Electromyographic biofeedback in the treatment of the hemiplegic hand: a placebo-controlled study. Biofeedback and functional electric stimulation in stroke rehabilitation. Electromyographic feedback and physical therapy for neuromuscular retraining in hemiplegia. The effectiveness of EMG biofeedback in the treatment of arm function after stroke. Evaluation of electromyographic biofeedback as an adjunct to therapeutic exercise in treating the lower extremities of hemiplegic patients. Electromyographic biofeedback and physical therapy of the hemiplegic upper limb. Electromyographic biofeedback for gait training after stroke. EMG feedback and the restoration of motor control. A controlled group study of 12 hemiparetic patients. Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs. Electromyographic feedback in the remobilization of stroke patients: a controlled trial. Rehabilitation of walking with electromyographic biofeedback in foot-drop after stroke.
To evaluate the efficacy of electromyographic (EMG) biofeedback treatment in the functional recovery of the hemiplegic hand.
                A total of 27 patients were randomly assigned to EMG biofeedback or placebo EMG biofeedback groups. Both treatments were applied five times a week for a period of 20 days. In addition, the patients in both groups received an exercise program according to the Brunnstrom's neurophysiologic approach. Goniometric measurements for wrist extension, scale for judging the performance of drinking from a glass, Brunnstrom's stages of recovery for hand, and surface EMG potentials were used for the clinical assessments. All patients were assessed before treatment and after 20 treatment sessions.
                The results showed that there were statistically significant improvements in all variables in both groups, but the improvements in active range of motion and surface EMG potentials were significantly greater in the EMG biofeedback group at the end of the treatment.
                Our study demonstrates the potential benefits of EMG biofeedback in conjunction with neurophysiologic rehabilitation technique to maximize the hand function in hemiplegic patients. The study examined the efficacy of functional electric stimulation (FES) and biofeedback (BFB) treatment of gait dysfunction in patients with hemiplegia after stroke. These two therapeutic modalities were tested alone and in combination in a prospective, controlled, randomized trial. The authors hypothesized that in concurrent use, these two modalities would complement one another. Thirty-six hemiplegic patients undergoing rehabilitation after stroke were accepted for study and randomized into four groups to receive either control, FES, BFB, or combined therapies. Each patient received 30 minutes of treatment three times per week for six weeks, in addition to their general rehabilitation program. Quantitative gait analysis was performed biweekly on each subject during the experimental therapy and for four weeks afterward. Thirty-two subjects completed the study. Combined therapy with BFB and FES resulted in improvements in both knee and ankle minimum flexion angles during swing phase that were statistically significant with p = 0.05 and p = 0.02, respectively. Velocity of gait, cycle time, and symmetry of stance phases also improved. The length of time elapsed since the stroke did not prove to be a significant factor. Electromyographic feedback was compared with physical therapy for its relative effectiveness in training motor activity in patients with hemiplegia. A cross over design was used, so that each patient served as his own control. Strong reinforcement for attentional direction and for successful response to established criteria was used with both modalities. Electromyography through auditory and visual display was found effective in improving electromyographic activity, but more limited in training effective function as measured by active range of motion. In some cases it was counterproductive. Using an instrumental modality permits attention to only a limited number of motor elements involved in a motion, and is even more limited with respect to the interplay of activation and inhibition of those components. The activity of physical therapy, using tactile, proprioceptive, visual and communicative modalities, has the capacity for attending and drawing attention to many motor elements, as well as to the complexities of activation of some components concomitantly with the inhibition of others during the training process. Electromyographic feedback was felt to be especially useful in its ability to enhance figure-background discrimination and bypass possible areas of sensory obtundation. The study was designed to evaluate the effect of electromyographic (EMG) biofeedback on the recovery of arm function after stroke. Patients who had impaired arm function and were between 2 and 8 weeks after stroke were randomly allocated to receive either treatment incorporating EMG biofeedback or a control treatment in addition to their routine physiotherapy. The two groups of 20 patients were compared before and after 6 weeks of treatment and at follow-up 6 weeks later. There were no significant differences between the groups before treatment or at follow-up, but at the end of treatment those who received EMG biofeedback scored significantly higher on tests of arm function. Patients with severe impairment were shown to benefit most from EMG biofeedback but there was no difference in response to treatment according to patient's age or side of stroke. Men had higher arm function scores than women before and at the end of treatment, but not at follow-up. The following controlled, preliminary investigation was designed to determine whether electromyographic biofeedback, in conjunction with therapeutic exercise, could influence the reacquisition of functional lower extremity movements in chronic hemiplegic patients. Both the control (standardized therapeutic exercise regimen) and experimental (therapeutic exercise regimen combined with electromyographic biofeedback) groups improved in ankle active range of motion; only the experimental group significantly shortened its timed ambulation over a carpeted surface. One patient in the experimental group who was given 12 additional training sessions showed further gains in knee and ankle joint angle measurements during walking. The apparent potential for rehabilitation of chronic hemiplegic patients and the benefits afforded to physical therapists from a standardized therapeutic exercise protocol are discussed. A long-term, comparison-group outcome trial with a partial crossover design was carried out on the effects of electromyographic biofeedback (EMGBF) plus physiotherapy (PT) versus PT alone in the treatment of the hemiplegic upper limb in stroke patients who were at least six months beyond the onset of their disability. Both the experimental and the control groups benefited from their treatment, but EMGBF was shown to have an additional effect, both in the experimental patients, and in the control patients when they switched over to the experimental treatment condition. To examine the effects of electromyographic (EMG) biofeedback training on the recovery of gait in the acute phase post stroke.
                Patients were randomly assigned to EMG biofeedback or control groups. They received treatment three times a week for six weeks. All patients were assessed prior to treatment, after 18 treatment sessions, and at three months follow-up.
                The study was carried out at Scunthorpe General Hospital in North Lincolnshire. The subjects were acute stroke patients who had been admitted on to the medical and elderly wards.
                The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy. The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles. The control group were treated using the same techniques, electrodes were used with this group of patients, but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect.
                A large battery of outcome measures was used for physical and psychological assessment. The physical measures consisted of active movement, muscle tone, sensation, proprioception, mobility and activities of daily living (ADL). The psychological measures included orientation, memory, spatial performance, language and IQ.
                Twenty-one patients were included in the study. Scores were combined into four groups: mild EMG, severe EMG, mild control and severe control. Results showed that there was an improvement in physical scores for active movement, mobility and ADL over time, but there was no significant difference between the EMG and control groups. Scores on the psychological tests were within normal limits, and there was no difference in performance between the EMG and control groups.
                This study showed no significant differences in the rate of improvement after stroke between the two groups. Although EMG biofeedback was used as an adjunct to physiotherapy and represented clinical practice, the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke. A controlled group study involving 12 patients was performed with the purpose of comparing the effects of EMG feedback in the (re-)learning of motor control to the effects of a conventional physical therapy procedure (NDT). The therapy was focussed on the improvement of the dorsiflexion function of the foot. Special attention was given to the measurement and evaluation of functional parameters (range of motion and gait). The results indicated no significant differences between the two methods. The implications of the results for the employment of EMG feedback and other therapeutic procedures in motor rehabilitation are discussed. This was a controlled study of the efficacy of two forms of therapy on upper limb functions of hemiparetic patients--one heavily behavioral and the other based on Bobath therapeutic exercises. It arose from an earlier pilot study comparing EMG biofeedback with physical therapy from which it was concluded that both the elapsed time since the acute stroke and the severity of residual disability were particularly important factors. Of 29 patients included and randomly assigned to one or the other heavily systematized therapies, 18 were classified as having early-severe and 11 as late-mild conditions. Multiple function tests by a "blinded" special technician in another location revealed that overall both forms of therapy obtained worthwhile clinical and statistical improvement, which was maintained at nine-month recheck testing; but there was no statistically significant superiority of one therapy over the other under the very specific circumstances of the research design. Ease of delivering care and other socioeconomic considerations become important factors in choosing either or both of these methods. Electromyographic biofeedback was compared with simple exercise therapy as to its effectiveness in improving foot-drop in 22 stroke patients. The study was designed to be a rigorous trial of biofeedback and the patients tested were aged and had stroke of long duration. One group of 11 patients underwent 6 weeks of exercise therapy 2 sessions per week for 15 minutes per session; the 2nd group of 11 patients underwent similar therapy with EMG feedback. All therapy was conducted by a research assistant who was not a trained therapist. The groups were assessed blind before treatment, after treatment and a 6-week follow-up. The significantly greater improvements in the biofeedback group in terms of muscle strength at the end of treatment were maintained at follow-up. On the range of movement and gait analysis measures, both groups showed some improvement after treatment. However, at follow-up this improvement had relapsed for the exercise group while for the biofeedback group it had been maintained. It is argued that controlled trials are possible in biofeedback and that using patients as their own controls is not justified in view of the present findings and the previously reported literature. 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.