Deformation and recovery of cartilage in the intact hip under physiological loads using 7 T MRI

Accurate measurement of cartilage deformation in loaded cadaver hip joints could be a valuable tool to answer clinically relevant research questions. MRI is a promising tool, but its use requires an understanding of cartilage deformation and recovery properties in the intact hip. Our objective was to answer the following questions: (1) How long does it take for hip cartilage to reach a deformed steady-state thickness distribution under simulated physiological load, and how much does the cartilage deform? (2) How long does it take for hip cartilage to return to the original cartilage thickness distribution once the load is removed?MethodsFive human hip specimens were axially loaded to 1980 N in a 7 T MR scanner and scanned every 15 min throughout loading. One specimen was scanned every hour throughout recovery from load. One repeatability specimen was loaded and scanned every day for 4 days. Hip cartilage was segmented as a single unit and thickness was measured radially.ResultsThe hip cartilage reached a steady-state thickness distribution after 225 min of load, and 16.5 h of recovery. Mean strain after 225 min of load was 30.9%. The repeatability specimen showed an average day-to-day change in mean cartilage thickness of 0.10 mm over 4 days of data collection. The amount of deformation (0.96 mm) was far greater than the image resolution (0.11 mm) and error due to repeatability (0.10 mm).ConclusionUsing an ex vivo model, this method has potential for assessing changes in hip cartilage strain due to injury or surgical intervention.     

Effects of eight different ligament property datasets on biomechanics of a lumbar L4-L5 finite element model

Ligaments assist trunk muscles in balancing external moments and providing spinal stability. In absence of the personalized material properties for ligaments, finite element (FE) models use dispersed data from the literature. This study aims to investigate the relative effects of eight different ligament property datasets on FE model responses. Eight L4-L5 models distinct only in ligament properties were constructed and loaded under moment (15 N m) alone or combined with a compressive follower load (FL). Range of motions (RoM) of the disc-alone model matched well in vitro data. Ligament properties significantly affected only sagittal RoMs (∼3.0–7.1° in flexion and ∼3.8–5.8° in extension at 10 N m). Sequential removal of ligaments shifted sagittal RoMs in and out of the corresponding in vitro ranges. When moment was combined with FL, center of rotation matched in vivo data for all models (3.8 ± 0.9 mm and 4.3 ± 1.8 mm posterior to the disc center in flexion and extension, respectively). Under 15 N m sagittal moments, ligament strains were often smaller or within the in vitro range in flexion whereas some posterior ligament forces approached their failure forces in some models. Ligament forces varied substantially within the models and affected the moment-sharing and internal forces on the disc and facet joints. Intradiscal pressure (IDP) had the greatest variation between models in extension. None of the datasets yielded results in agreement with all reported measurements. Results emphasized the important role of ligaments especially under larger moments and the need for their accurate representation in search for valid spinal models.     

Evaluation of the effect of glucosamine on an experimental rat osteoarthritis model

AimsTo investigate the in vivo effect of glucosamine on articular cartilage in osteoarthritis (OA), we evaluated serum biomarkers such as CTX-II (type II collagen degradation) and CPII (type II collagen synthesis) as well as histopathological changes (Mankin score, toluidine blue staining of proteoglycans in an experimental OA model using rats.Main methodsOA was surgically induced in the knee joint by anterior cruciate ligament transection (ACLT) in rats. Animals were divided into three groups: sham-operated group (Sham), ACLT group without GlcN administration (? GlcN) and ACLT group with oral administration of glucosamine hydrochloride (+ GlcN; 1000 mg/kg/day for 56 days).Key findingsACLT induced macroscopic erosive changes on the surfaces of articular cartilage and histological damages such as increase of Mankin score. Of note, glucosamine administration substantially suppressed the macroscopic changes, although the effect on Mankin score was not significant. In addition, serum CTX-II levels were elevated in ?GlcN group compared to that in Sham group after the operation. Of importance, the increase of CTX-II was significantly suppressed by GlcN administration. Moreover, serum CP-II levels were substantially increased in + GlcN group compared to those in Sham and ? GlcN groups after the operation.SignificanceGlcN has a potential to exert a chondroprotective action on OA by inhibiting type II collagen degradation and enhancing type II collagen synthesis in the articular cartilage.     

Prediction of joint center location by customizable multiple regressions: Application to clavicle,scapula and humerus

Accurate spatial location of joint center (JC) is a key issue in motion analysis since JC locations are used to define standardized anatomical frames, in which results are represented. Accurate and reproducible JC location is important for data comparison and data exchange. This paper presents a method for JC locations based on the multiple regression algorithms without preliminary assumption on the behavior of the joint-of-interest. Regression equations were obtained from manually palpable ALs on each bone-of-interest. Results are presented for all joint surfaces found on the clavicle, scapula and humeral bone. Mean accuracy errors on the JC locations obtained on dry bones were 5.2±2.5 mm for the humeral head, 2.5±1.1 mm for the humeral trochlea, 2.3±0.9 mm for the humeral capitulum, 8.2±3.9 mm for the scapula glenoid cavity, 7.2±3.2 mm for the scapular aspect of the acromio-clavicular joint, 3.5±1.8 mm for the clavicular aspect of the sternoclavicular joint and 3.2±1.4 mm for the clavicular aspect of the acromio-clavicular joint. In-vitro and in-vivo validation accuracy was 5.3 and 8.5 mm, respectively, for the humeral head center location. Regression coefficients for joint radius dimension and joint surface orientation were also processed and reported in this paper.     

Biomechanical characterisation of ovine spinal facet joint cartilage

The spinal facet joints are known to be an important component in the kinematics and the load transmission of the spine. The articular cartilage in the facet joint is prone to degenerative changes which lead to back pain and treatments for the condition have had limited long term success. There is currently a lack of information on the basic biomechanical properties of the facet joint cartilage which is needed to develop tissue substitution or regenerative interventions. In the present study, the thickness and biphasic properties of ovine facet cartilage were determined using a combination of indentation tests and computational modelling. The equilibrium biphasic Young's modulus and permeability were derived to be 0.76±0.35 MPa and 1.61±1.10×10^?15 m⁴/(Ns) respectively, which were within the range of cartilage properties characterised from the human synovial joints. The average thickness of the ovine facet cartilage was 0.52±0.10 mm, which was measured using a needle indentation test. These properties could potentially be used for the development of substitution or tissue engineering interventions and for computational modelling of the facet joint. Furthermore, the developed method to characterise the facet cartilage could be used for other animals or human donors.     

In vivo estimation of the short-range stiffness of cross-bridges from joint rotation

Short-range stiffness (SRS) is a mechanical property of muscles that is characterized by a disproportionally high stiffness within a short length range during both lengthening and shortening movements. SRS is attributed to the cross-bridges and is beneficial for stabilizing a joint during, e.g., postural conditions. Thus far, SRS has been estimated mainly on isolated mammalian muscles. In this study we presented a method to estimate SRS in vivo in the human wrist joint.SRS was estimated at joint level in the angular domain (N m/rad) for both flexion and extension rotations of the human wrist in nine healthy subjects. Wrist rotations of 0.15 rad at 3 rad/s were imposed at eight levels of voluntary contraction ranging from 0 to 2.1 N m by means of a single axis manipulator.Flexion and extension SRS of the wrist joint was estimated consistently and accurately using a dynamic nonlinear model that was fitted onto the recorded wrist torque. SRS increased monotonically with torque in a way consistent with previous studies on isolated muscles.It is concluded that in vivo measurement of joint SRS represents the population of coupled cross-bridges in wrist flexor and extensor muscles. In its current form, the presented technique can be used for clinical applications in many neurological and muscular diseases where altered joint torque and (dissociated) joint stiffness are important clinical parameters.     

The effects of wrist motion and hand orientation on muscle forces: A physiologic wrist simulator study

Although the orientations of the hand and forearm vary for different wrist rehabilitation protocols, their effect on muscle forces has not been quantified. Physiologic simulators enable a biomechanical evaluation of the joint by recreating functional motions in cadaveric specimens. Control strategies used to actuate joints in physiologic simulators usually employ position or force feedback alone to achieve optimum load distribution across the muscles. After successful tests on a phantom limb, unique combinations of position and force feedback – hybrid control and cascade control – were used to simulate multiple cyclic wrist motions of flexion-extension, radioulnar deviation, dart thrower’s motion, and circumduction using six muscles in ten cadaveric specimens. Low kinematic errors and coefficients of variation of muscle forces were observed for planar and complex wrist motions using both novel control strategies. The effect of gravity was most pronounced when the hand was in the horizontal orientation, resulting in higher extensor forces (p < 0.017) and higher out-of-plane kinematic errors (p < 0.007), as compared to the vertically upward or downward orientations. Muscle forces were also affected by the direction of rotation during circumduction. The peak force of flexor carpi radialis was higher in clockwise circumduction (p = 0.017), while that of flexor carpi ulnaris was higher in anticlockwise circumduction (p = 0.013). Thus, the physiologic wrist simulator accurately replicated cyclic planar and complex motions in cadaveric specimens. Moreover, the dependence of muscle forces on the hand orientation and the direction of circumduction could be vital in the specification of such parameters during wrist rehabilitation.     

Étude de la variabilité de la clairance hépatique de la mébrofénine-99mTc en scintigraphie hépatobiliaire

AimThe purpose of this study was to investigate some of the parameters likely to influence mebrofenin-^99mTc hepatic clearance calculation and inter-and intra-observers reproducibility.Materials and methodsHepatic clearance (%/min m²) of 30 scintigraphies was calculated from the values of hepatic, cardiac, and total activities, according to the method recommended in the literature. We studied: 1) impact of injection–acquisition delay variations; 2) acquisition type: anterior face only (FA) or geometric mean (GM); 3) clearances calculated according to four different body surface area (BSA) formulas; 4) intra-and inter-observers reproducibility for three observers (two evaluations for each observer).Results1) Clearance differences between different studied intervals were statistically significant, more important if the studied interval was far from reference interval (150–350 secondes) and even more when the interval studied was too early (110–310 secondes). 2) There was a statistically significant difference between clearance calculated using either FA or GM datasets (0.85 %/min m²). 3) There were small but statistically significant differences for four of the clearance comparisons using different BSA formulas. 4) Despite differences in size of cardiac and hepatic regions of interest (ROI), intra-observer reproducibility of hepatic clearance was excellent for each observer. Inter-observers reproducibility was also excellent (r = 0.982).ConclusionHepatic clearance of mebrofenin-^99mTc appears to be a highly reproducible method provided that acquisition and clearance calculation are standardized. It provides additionnal functional information to morphological and biological data usually performed before major hepatectomy. Thereby, the definition of a standardized protocol would enable realization of multicentric studies.     

Matrix metalloproteinase-3 in articular cartilage is upregulated by joint immobilization and suppressed by passive joint motion

Both underloading and overloading of joints can lead to articular cartilage degradation, a process mediated in part by matrix metalloproteinases (MMPs). Here we examine the effects of reduced loading of rat hindlimbs on articular cartilage expression of MMP-3, which not only digests matrix components but also activates other proteolytic enzymes. We show that hindlimb immobilization resulted in elevated MMP-3 mRNA expression at 6 h that was sustained throughout the 21 day immobilization period. MMP-3 upregulation was higher in the medial condyle than the lateral, and was greatest in the superficial cartilage zone, followed by middle and deep zones. These areas also showed decreases in safranin O staining, consistent with reduced cartilage proteoglycan content, as early as 7 days after immobilization. One hour of daily moderate mechanical loading, applied as passive joint motion, reduced the MMP-3 and ADAMTS-5 increases that resulted from immobilization, and also prevented changes in safranin O staining. Intra-articular injections of an MMP-3 inhibitor, N-isobutyl-N-(4-methoxyphenylsulfonyl)-glycylhydroxamic acid (NNGH), dampened the catabolic effects of a 7 day immobilization period, indicating a likely requirement for MMP-3 in the regulation of proteoglycan levels through ADAMTS-5. These results suggest that biomechanical forces have the potential to combat cartilage destruction and can be critical in developing effective therapeutic strategies.     

Biomechanical properties of murine TMJ articular disc and condyle cartilage via AFM-nanoindentation

This study aims to quantify the biomechanical properties of murine temporomandibular joint (TMJ) articular disc and condyle cartilage using AFM-nanoindentation. For skeletally mature, 3-month old mice, the surface of condyle cartilage was found to be significantly stiffer (306 ± 84 kPa, mean ± 95% CI) than those of the superior (85 ± 23 kPa) and inferior (45 ± 12 kPa) sides of the articular disc. On the disc surface, significant heterogeneity was also detected across multiple anatomical sites, with the posterior end being the stiffest and central region being the softest. Using SEM, this study also found that the surfaces of disc are composed of anteroposteriorly oriented collagen fibers, which are sporadically covered by thinner random fibrils. Such fibrous nature results in both an F-D^3/2 indentation response, which is a typical Hertzian response for soft continuum tissue under a spherical tip, and a linear F-D response, which is typical for fibrous tissues, further signifying the high degree of tissue heterogeneity. In comparison, the surface of condyle cartilage is dominated by thinner, randomly oriented collagen fibrils, leading to Hertzian-dominated indentation responses. As the first biomechanical study of murine TMJ, this work will provide a basis for future investigations of TMJ tissue development and osteoarthritis in various murine TMJ models.     

Estimating in vivo passive forces of the index finger muscles: Exploring model parameters

We compared predicted passive finger joint torques from a biomechanical model that includes the exponential passive muscle force–length relationship documented in the literature with finger joint torques estimated from measures in ten adult volunteers. The estimated finger joint torques were calculated from measured right index fingertip force, joint postures, and anthropometry across 18 finger and wrist postures with the forearm muscles relaxed. The biomechanical model predicting passive finger joint torques included three extrinsic and three intrinsic finger muscles. The values for the predicted passive joint torques were much larger than the values calculated from the fingertip force and posture measures with an average RMS error of 7.6 N cm. Sensitivity analysis indicated that the predicted joint torques were most sensitive to passive force–length model parameters compared to anthropometric and postural parameters. Using Monte Carlo simulation, we determined a new set of values for the passive force–length model parameters that reduced the differences between the joint torques calculated from the two methods to an average RMS value of 0.5 N cm, a 94% average improvement of error from the torques predicted using the existing data. These new parameter values did vary across individuals; however, using an average set for the parameter values across subjects still reduced the average RMS difference to 0.8 N cm. These new parameters may improve dynamic modeling of the finger during sub-maximal force activities and are based on in vivo data rather than traditional in vitro data.     

Conceptualisation of articular cartilage as a giant reverse micelle: A hypothetical mechanism for joint biocushioning and lubrication

Phospholipid (PL) molecules form the main structure of the membrane that prevents the direct contact of opposing articular cartilage layers. In this paper we conceptualise articular cartilage as a giant reverse micelle (GRM) in which the highly hydrated three-dimensional network of phospholipids is electrically charged and able to resist compressive forces during joint movement, and hence loading. Using this hypothetical base, we describe a hydrophilic–hydrophilic (HL–HL) biopair model of joint lubrication by contacting cartilages, whose mechanism is reliant on lamellar cushioning. To demonstrate the viability of our concept, the electrokinetic properties of the membranous layer on the articular surface were determined by measuring via microelectrophoresis, the adsorption of ions H, OH, Na and Cl on phospholipid membrane of liposomes, leading to the calculation of the effective surface charge density. The surface charge density was found to be −0.08 ± 0.002 cm⁻² (mean ± S.D.) for phospholipid membranes, in 0.155 M NaCl solution and physiological pH. This value was approximately five times less than that measured in 0.01 M NaCl. The addition of synovial fluid (SF) to the 0.155 M NaCl solution reduced the surface charge density by 30% which was attributed to the binding of synovial fluid macromolecules to the phospholipid membrane. Our experiments show that particles charge and interact strongly with the polar core of RM. We demonstrate that particles can have strong electrostatic interactions when ions and macromolecules are solubilized by reverse micelle (RM). Since ions are solubilized by reverse micelle, the surface entropy influences the change in the charge density of the phospholipid membrane on cartilage surfaces. Reverse micelles stabilize ions maintaining equilibrium, their surface charges contribute to the stability of particles, while providing additional screening for electrostatic processes.     

Joint kinematics estimation using a multi-body kinematics optimisation and an extended Kalman filter,and embedding a soft tissue artefact model

To reduce the impact of the soft tissue artefact (STA) on the estimate of skeletal movement using stereophotogrammetric and skin-marker data, multi-body kinematics optimisation (MKO) and extended Kalman filters (EKF) have been proposed. This paper assessed the feasibility and efficiency of these methods when they embed a mathematical model of the STA and simultaneously estimate the ankle, knee and hip joint kinematics and the model parameters. A STA model was used that provides an estimate of the STA affecting the marker-cluster located on a body segment as a function of the kinematics of the adjacent joints. The MKO and the EKF were implemented with and without the STA model. To assess these methods, intra-cortical pin and skin markers located on the thigh, shank, and foot of three subjects and tracked during the stance phase of running were used. Embedding the STA model in MKO and EKF reduced the average RMS of marker tracking from 12.6 to 1.6 mm and from 4.3 to 1.9 mm, respectively, showing that a STA model trial-specific calibration is feasible. Nevertheless, with the STA model embedded in MKO, the RMS difference between the estimated and the reference joint kinematics determined from the pin markers slightly increased (from 2.0 to 2.1 deg) On the contrary, when the STA model was embedded in the EKF, this RMS difference was slightly reduced (from 2.0 to 1.7 deg) thus showing a better potentiality of this method to attenuate STA effects and improve the accuracy of joint kinematics estimate.     

TEMP/TDM et scintigraphie osseuse en cancérologie : impact d’une acquisition scannographique basse dose chez les patients avec foyer isolé suspect ou de nature indéterminée

AimTo evaluate the usefulness of a low dose SPECT/CT and the added value of an additional “diagnostic” centred CT-scan in cancer patients with a solitary focus observed on planar whole-body bone scintigraphy (PWBS) and classified as indeterminate or suspicious.Material and methodsSixty consecutive patients underwent a low dose SPECT/CT acquisition (120 kV, 30 mAs, 3 mm slice thickness) followed by a “diagnostic” CT-scan (120 kV, 100 mAs, 1.25 mm slice thickness) centred on the focus. The first observer considered prospectively WBS, low-dose SPECT/CT and finally the centred SPECT/CT. A blinded review was performed by a second observer.ResultsPWBS depicted solitary indeterminate or suspicious foci in 38 and 22 patients, respectively. SPECT/CT acquisitions clarified 73% (44/60) of the foci. Additional diagnostic CT-scan altered low-dose SPECT/CT results in nine patients. Additional foci (not found by PWBS) located outside the scanning area of the centred diagnostic CT-scan were found in 20 patients. Inter observer agreement for PWBS, low-dose SPECT/CT and diagnostic SPECT/CT was equal to 0.542, 0.68 and 0.694, respectively. ROC analysis showed no difference between low-dose SPECT/CT and diagnostic SPECT/CT for observer 1 and observer 2.ConclusionThis study shows that a conventional low-dose SPECT/CT in patients presenting with a solitary focus on PWBS is sufficient to improve both accuracy and inter observer variability of bone scanning. A CT volume session should not be limited to the area of the solitary focus since additional foci located outside the centred CT-scan frequently occurred.     

The effect of sliding velocity on chondrocytes activity in 3D scaffolds

Sliding motion and shear are important mediators for the synthesis of cartilage matrix and surface molecules. This study investigated the effects of velocity magnitude and motion path on the response of bovine chondrocytes cultured in polyurethane scaffolds and subjected to oscillation against a ceramic ball. In order to vary velocity magnitude, the ball oscillated ±25° at 0.01, 0.1, and 1 Hz to generate 0.28, 2.8, and 28 mm/s, respectively. The median velocity of these ‘open’ motion trajectories was tested against ‘closed’ motion trajectories in that the scaffold oscillated ±20° against the ball at 1 Hz, reaching 2.8 mm/s. Constructs were loaded twice a day for 1 h over 5 days. Gene expression of cartilage oligomeric matrix protein (COMP), proteoglycan 4 (PRG4, lubricin), and hyaluronan synthase 1 (HAS1) and release of COMP, PRG4, and hyaluronan (HA) were analyzed.Velocity magnitude determined both gene expression and release of target molecules. Using regression analysis, there was a positive and significant relationship with all outcome variables. However, only COMP reacted significantly at 0.28 mm/s, while all other measured variables were considerably up-regulated at 28 mm/s. Motion path characteristics affected COMP, but not PRG4 and HAS1/HA.To conclude, velocity magnitude is a critical determinant for cellular responses in tissue engineered cartilage constructs. The motion type also plays a role. However, different molecules are affected in different ways. A molecule specific velocity threshold appears necessary to induce a significant response. This should be considered in further studies investigating the effects of continuous or intermittent motion.     

Lower limb joint work and joint work contribution during downhill and uphill walking at different inclinations

Work performance and individual joint contribution to total work are important information for creating training protocols, but were not assessed so far for sloped walking. Therefore, the purpose of this study was to analyze lower limb joint work and joint contribution of the hip, knee and ankle to total lower limb work during sloped walking in a healthy population. Eighteen male participants (27.0 ± 4.7 yrs, 1.80 ± 0.05 m, 74.5 ± 8.2 kg) walked on an instrumented ramp at inclination angles of 0°, ±6°, ±12° and ±18° at 1.1 m/s. Kinematic and kinetic data were captured using a motion-capture system (Vicon) and two force plates (AMTI). Joint power curves, joint work (positive, negative, absolute) and each joint’s contribution to total lower limb work were analyzed throughout the stance phase using an ANOVA with repeated measures. With increasing inclination positive joint work increased for the ankle and hip joint and in total during uphill walking. Negative joint work increased for each joint and in total work during downhill walking. Absolute work was increased during both uphill (all joints) and downhill (ankle & knee) walking. Knee joint contribution to total negative and absolute work increased during downhill walking while hip and ankle contributions decreased. This study identified, that, when switching from level to a 6° and from 6° to a 12° inclination the gain of individual joint work is more pronounced compared to switching from 12° to an 18° inclination. The results might be used for training recommendations and specific training intervention with respect to sloped walking.     

Incorporating the length-dependent passive-force generating muscle properties of the extrinsic finger muscles into a wrist and finger biomechanical musculoskeletal model

Dynamic movement trajectories of low mass systems have been shown to be predominantly influenced by passive viscoelastic joint forces and torques compared to momentum and inertia. The hand is comprised of 27 small mass segments. Because of the influence of the extrinsic finger muscles, the passive torques about each finger joint become a complex function dependent on the posture of multiple joints of the distal upper limb. However, biomechanical models implemented for the dynamic simulation of hand movements generally don’t extend proximally to include the wrist and distal upper limb. Thus, they cannot accurately represent these complex passive torques. The purpose of this short communication is to both describe a method to incorporate the length-dependent passive properties of the extrinsic index finger muscles into a biomechanical model of the upper limb and to demonstrate their influence on combined movement of the wrist and fingers. Leveraging a unique set of experimental data, that describes the net passive torque contributed by the extrinsic finger muscles about the metacarpophalangeal joint of the index finger as a function of both metacarpophalangeal and wrist postures, we simulated the length-dependent passive properties of the extrinsic finger muscles. Dynamic forward simulations demonstrate that a model including these properties passively exhibits coordinated movement between the wrist and finger joints, mimicking tenodesis, a behavior that is absent when the length-dependent properties are removed. This work emphasizes the importance of incorporating the length-dependent properties of the extrinsic finger muscles into biomechanical models to study healthy and impaired hand movements.     

Lower limb joint stiffness and muscle co-contraction adaptations to instability footwear during locomotion

Unstable shoes (US) continually perturb gait which can train the lower limb musculature, but muscle co-contraction and potential joint stiffness strategies are not well understood. A shoe with a randomly perturbing midsole (IM) may enhance these adaptations. This study compares ankle and knee joint stiffness, and ankle muscle co-contraction during walking and running in US, IM and a control shoe in 18 healthy females. Ground reaction forces, three-dimensional kinematics and electromyography of the gastrocnemius medialis and tibialis anterior were recorded. Stiffness was calculated during loading and propulsion, derived from the sagittal joint angle-moment curves. Ankle co-contraction was analysed during pre-activation and stiffness phases. Ankle stiffness reduced and knee stiffness increased during loading in IM and US whilst walking (ankle, knee: p = 0.008, 0.005) and running (p < 0.001; p = 0.002). During propulsion, the opposite joint stiffness re-organisation was found in IM whilst walking (both joints p < 0.001). Ankle co-contraction increased in IM during pre-activation (walking: p = 0.001; running: p < 0.001), and loading whilst walking (p = 0.003), not relating to ankle stiffness. Results identified relative levels of joint stiffness change in unstable shoes, providing new evidence of how stability is maintained at the joint level.     

Quantitative evaluation of motor functional recovery process in chronic stroke patients during robot-assisted wrist training

This study was to investigate the motor functional recovery process in chronic stroke during robot-assisted wrist training. Fifteen subjects with chronic upper extremity paresis after stroke attended a 20-session wrist tracking training using an interactive rehabilitation robot. Electromyographic (EMG) parameters, i.e., EMG activation levels of four muscles: biceps brachii (BIC), triceps brachii (TRI, lateral head), flexor carpiradialis (FCR), and extensor carpiradialis (ECR) and their co-contraction indexes (CI) were used to monitor the neuromuscular changes during the training course. The EMG activation levels of the FCR (11.1% of decrease from the initial), BIC (17.1% of decrease from the initial), and ECR (29.4% of decrease from the initial) muscles decreased significantly during the training (P < 0.05). Such decrease was associated with decreased Modified Ashworth Scores for both the wrist and elbow joints (P < 0.05). Significant decrease (P < 0.05) was also found in CIs of muscle pairs, BIC&TRI (21% of decrease from the initial), FCR&BIC (11.3% of decrease from the initial), ECR&BIC (49.3% of decrease from the initial). The decreased CIs related to the BIC muscle were mainly caused by the reduction in the BIC EMG activation level, suggesting a better isolation of the wrist movements from the elbow motions. The decreased CI of ECR& FCR in the later training sessions (P < 0.05) was due to the reduced co-contraction phase of the antagonist muscle pair in the tracking tasks. Significant improvements (P < 0.05) were also found in motor outcomes related to the shoulder/elbow and wrist/hand scores assessed by the Fugl–Meyer assessment before and after the training. According to the evolution of the EMG parameters along the training course, further motor improvements could be obtained by providing more training sessions, since the decreases of the EMG parameters did not reach a steady state before the end of the training. The results in this study provided an objective and quantitative EMG measure to describe the motor recovery process during poststroke robot-assisted wrist for the further understanding on the neuromuscular mechanism associated with the recovery.