This article critically reviews publications on EMG biofeedback applications to stroke patients. The state of the art on specificity of treatment effects, consistency across training procedures, measurement techniques, outcome assessments, transfer of treatment effect, and mechanism of action is discussed. Although EMG biofeedback may augment movement capabilities, at least as well as exercise regimens, data relating neuromuscular changes to function are limited. The deficiencies in our current knowledge about this application to stroke patients are identified, and suggestions for items requiring future clarification are delineated.

Electromyographic biofeedback applications to stroke patients. A critical review.

Background and Purpose: The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). Method: Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. Results: The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. Discussion and Conclusion: The Ottawa Panel recommend...

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation

Alterations of gait cycle and foot-drop on the paretic limb are characteristic of stroke patients. Electromyographic biofeedback treatment has been used in rehabilitation of walking, but results are controversial. We performed gait analysis to evaluate the efficacy of electromyographic biofeedback compared with physical therapy.

Sixteen patients with ischemic stroke were enrolled in the study. The experimental group (4 men, 4 women) received electromyographic biofeedback treatment together with physical therapy. The control group (5 men, 3 women) was treated with physical therapy only. Clinical and functional evaluations before and after treatment were performed using Canadian Neurological, Adams, Ashworth, Basmajian, and Barthel Index scales. Computerized gait analysis was performed in all patients.

Electromyographic biofeedback patients showed significantly increased scores on the Adams scale (P < .05) and Basmajian scale (P < .01). Gait analysis in this group showed a recovery of foot-drop in the swing phase (P < .02) after training.

Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia.

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.25.6.1189

Rehabilitation of walking with electromyographic biofeedback in foot-drop after stroke.

Rehabilitation is a multidisciplinary process that includes the cooperative efforts of various medical specialists and their associates in related health fields to improve the mental, social, physical, and vocational aptitudes of persons who are handicapped, with the object of upgrading their ability to live happily and productively within their environment. The health professionals involved in physical medicine and rehabilitation services are specially trained physicians (physiatrists), physical therapists, psychologists, social workers, recreational therapists, occupational therapists, nurses, vocational counselors, speech therapists, and others. Because many health professionals are involved who are experts in their specialized areas, feedback techniques in rehabilitation settings are varied. Although electromyographic techniques are mainly used by physical therapists and psychologists, other kinds of feedback techniques include EEG, thermal, position sensing, and other devices that are used or could be used by various specialists. Electromyographic feedback, audiovisual neuromuscular reeducation, and neuromyometry are synonymous terms used in the literature. They refer to treatment and evaluation of patients using electromyographic devices for the striated-muscle reeducation process. The clinical literature is

Biofeedback in physical medicine and rehabilitation.

Electromyographic biofeedback is becoming widely used to help patients regain voluntary control of specific muscles affected by neuromuscular disorders. Electromyographic feedback training has been employed in the rehabilitation of patients affected by poliomyelitis, cerebrovascular accident, torticollis, nerve injury, temporomandibular joint syndrome, bruxism, and other disorders. While EMG biofeedback appears to be a promising treatment technique, the research literature on its effectiveness consists mainly of uncontrolled case reports and clinical trials. It is concluded that new studies with more sophisticated designs and more careful control are needed to demonstrate that EMG biofeedback makes a unique contribution to the treatment of neuromuscular disorders. Research is needed to identify relevant patient characteristics predictive of success, specify appropriate muscle groups for the treatment of particular disorders, determine how feedback can be most efficiently combined with more conventional techniques in achieving a therapeutic effect, and establish meaningful criteria of success in the treatment of neuromuscular disorders.

Electromyographic biofeedback: Behavioral treatment of neuromuscular disorders

Electromyographic (EMG) feedback was used to train a patient to inhibit spastic muscles voluntarily. The EMG activity was recorded with surface electrodes placed over the belly of the medial gastrocnemius muscle and displayed on a meter. The patient trained himself at home for thirty minutes daily for two months. Following training, improved muscle control could be seen even without the use of the EMG feedback device.

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Carl A. Hermsmeyer

Papers

Use of electromyographic feedback to increase inhibitory control of spastic muscles