{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:29:42Z","timestamp":1793233782383,"version":"4.5.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100019345","name":"King Salman Center for Disability Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019345","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p>This study presents an AI-enhanced hybrid rehabilitation system that integrates a dual-arm robotic platform with electromyography (EMG)-guided neuromuscular electrical stimulation (NMES) to support upper-limb motor recovery in stroke survivors. The system features a symmetrical robotic arm with real-time anatomical adaptation for bilateral therapy and incorporates a Support Vector Machine (SVM)-based model for continuous muscle fatigue detection using time-frequency features extracted from EMG signals. A ROS2-based architecture enables real-time signal processing, adaptive control, and remote supervision by clinicians. The system dynamically adjusts stimulation parameters based on fatigue classification results, allowing personalized and responsive therapy. Preliminary clinical validation with three post-stroke patients demonstrated a 44% increase in range of motion, 45% enhancement in active torque, and 36% reduction in passive torque. The SVM model achieved a 95% accuracy in fatigue detection, and initial patient results suggest the feasibility and potential benefits of this intelligent, closed-loop rehabilitation approach.<\/jats:p>","DOI":"10.3389\/fbioe.2025.1619247","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T06:38:11Z","timestamp":1750833491000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["AI-driven hybrid rehabilitation: synergizing robotics and electrical stimulation for upper-limb recovery after stroke"],"prefix":"10.3389","volume":"13","author":[{"given":"Ismail","family":"Ben Abdallah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yassine","family":"Bouteraa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Alotaibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"B1","first-page":"047","article-title":"An optimized stimulation control system for upper limb exoskeleton robot-assisted rehabilitation using a fuzzy logic-based pain detection approach","volume-title":"Sens.","author":"Abdallah","year":"2024"},{"key":"B2","first-page":"04294","article-title":"RISE controller tuning and system identification through machine learning for human lower limb rehabilitation via neuromuscular electrical stimulation","volume-title":"Eng. Appl. Artif. Intell.","author":"Arcolezi","year":"2021"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1109\/etcm56276.2022.9935755","article-title":"A ROS2 based trajectory tracking controller of a 3UPS-1RPU parallel robot for knee rehabilitation","author":"Arcos","year":"2022"},{"key":"B4","doi-asserted-by":"publisher","first-page":"219","DOI":"10.3390\/bioengineering10020219","article-title":"A new wrist\u2013forearm rehabilitation protocol integrating human biomechanics and SVM-based machine learning for muscle fatigue estimation","volume":"10","author":"Bouteraa","year":"2023","journal-title":"Bioengineering"},{"key":"B5","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1108\/ir-02-2020-0041","article-title":"Design and control of an exoskeleton robot with EMG-Driven electrical stimulation for upper limb rehabilitation","volume":"47","author":"Bouteraa","year":"2020","journal-title":"Ind. Robot."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1014681","DOI":"10.3389\/frobt.2022.1014681","article-title":"Editorial: robot-Assisted rehabilitation for neurological disorders","volume":"9","author":"Carbone","year":"2022","journal-title":"Front. Robotics AI"},{"key":"B7","volume-title":"Bioinspired hierarchical electronic architecture for robotic locomotion assistance: application in exoskeletons","author":"Delgado-Oleas","year":"2023"},{"key":"B8","first-page":"201","article-title":"Neuromuscular electrical stimulation for skeletal muscle function","volume":"85","author":"Doucet","year":"2012","journal-title":"Yale J. Biol. Med."},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1109\/RoMoCo60539.2024.10604375","article-title":"ExoReha exoskeleton digital twin in metaverse for telerehabilitation","volume-title":"13th international workshop on robot motion and control (RoMoCo)","author":"Falkowski","year":"2024"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1259773","DOI":"10.3389\/fnbot.2023.1259773","article-title":"Editorial: EMG\/EEG signals-based control of assistive and rehabilitation robots, volume II","volume":"17","author":"Gopura","year":"2023","journal-title":"Front. Neurorobotics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2104","DOI":"10.3390\/s23042104","article-title":"Automatic assessments of parkinsonian gait with wearable sensors for human assistive systems","volume":"23","author":"Han","year":"2023","journal-title":"Sensors"},{"key":"B12","doi-asserted-by":"publisher","first-page":"20220001","DOI":"10.2490\/prm.20220001","article-title":"Development of a gait rehabilitation robot using an exoskeleton and functional electrical stimulation: validation in a pseudo-paraplegic model","volume":"7","author":"Inoue","year":"2022","journal-title":"Prog. Rehabilitation Med."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/mi13071033","article-title":"Hand rehabilitation devices: a comprehensive systematic review","volume":"1033","author":"Kabir","year":"2022","journal-title":"Micromachines"},{"key":"B14","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1016\/j.apmr.2017.10.028","article-title":"Clinical use of neuromuscular electrical stimulation for neuromuscular rehabilitation: what are we overlooking?","volume":"99","author":"Maffiuletti","year":"2018","journal-title":"Archives Phys. Med. Rehabilitation"},{"key":"B15","doi-asserted-by":"publisher","first-page":"111104","DOI":"10.1016\/j.jbiomech.2022.111104","article-title":"EMG-Driven fatigue-based self-adapting admittance control of a hand rehabilitation robot","volume":"138","author":"Mashayekhi","year":"2022","journal-title":"J. Biomechanics"},{"key":"B16","doi-asserted-by":"publisher","first-page":"11489","DOI":"10.3390\/app142411489","article-title":"A smart motor rehabilitation system based on the internet of things and humanoid robotics","volume":"14","author":"Moghbelan","year":"2024","journal-title":"Appl. Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2693","DOI":"10.3390\/s22072693","article-title":"Biomechanical assessment of post-stroke patients\u2019 upper limb before and after rehabilitation therapy based on FES and VR","volume":"22","author":"Montoya","year":"2022","journal-title":"Sensors"},{"key":"B18","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1109\/tnsre.2019.2891004","article-title":"Synergy-based FES for post-stroke rehabilitation of upper-limb motor functions","volume":"27","author":"Niu","year":"2019","journal-title":"IEEE Trans. Neural Syst. Rehabilitation Eng."},{"key":"B19","doi-asserted-by":"publisher","first-page":"136621","DOI":"10.1016\/j.neulet.2022.136621","article-title":"A pilot study of synergy-based FES for upper-extremity poststroke rehabilitation","volume":"780","author":"Niu","year":"2022","journal-title":"Neurosci. Lett."},{"key":"B20","year":"","journal-title":"Open Source Robot. Found. (OSRF)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1146\/annurev.bioeng.6.040803.140103","article-title":"Functional electrical stimulation for neuromuscular applications","volume":"7","author":"Peckham","year":"2005","journal-title":"Annu. Rev. Biomed. Eng."},{"key":"B22","doi-asserted-by":"publisher","first-page":"7420","DOI":"10.1016\/j.eswa.2012.01.102","article-title":"Feature reduction and selection for EMG signal classification","volume":"39","author":"Phinyomark","year":"2012","journal-title":"Expert Syst. Appl."},{"key":"B23","first-page":"1013","article-title":"Architectural proposal for low-cost brain\u2013computer interfaces with ROS systems for the control of robotic arms in autonomous wheelchairs","volume-title":"Electron.","author":"Rivas","year":"2024"},{"key":"B24","doi-asserted-by":"publisher","first-page":"8090","DOI":"10.3390\/app10228090","article-title":"Switched control of motor assistance and functional electrical stimulation for biceps curls","volume":"10","author":"Rouse","year":"2020","journal-title":"Appl. Sci. Switz."},{"key":"B25","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.rehab.2018.06.005","article-title":"Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis","volume":"61","author":"Sharififar","year":"2018","journal-title":"Ann. Phys. Rehabilitation Med."},{"key":"B26","first-page":"1","article-title":"Robot-inspired human impedance control through functional electrical stimulation","author":"Sierotowicz","year":"2023","journal-title":"In 2023 International Conference on Rehabilitation Robotics (ICORR), IEEE"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.3390\/s22041409","article-title":"Usability of functional electrical stimulation in upper limb rehabilitation in post-stroke patients: a narrative review","volume":"22","author":"Sousa","year":"2022","journal-title":"Sensors"},{"key":"B28","doi-asserted-by":"publisher","first-page":"893275","DOI":"10.3389\/fnsys.2022.893275","article-title":"Application of surface electromyography in exercise fatigue: a review","volume":"16","author":"Sun","year":"2022","journal-title":"Front. Syst. Neurosci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"139","DOI":"10.46292\/sci21-00004","article-title":"Improving upper extremity strength, function, and trunk stability using wide-pulse functional electrical stimulation in combination with functional task-specific practice","volume":"28","author":"Tefertiller","year":"2022","journal-title":"Top. spinal cord Inj. rehabilitation"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1109\/lra.2025.3530320","article-title":"A multi-layered quantitative assessment approach for hand spasticity based on a cable-actuated hand exoskeleton","volume":"10","author":"Yu","year":"2025","journal-title":"IEEE Robotics Automation Lett."},{"key":"B31","doi-asserted-by":"publisher","first-page":"10398","DOI":"10.3390\/ijerph191610398","article-title":"Application of an EMG-rehabilitation robot in patients with post-coronavirus fatigue syndrome (COVID-19)\u2014A feasibility study","volume":"19","author":"Zasadzka","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1619247\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T06:38:13Z","timestamp":1750833493000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1619247\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":31,"alternative-id":["10.3389\/fbioe.2025.1619247"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1619247","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]},"article-number":"1619247"}}