Journal of Rehabilitation Medicine 51-2 | Page 34

J Rehabil Med 2019; 51: 109–112 ORIGINAL REPORT DOES ELECTROMYOGRAPHIC BIOFEEDBACK IMPROVE EXERCISE EFFECTS IN HEMIPLEGIC PATIENTS? A PILOT RANDOMIZED CONTROLLED TRIAL Selcan ARPA, MD, and Suheda OZCAKIR, MD From the Uludag University School of Medicine Department of Physical Medicine and Rehabilitation, Bursa, Turkey Objective: The aim of this pilot randomized study was to assess the efficacy potential of an electromyo­ graphic biofeedback-assisted exercise programme on clinical and functional outcomes of hemiplegic patients in comparison with sham electromyogra­ phic biofeedback. Patients and methods: Thirty-four patients with he- miplegia were randomized into 2 groups. Both groups participated in an inpatient rehabilitation program- me including exercise interventions and ambulation training 5 days a week for 2 weeks. Lower extre- mity exercises were performed via electromyogra­ phic biofeedback in Group 1 (n  = 17), while a sham technique was used for patients in Group 2 (n  = 17). Range of motion, spasticity, muscle strength, func­ tional level and walking speed were assessed before and after treatment. Follow-up was performed at 1 and 3 months after treatment. Results: Significant improvements were found for range of motion, muscle strength, Barthel Index and 10-m walking time in both groups. Conclusion: This study suggests that exercise with or without electromyographic biofeedback is effec- tive for improving clinical and functional parameters in hemiplegic patients. Larger studies are needed to determine whether electromyographic biofeedback- assisted exercises provide additional benefits. Key words: EMG biofeedback; exercise; stroke. Accepted Dec 6, 2018; Epub ahead of print Jan 22, 2019 J Rehabil Med 2019; 51: 109–112 LAY ABSTRACT This study suggests that exercise with or without elec- tromyographic biofeedback is effective for improving clinical and functional parameters in hemiplegic pa- tients. Various approaches can be used for motor recovery; however, the effectiveness of these approaches and their superiority remain controversial. Historically, corrective exercise based on orthopaedic principles, neurophysiological approaches and motor learning techniques have been used (5). Biofeedback (BF), which is a method that supports the motor learning principles, has been used in rehabilitation for over 40 years (6). Electromyographic BF (EMG BF) uses electrodes placed on patients’ muscles to record an ac- tion potential creating a visual and auditory feedback after amplification. It may be possible for individuals to learn how to use the unaffected pathways through the artificial proprioception provided by the BF apparatus (7). Meta-analysis indicates that there is some evidence suggesting that EMG BF is beneficial when used with standard physiotherapy techniques, and emphasizes the need for randomized clinical trials using standardized assessment scales (8). The aim of this pilot randomized study was to assess the efficacy potential of an EMG biofeedback (EMG BF)-assisted exercise programme on clinical and functional outcomes of hemiplegic patients in comparison with sham EMG BF. Correspondence address: Suheda Ozcakir, Uludag University School of Medicine, Department of Physical Medicine and Rehabilitation, Bursa, Turkey. E-mail: [email protected] S troke is the leading cause of death and disability worldwide. Although the incidence and mortality rates of stroke have decreased over time, the number of stroke survivors and the overall global burden of stroke are increasing (1, 2). Almost 50% of the community-dwelling stroke population is still living with sequelae after 6 months, and the most common impairment after stroke is motor impairment (3). Strength is one of the most impacted domains 6 years post-stroke and appropriate rehabilitation interventions are necessary to reduce the long-term negative impact (4). Therefore, much of the rehabilitation efforts are focused on motor impairment and walking ability. METHODS A total of 34 patients with hemiplegia due to vascular causes who were over 18 years old were included in the study after approval by the Institutional Review Board. Written informed consent was obtained from each patient. Patients with visual, auditory or cognitive deficits who were incompatible with the treatment requirements and patients with peripheral vascular diseases and severe spasticity or contracture at the ankle were excluded. Since the patients’s walking speed was to be measured, patients who could not walk with or without assistance were excluded. Patients were randomly assigned to EMG BF or sham EMG BF treatment groups in a 1:1 ratio. Block randomization was performed in blocks of 4 to ensure balance between the groups. Random numbers generated using statistical software were used to select randomly among possible blocks (SO). Assessments were performed blind by the other investigator (SA). Both groups received an inpatient rehabilitation programme, including exercise interventions and ambulation training. Ex- This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2513