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S. Arpa and S. Ozcakir
therapy, resulted in better spasticity scores in hemi-
plegic patients in some studies, whereas the others
recorded no statistically significant differences in the
EMG BF group (14–16).
Only one study has been performed with sham EMG
biofeedback for the lower extremity of the hemiplegic
control group (17). Bradley and colleagues did not find
any difference between the 2 groups after 18 sessions
of treatment, including active movement, mobility and
function. However, their patients were in the acute
phase, and 14 out of 21 participants were not able to
perform the 10-m walk test.
Muscle strength, in our study, was significantly
improved in both groups. In contrast to the other stu-
dies, we tested the muscle strength with an isokinetic
dynamometer. In the articles recording significant
improvements in the EMG BF group, the results were
based on manual testing or EMG activity (15, 18, 19).
In the study by Intiso et al. (15), Bartel Index results
showed no significant improvement in either EMG
BF or control groups. In contrast, our patients both
in the exercise and EMG BF-assisted exercise groups
reached significantly better results. The conflicting
results between the 2 studies can be explained by the
shorter stroke duration of our patients.
Various walking parameters were used to evaluate
gait. Some of the studies assessed gait with video-re-
cording methods. Cozean et al. (20) reported significant
improvements in the EMG BF plus functional electrical
stimulation group, but not in the EMG BF group. In
the EMG BF-treated groups, Intiso (15) and Mulder
(19) found statistically significant improvements in
gait parameters after the treatment, and Burnside
(18) recorded similar findings in the follow-up visits.
Bradley et al. (17) found no difference between EMG
BF and controls in the 10-m walking time, whereas
Binder (21) reported significantly better results in the
50-m walking time in the EMG BF group.
This study has some limitations. The patients were
not divided into acute, subacute or chronic groups ac-
cording to stroke duration. Grouping patients by parti-
cular stroke duration could have been resulted in more
reliable results. In addition, the number of treatment
sessions can be considered as a limitation, as the treat-
ment was limited to 10 sessions. However, the patients
were advised to continue a home exercise programme
and were encouraged at each visit to perform exercises.
In conclusion, this study suggests that exercise with
or without EMG biofeedback is effective for improving
clinical and functional parameters in hemiplegic pa-
tients. Larger studies are needed to determine whether
EMG BF assisted exercises provide additional benefits.
The authors have no conflicts of interest to declare.
www.medicaljournals.se/jrm
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