessment, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. The r values range from \u0026minus;\u0026thinsp;1 to 1. Values approaching\u0026thinsp;\u0026plusmn;\u0026thinsp;1 indicates a strong positive (negative) correlation, while values near 0 suggest no significant correlation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiscrepancies in two measurement methods pre/post-treatment and sEMG in stroke patients (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTraditional tools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eEJTMD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ed values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAROM (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109.55\u0026thinsp;\u0026plusmn;\u0026thinsp;19.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111.59\u0026thinsp;\u0026plusmn;\u0026thinsp;17.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114.09\u0026thinsp;\u0026plusmn;\u0026thinsp;19.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118.18\u0026thinsp;\u0026plusmn;\u0026thinsp;16.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRD muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.23\u0026thinsp;\u0026plusmn;\u0026thinsp;8.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBB muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTB muscle strength (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion iEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion RMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.38\u0026thinsp;\u0026plusmn;\u0026thinsp;24.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.61\u0026thinsp;\u0026plusmn;\u0026thinsp;24.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.15\u0026thinsp;\u0026plusmn;\u0026thinsp;83.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.23\u0026thinsp;\u0026plusmn;\u0026thinsp;83.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension iEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension RMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.23\u0026thinsp;\u0026plusmn;\u0026thinsp;31.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.38\u0026thinsp;\u0026plusmn;\u0026thinsp;31.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.83\u0026thinsp;\u0026plusmn;\u0026thinsp;76.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.43\u0026thinsp;\u0026plusmn;\u0026thinsp;77.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: compared with traditional tools, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis between sEMG characteristics and elbow joint functional assessment scales (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eElbow flexion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eElbow extension\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eiEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eiEMG (V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRMS (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFugl-Meyer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWMFT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLindmark\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: the r values range between \u0026minus;\u0026thinsp;1 and 1. Values near \u0026plusmn;\u0026thinsp;1 indicate strong positive (negative) associations, while those near 0 suggest no correlation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Results of mechanical characteristics of bilateral upper limbs and neuro-electrophysiological testing in stroke patients\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows that PT and PT/BW are weaker on the lesion side compared to the healthy side in low, medium, and high-speed tests (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), especially in the low-speed test (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, PT values of elbow extension and flexion on lesion side exceed those on the healthy side during the low-speed test (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In medium and high-speed tests, PT values of elbow extension and flexion on the lesion side show an increasing trend, but not significantly significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The data indicate that stroke patients exhibit lower flexor and extensor muscular strength on the lesion side, with a more pronounced decline in extensor muscle strength observed during low-speed testing. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e(c) to 3(g) and Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, compared with the healthy side, the MEP latency and CMCT of the lesion side of stroke patients are prolonged (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while the MEP amplitude is reduced (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e illustrates that iEMG and RMS values of BRD, BB, and TB on the affected side are significantly lower than those on the unaffected side during elbow movements (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The findings suggest that a conduction block, which leads to decreased muscle activity on the lesion side, may be a potential cause of the diminished motor function observed in stroke patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of bilateral PT and PT/BW in stroke patients (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMuscles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpeed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePT (Nm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePT/BW (Nm/kg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u0026deg;/s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealthy side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLesion side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHealthy side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLesion side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlexor muscles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.81\u0026thinsp;\u0026plusmn;\u0026thinsp;6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.30\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtensor muscles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.84\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.70\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.11\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.59\u0026thinsp;\u0026plusmn;\u0026thinsp;8.42\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: compared with the healthy side, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of PT values of elbow extension and flexion in stroke patients (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeed (\u0026deg;/s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLesion side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: compared with the healthy side, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of neuro-electrophysiological results in stroke patients (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLesion side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMEP latency (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.73\u0026thinsp;\u0026plusmn;\u0026thinsp;18.07\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-13.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMEP amplitude (\u0026micro;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e219.55\u0026thinsp;\u0026plusmn;\u0026thinsp;25.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148.18\u0026thinsp;\u0026plusmn;\u0026thinsp;26.84\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCMCT (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.09\u0026thinsp;\u0026plusmn;\u0026thinsp;18.30\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: compared with the healthy side, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of iEMG and RMS during elbow movements in stroke patients (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\bar {x} \\pm s\\)\u003c/span\u003e\u003c/span\u003e, n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eiEMS (V)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eRMS (\u0026micro;V)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealthy side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLesion side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHealthy side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLesion side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e133.65\u0026thinsp;\u0026plusmn;\u0026thinsp;97.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72.70\u0026thinsp;\u0026plusmn;\u0026thinsp;70.06\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e173.26\u0026thinsp;\u0026plusmn;\u0026thinsp;129.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.14\u0026thinsp;\u0026plusmn;\u0026thinsp;84.72\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLOTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e36.49\u0026thinsp;\u0026plusmn;\u0026thinsp;24.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLATB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e36.68\u0026thinsp;\u0026plusmn;\u0026thinsp;23.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.44\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e60.92\u0026thinsp;\u0026plusmn;\u0026thinsp;75.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.46\u0026thinsp;\u0026plusmn;\u0026thinsp;19.00\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e30.31\u0026thinsp;\u0026plusmn;\u0026thinsp;13.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLOTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e150.32\u0026thinsp;\u0026plusmn;\u0026thinsp;120.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e71.00\u0026thinsp;\u0026plusmn;\u0026thinsp;39.43\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLATB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e194.26\u0026thinsp;\u0026plusmn;\u0026thinsp;237.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72.05\u0026thinsp;\u0026plusmn;\u0026thinsp;39.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: compared with the healthy side, a: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, b: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, c: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis work is one of the first crossover trials to explore the effects of EJTMD evaluating elbow joint movements in both healthy subjects and stroke patients. Furthermore, this study explores the mechanical characteristics of the elbow joint using EJTMD and investigates the underlying mechanisms of differences in bilateral upper limb movements post-stroke. Results show that EJTMD exhibits superior muscle strength, AROM, iEMG, and RMS compared to traditional tools (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The data suggest that stroke patients demonstrate reduced flexor and extensor muscular strength on the lesion side, with a more pronounced decline observed in the extensor muscles during low-speed testing (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The reduction in iEMG, RMS, and MEP amplitude, along with the prolongation of MEP latency and CMCT, may elucidate the decline in motor function on the lesion side post-stroke.\u003c/p\u003e \u003cp\u003eThis study discovers that EJTMD shows larger muscle strength and AROM in both healthy subjects and stroke patients. This improvement may be attributed to the participants' direct interaction with the device, resulting in increased attention towards the device itself rather than the muscles engaged in elbow flexion and extension. By independently planning the anticipated movement trajectory and rapidly activating the muscles, participants attain superior muscle strength and AROM. This phenomenon may be associated with the focus of attention theory. Extensive research on attentional focus consistently shows that directing attention externally (towards the anticipated movement trajectory) leads to superior motor performance compared to an internal focus (on body movement) \u003csup\u003e\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Marchant et al. found that during the maximal isometric contraction of BB, healthy subjects who directed their attention to the bent rod of the device (external focus) achieved greater PT in the elbow flexor muscle compared to when they focused on the arm muscles (internal focus) \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Moreover, Wulf et al. observed that participants who focused on an external focus could generate more power, resulting in a higher vertical jump \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. While the underlying mechanism of the focus of attention theory remains elusive, recent studies suggest a potential link to corticospinal excitability and activation of the default mode network \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe data indicate a notable decline in the strength of both flexor and extensor muscles on the lesion side in stroke patients during low-speed testing, with a more pronounced decrease observed in the extensor muscles. This observation could be associated with the emergence of a speed-dependent spasm pattern in the upper limb post-stroke. Limb spasticity following a stroke is a common motor sensory dysfunction arising from upper motor neuron injury, characterized by a speed-dependent myotatic reflex that often affects the elbow joint \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Previous studies have demonstrated a significant negative correlation between spasticity scores and movement speed \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Additionally, the spinal anterior horn cells of the flexor muscles exhibit greater excitability and recovery following upper motor neuron damage compared to the extensor muscles, potentially leading to an earlier recovery of the flexor muscles in the upper limb \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Hence, this study recommends that during upper limb strength training, stroke patients should prioritize low-speed training for the extensor muscle group.\u003c/p\u003e \u003cp\u003eThe data demonstrate a decline in iEMS, RMS, and MEP amplitude, alongside an increase in MEP latency and CMCT on the affected side post-stroke. iEMG refers to the total discharge of motor units involved in muscle activity in a specific time and reflecting the muscle contraction characteristics over time \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. RMS is the square root of the squared mean of the instantaneous EMG amplitude over a duration, serves as a measure of muscle activity level \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. MEP can reflect the integrity of the conduction path of motor information from the brain through the spinal cord to the muscles \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. CMCT stands as a crucial indicator for assessing CST integrity \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. It is inferred that post-stroke damage to the CST prolongs CMCT, reduces motor unit recruitment, diminishes the descending driving force from the corticospinal pathway to the motor neuron pool, and weakens muscle contraction intensity, ultimately leading to decreased muscle strength.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eThis paper introduces a novel EJTMD capable of concurrently measuring muscle strength and AROM in the elbow joint, providing a quantitative assessment approach. To demonstrate the clinical utility and reliability of EJTMD, experiments were done in the elbow joint of healthy subjects and stroke patients. The device exhibits greater sensitivity to subtle changes in the elbow joint (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, the function of the flexor and extensor muscles on the affected side of stroke patients may be decreased due to the conduction block of the CST, and the extensor muscles decline is more obvious during low-speed testing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eData supporting the current study are available from the corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Hospital Ethics Committee (application number: PJ2024-06-18), and adhered to the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e This work was supported by the Anhui Provincial Department of Education (grant number: 2022AH051160). The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement:\u0026nbsp;\u003c/strong\u003eQingqin Xu, Mengxuan Hu and Lei Li conceived and designed research; Shi Chen and Bo Liu performed experiments; Qingqin Xu and Jianwei Lu analyzed data; Qingqin Xu, Mengxuan Hu and Hemu Chen drafted and revised the manuscript.\u0026nbsp;All authors read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHayward, K. S.\u003cem\u003e et al.\u003c/em\u003e Timing and dose of upper limb motor intervention after stroke: a systematic review. \u003cem\u003eStroke\u003c/em\u003e \u003cstrong\u003e52\u003c/strong\u003e, 3706-3717, doi:10.1161/strokeaha.121.034348 (2021).\u003c/li\u003e\n\u003cli\u003eGregory, W. J. \u0026amp; Saygin, D. Assessment of physical activity and muscle function in adult inflammatory myopathies. \u003cem\u003eCurrent Rheumatology Reports\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 54-63, doi:10.1007/s11926-022-01059-5 (2022).\u003c/li\u003e\n\u003cli\u003eWang, J.\u003cem\u003e et al.\u003c/em\u003e Advanced rehabilitation in ischaemic stroke research. \u003cem\u003eStroke and Vascular Neurology\u003c/em\u003e, doi:10.1136/svn-2022-002285 (2023).\u003c/li\u003e\n\u003cli\u003eJuan, C., Xiang, C. \u0026amp; Minfen, S. A framework for daily activity monitoring and fall detection based on surface electromyography and accelerometer signals. \u003cem\u003eIEEE Journal of Biomedical and Health Informatics\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 38-45, doi:10.1109/titb.2012.2226905 (2013).\u003c/li\u003e\n\u003cli\u003eCampos, B.\u003cem\u003e et al.\u003c/em\u003e Rethinking remapping: circuit mechanisms of recovery after stroke. \u003cem\u003eThe Journal of Neuroscience\u003c/em\u003e \u003cstrong\u003e43\u003c/strong\u003e, 7489-7500, doi:10.1523/jneurosci.1425-23.2023 (2023).\u003c/li\u003e\n\u003cli\u003ePandis, N., Chung, B., Scherer, R. W., Elbourne, D. \u0026amp; Altman, D. G. CONSORT 2010 statement: extension checklist for reporting within person randomised trials. \u003cem\u003eBMJ\u003c/em\u003e \u003cstrong\u003e357\u003c/strong\u003e, j2835, doi:10.1136/bmj.j2835 (2017).\u003c/li\u003e\n\u003cli\u003eBhalerao, S. \u0026amp; Kadam, P. Sample size calculation. \u003cem\u003eInternational Journal of Ayurveda Research\u003c/em\u003e \u003cstrong\u003e1\u003c/strong\u003e, doi:10.4103/0974-7788.59946 (2010).\u003c/li\u003e\n\u003cli\u003eHuang, M., Miller, T., Ying, M. \u0026amp; Pang, M. Y. C. Whole-body vibration modulates leg muscle reflex and blood perfusion among people with chronic stroke: a randomized controlled crossover trial. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 1473, doi:10.1038/s41598-020-58479-5 (2020).\u003c/li\u003e\n\u003cli\u003eLiu, L.\u003cem\u003e et al.\u003c/em\u003e Chinese stroke association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases. \u003cem\u003eStroke and vascular neurology\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 159-176, doi:10.1136/svn-2020-000378 (2020).\u003c/li\u003e\n\u003cli\u003ePan, B.\u003cem\u003e et al.\u003c/em\u003e Motor function assessment of upper limb in stroke patients. \u003cem\u003eJournal of Healthcare Engineering\u003c/em\u003e \u003cstrong\u003e2021\u003c/strong\u003e, 1-11, doi:10.1155/2021/6621950 (2021).\u003c/li\u003e\n\u003cli\u003eLiao, L. Y.\u003cem\u003e et al.\u003c/em\u003e Intermittent theta-burst stimulation for stroke: primary motor cortex versus cerebellar stimulation: a randomized sham-controlled trial. \u003cem\u003eStroke\u003c/em\u003e, doi:10.1161/strokeaha.123.044892 (2023).\u003c/li\u003e\n\u003cli\u003eDu, J.\u003cem\u003e et al.\u003c/em\u003e Aberrances of cortex excitability and connectivity underlying motor deficit in acute stroke. \u003cem\u003eNeural Plasticity\u003c/em\u003e \u003cstrong\u003e2018\u003c/strong\u003e, 1-10, doi:10.1155/2018/1318093 (2018).\u003c/li\u003e\n\u003cli\u003eBuetefisch, C. M.\u003cem\u003e et al.\u003c/em\u003e Stroke lesion volume and injury to motor cortex output determines extent of contralesional motor cortex reorganization. \u003cem\u003eNeurorehabilitation and Neural Repair\u003c/em\u003e \u003cstrong\u003e37\u003c/strong\u003e, 119-130, doi:10.1177/15459683231152816 (2023).\u003c/li\u003e\n\u003cli\u003eLi, J.\u003cem\u003e et al.\u003c/em\u003e Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction. \u003cem\u003eNeural Regen Res\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 1584-1590, doi:10.4103/1673-5374.193236 (2016).\u003c/li\u003e\n\u003cli\u003eGladstone, D. J., Danells, C. J. \u0026amp; Black, S. E. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. \u003cem\u003eThe American Society of Neurorehabilitation\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 232-240, doi:10.1177/154596802401105171 (2002).\u003c/li\u003e\n\u003cli\u003eWolf, S. L.\u003cem\u003e et al.\u003c/em\u003e Assessing wolf motor function test as outcome measure for research in patients after stroke. \u003cem\u003eStroke\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 1635-1639, doi:10.1161/01.STR.32.7.1635 (2001).\u003c/li\u003e\n\u003cli\u003eFerraro, M.\u003cem\u003e et al.\u003c/em\u003e Assessing the motor status score: a scale for the evaluation of upper limb motor outcomes in patients after stroke. \u003cem\u003eThe American Society of Neurorehabilitation\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 283-289, doi:10.1177/154596830201600306 (2002).\u003c/li\u003e\n\u003cli\u003eGong, X., Jin, S., Zhou, Y., Lai, L. H. \u0026amp; Wang, W. Y. Curative effect of medicine cake sticking ultrasound drug penetration combined with body training on hemiplegia after stroke: an in vitro ultrasound targeted drug controlled release technology. \u003cem\u003ePreventive Medicine\u003c/em\u003e \u003cstrong\u003e173\u003c/strong\u003e, doi:10.1016/j.ypmed.2023.107600 (2023).\u003c/li\u003e\n\u003cli\u003eSubramanian, S. K., Bani\u0026ntilde;a, M. C., Turolla, A. \u0026amp; Levin, M. F. Reaching performance scale for stroke test‐retest reliability, measurement error, concurrent and discriminant validity. \u003cem\u003ePm\u0026amp;R\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 337-347, doi:10.1002/pmrj.12584 (2021).\u003c/li\u003e\n\u003cli\u003eKuhn, Y. A., Keller, M., Ruffieux, J. \u0026amp; Taube, W. Adopting an external focus of attention alters intracortical inhibition within the primary motor cortex. \u003cem\u003eActa Physiologica\u003c/em\u003e \u003cstrong\u003e220\u003c/strong\u003e, 289-299, doi:10.1111/apha.12807 (2016).\u003c/li\u003e\n\u003cli\u003eMarchant, D. C., Greig, M. \u0026amp; Scott, C. Attentional focusing instructions influence force production and muscular activity during isokinetic elbow flexions. \u003cem\u003eJournal of Strength and Conditioning Research\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 2358-2366, doi:10.1519/JSC.0b013e3181b8d1e5 (2009).\u003c/li\u003e\n\u003cli\u003eWulf, G. Attentional focus and motor learning: a review of 15 years. \u003cem\u003eInternational Review of Sport and Exercise Psychology\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 77-104, doi:10.1080/1750984x.2012.723728 (2013).\u003c/li\u003e\n\u003cli\u003eWulf, G. \u0026amp; Dufek, J. Increased jump height with an external focus due to enhanced lower extremity joint kinetics. \u003cem\u003eJournal of Motor Behavior\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 401-409, doi:10.1080/00222890903228421 (2009).\u003c/li\u003e\n\u003cli\u003eWissel, J.\u003cem\u003e et al.\u003c/em\u003e Early development of spasticity following stroke: a prospective, observational trial. \u003cem\u003eJournal of Neurology\u003c/em\u003e \u003cstrong\u003e257\u003c/strong\u003e, 1067-1072, doi:10.1007/s00415-010-5463-1 (2010).\u003c/li\u003e\n\u003cli\u003eLindberg, P. G.\u003cem\u003e et al.\u003c/em\u003e Validation of a new biomechanical model to measure muscle tone in spastic muscles. \u003cem\u003eNeurorehabilitation and Neural Repair\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 617-625, doi:10.1177/1545968311403494 (2011).\u003c/li\u003e\n\u003cli\u003eSorinola, I. O., White, C. M., Rushton, D. N. \u0026amp; Newham, D. J. Electromyographic response to manual passive stretch of the hemiplegic wrist: accuracy, reliability, and correlation with clinical spasticity assessment and function. \u003cem\u003eNeurorehabilitation and Neural Repair\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 287-294, doi:10.1177/1545968308321778 (2009).\u003c/li\u003e\n\u003cli\u003eDashtipour, K., Chen, J. J., Walker, H. W. \u0026amp; Lee, M. Y. Systematic literature review of abobotulinumtoxina in clinical trials for adult upper limb spasticity. \u003cem\u003eAmerican Journal of Physical Medicine \u0026amp; Rehabilitation\u003c/em\u003e \u003cstrong\u003e94\u003c/strong\u003e, 229-238, doi:10.1097/phm.0000000000000208 (2015).\u003c/li\u003e\n\u003cli\u003eJin, Y. \u0026amp; Zhao, Y. Post-stroke upper limb spasticity incidence for different cerebral infarction site. \u003cem\u003eOpen Medicine\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 227-231, doi:10.1515/med-2018-0035 (2018).\u003c/li\u003e\n\u003cli\u003eOnishi, H.\u003cem\u003e et al.\u003c/em\u003e Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes. \u003cem\u003eJournal of Electromyography and Kinesiology\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 59-67, doi:10.1016/S1050-6411(99)00020-6 (2000).\u003c/li\u003e\n\u003cli\u003eAshraf, H.\u003cem\u003e et al.\u003c/em\u003e Evaluation of windowing techniques for intramuscular EMG-based diagnostic, rehabilitative and assistive devices. \u003cem\u003eJournal of Neural Engineering\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, doi:10.1088/1741-2552/abcc7f (2021).\u003c/li\u003e\n\u003cli\u003eHallett, M. Transcranial magnetic stimulation: a primer. \u003cem\u003eNeuron\u003c/em\u003e \u003cstrong\u003e55\u003c/strong\u003e, 187-199, doi:10.1016/j.neuron.2007.06.026 (2007).\u003c/li\u003e\n\u003cli\u003eGroppa, S.\u003cem\u003e et al.\u003c/em\u003e A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee. \u003cem\u003eClinical Neurophysiology\u003c/em\u003e \u003cstrong\u003e123\u003c/strong\u003e, 858-882, doi:10.1016/j.clinph.2012.01.010 (2012).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Elbow joint, healthy subjects, motor evoked potentials, stroke, surface electromyography","lastPublishedDoi":"10.21203/rs.3.rs-4945340/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4945340/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCurrent clinical practice lacks quantitative assessment methods for elbow joint movements. In response to existing research limitations, this study introduces the innovative elbow joint torque measurement device (EJTMD), which concurrently measures muscle strength and active range of motion (AROM) using multi-source sensing detection technology. Healthy subjects (n=22) and stroke patients (n=22) were recruited in this randomized crossover study. Each participant underwent two measurement methods: EJTMD or traditional tools like a protractor and muscle strength tester. Participants were randomly allocated to EJTMD first or traditional tools first. The efficacy of EJTMD was assessed by comparing muscle strength and AROM with traditional tools. Integrated EMG (iEMG) and root mean square (RMS) were utilized to analyze outcomes during elbow movements. The peak torque (PT) and peak torque/body weight (PT/BW) were examined to explore the differences in mechanical characteristics of bilateral elbow joints. Motor evoked potentials (MEP) and central motor conduction time (CMCT) were employed to investigate potential mechanisms of underlying motor discrepancies post-stroke.\u003cstrong\u003e \u003c/strong\u003eEJTMD demonstrates superior muscle strength, AROM, iEMS, and RMS during elbow movements compared to traditional tools (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Repeated EJTMD measurement outcomes have a good correlation on the same day (r≥0.999, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). EJTMD exhibits a statistic difference in measurement outcomes pre- and post-treatment among stroke patients than traditional tools (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Stroke patients reveal weaker PT and PT/BW on the lesion side during low-speed testing (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Stroke patients show decreased iEMS and RMS on the affected side during elbow movements (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), with prolonged MEP latency and CMCT (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), and reduced MEP amplitude (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Based on the results, EJTMD demonstrates reliability and effectiveness in elbow movements for healthy subjects and stroke patients, showing sensitivity to minor joint changes. Stroke patients have decreased flexor and extensor function on the lesion side, potentially due to blocked corticospinal tract conduction.\u003c/p\u003e","manuscriptTitle":"Effects of the novel elbow joint torque measurement device assessing elbow joint movements in healthy subjects and stroke patients: a randomized crossover trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-21 06:31:52","doi":"10.21203/rs.3.rs-4945340/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-29T08:13:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-28T15:43:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285004286548385326991056046119784343917","date":"2025-01-02T19:54:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-20T20:04:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274552324623936088880465472649201337105","date":"2024-11-06T20:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30519690024019176975032594691253859169","date":"2024-11-05T07:43:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-16T17:32:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-11T16:07:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-03T11:26:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-03T04:13:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-08-20T13:25:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4fceb29b-51d8-44e1-94e8-e0f0d6d3618d","owner":[],"postedDate":"October 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":38426994,"name":"Biological sciences/Neuroscience"},{"id":38426995,"name":"Health sciences/Diseases"},{"id":38426996,"name":"Health sciences/Health care"},{"id":38426997,"name":"Health sciences/Medical research"},{"id":38426998,"name":"Physical sciences/Engineering"}],"tags":[],"updatedAt":"2025-04-14T16:11:11+00:00","versionOfRecord":{"articleIdentity":"rs-4945340","link":"https://doi.org/10.1038/s41598-025-97953-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-04-13 16:05:46","publishedOnDateReadable":"April 13th, 2025"},"versionCreatedAt":"2024-10-21 06:31:52","video":"","vorDoi":"10.1038/s41598-025-97953-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-97953-w","workflowStages":[]},"version":"v1","identity":"rs-4945340","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4945340","identity":"rs-4945340","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}