Development of high-density surface-electromyographic biomarkers to improve stroke rehabilitation, management, and prognosis

Project title

Development of high-density surface-electromyographic biomarkers to improve stroke rehabilitation, management, and prognosis

Description

External Co-Investigating

Prof Jacqui Morris, University of Dundee

Dr Martin Seyres, University of Dundee

Jasmine Usher, Univesity of Dundee 

Project Description 

Stroke is a leading cause of long-term disability worldwide, creating substantial challenges for healthcare systems and rehabilitation services. Although advances in acute stroke care have improved survival rates, clinicians continue to rely on relatively subjective assessments to evaluate motor impairment, predict recovery, and guide rehabilitation. The Development of High-Density Surface-Electromyographic Biomarkers to Improve Stroke Rehabilitation, Management and Prognosis project aims to address this gap through the development of objective neurophysiological biomarkers capable of improving stroke rehabilitation, management, and prognostic decision-making.

Funded by the Engineering and Physical Sciences Research Council (EPSRC), the project investigates whether high-density surface electromyography (HDsEMG) can provide sensitive measures of neuromuscular function and recovery following stroke. Through a longitudinal study design, individuals are assessed from the hyper-acute stages of stroke through the first six months of recovery, combining detailed clinical assessments with measures of upper-limb function, movement quality, and muscle activation.

The research has established a unique dataset integrating clinical, biomechanical, and neurophysiological outcomes, enabling unprecedented insight into the processes of neuromuscular reorganisation that occur after stroke. Alongside experimental work, the programme has delivered evidence syntheses examining the relationships between motor function, proprioception, spasticity, and recovery, helping to identify the mechanisms most strongly associated with functional outcomes after stroke.

By identifying electrophysiological signatures that reflect impairment severity and recovery potential, the project seeks to underpin a new generation of objective biomarkers for stroke rehabilitation. These biomarkers have the potential to support more accurate prognoses, facilitate personalised rehabilitation pathways, optimise clinical decision-making, and ultimately improve functional outcomes and quality of life for stroke survivors. Furthermore, the methodologies developed may be transferable to other neurological conditions, extending their impact beyond stroke rehabilitation alone. 

Impact

The project is progressing towards impact across clinical practice, research infrastructure, and health service innovation, although formal evidence of downstream impact has not yet been systematically collected given the ongoing nature of the work. At present, the project's principal realised contributions include the establishment of a unique longitudinal dataset integrating high-density surface electromyography, clinical assessments, and biomechanical measures of upper-limb recovery following stroke. This dataset represents a valuable research resource with potential applications extending beyond the immediate objectives of the project, including the development of digital biomarkers, artificial intelligence approaches to recovery prediction, and future multicentre rehabilitation studies.

Emerging impact is evident through engagement with clinical, engineering, and rehabilitation communities. Findings and methodological developments have been disseminated through national and international conferences, including the Scottish Stroke Annual Meeting, Women in Data Science Aberdeen, and other rehabilitation and biomedical engineering forums, helping to raise awareness of the potential of objective neurophysiological markers for stroke management and recovery prediction.

The anticipated longer-term impact of the research lies in the development of clinically applicable biomarkers capable of supporting more accurate prognostic assessment and personalised rehabilitation planning. Current stroke rehabilitation pathways rely heavily on observational and clinician-rated measures; therefore, objective measures derived from high-density surface electromyography could provide additional information regarding recovery potential and neuromuscular reorganisation following stroke. The project was specifically designed to address this unmet clinical need and to generate evidence required for future translational studies and clinical implementation.

While evidence of changes to clinical practice, policy, or patient outcomes is not yet available, the project has established the necessary scientific, methodological, and collaborative foundations through which such impact may be realised and evaluated in future phases of research.

Further Information

Findings from the EMBRS project have been disseminated nationally and internationally through invited talks, conference presentations, and scientific posters. To date, project outputs have been presented at the Women in Data Science (WiDS) Conference (Aberdeen), the Scottish Stroke Annual Meeting, BioMedEng25, the UK Stroke Forum, the ABIBA Forum at the University of East Anglia, and the World Congress for Neurorehabilitation (WCNR). These presentations have engaged multidisciplinary audiences spanning rehabilitation medicine, stroke care, biomedical engineering, data science, and neurorehabilitation, helping to raise awareness of the potential for high-density surface electromyography and digital biomarkers to transform stroke rehabilitation and recovery prediction.

 

 

 

Publications and outputs

Peer-Reviewed Publications

Usher J, Morris J, Aranceta-Garza A. Assessing and quantifying the interactions between spasticity, proprioception, and motor function of the upper limb after stroke: A meta-analysis. Published in the Journal of Rehabilitation and Assistive Technologies Engineering (2025). This meta-analysis synthesised current evidence regarding the interrelationships between key impairments affecting upper-limb recovery following stroke and provides an important evidence base for the biomarker development programme.

Manuscripts in Preperation/Submission

Usher J, Seyres M, Wylie G, Morris J, Aranceta-Garza A. Longitudinal changes in elbow-trunk coordination and compensatory movement strategies during the first six months after stroke: a comparison of ipsilesional, contralesional and healthy upper limbs. Clinical Biomechanics (Under review). This manuscript presents longitudinal biomechanical analyses of compensatory movement strategies during upper-limb recovery following stroke.

Usher J, Wylie G, Morris J, Aranceta-Garza A. Assessing the relationships between spasticity, proprioception and movement following stroke: a systematic review and meta-analysis. Disability and Rehabilitation (Under review). This manuscript extends previous work by quantitatively examining the interactions between key neurological impairments and motor recovery after stroke.

Usher J, Seyres M, Wylie G, Morris J, Aranceta-Garza A. Longitudinal neuromuscular reorganisation following stroke: distinct amplitude, frequency and spatial activation signatures across upper-limb and trunk muscles. Target journal: Journal of NeuroEngineering and Rehabilitation (JNER). This flagship manuscript reports longitudinal changes in motor-unit behaviour and muscle activation patterns from the hyper-acute to chronic phases of stroke recovery and explores their potential as candidate neurophysiological biomarkers.

Conference Outputs

Aranceta-Garza A, Seyres M, Morris J, Usher J. EMBRS: ElectroMyographic Biomarkers for Rehabilitation after Stroke. Poster presented at the Scottish Stroke Annual Meeting, Dundee, UK (2024).

Aranceta-Garza A, Usher J, Morris J. Assessing and quantifying the relationships between spasticity, proprioception and movement post-stroke. Poster presented at BioMedEng25, Glasgow, UK (2025).

Project findings have also been disseminated through invited presentations at the Women in Data Science Aberdeen Conference, the ABIBA Forum, national stroke research meetings, the UK Stroke Forum, and the World Congress for Neurorehabilitation (WCNR), broadening engagement with clinical, engineering, rehabilitation, and data science communities.