Overview of clinical trials with MIT-MANUS: a robot-aided neuro-rehabilitation facility. Rehabilitation of Walking With Electromyographic Biofeedback in Foot‐Drop After Stroke Effects of virtual reality training on gait biomechanics of individuals post-stroke. The development and clinical evaluation of a standing biofeedback trainer. Light touch cue through a cane improves pelvic stability during walking in stroke. Electromyographic biofeedback for gait training after stroke Electromyographic versus rhythmic positional biofeedback in computerized gait retraining with stroke patients. Effect of Force-Feedback Treatments in Patients with Chronic Motor Deficits After a Stroke Electromyographic feedback in the remobilization of stroke patients: a controlled trial. Cortical activation changes induced by visual biofeedback tracking training in chronic stroke patients. The effects of balance training on gait late after stroke: a randomized controlled trial Use of visual feedback in retraining balance following acute stroke. Failure of electrical myofeedback to augment the effects of physiotherapy in stroke Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bo bath and feedback training approaches The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial. Base of support feedback in gait rehabilitation Effects of balance training on hemiplegic stroke patients. Feedback of ankle joint angle and soleus electromyography in the rehabilitation of hemiplegic gait. [Postural biofeedback and locomotion reeducation in stroke patients]. Vertical ground reaction force feedback to enhance stroke patients' symmetrical body-weight distribution while rising/sitting down. [Interest of visual biofeedback training in rehabilitation of balance after stroke]. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Biofeedback and functional electric stimulation in stroke rehabilitation. Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Task-Oriented Biofeedback to Improve Gait in Individuals With Chronic Stroke: Motor Learning Approach EMG feedback and the restoration of motor control. A controlled group study of 12 hemiparetic patients. International Randomized Clinical Trial, Stroke Inpatient Rehabilitation With Reinforcement of Walking Speed (SIRROWS), Improves Outcomes Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function. Biofeedback treatment of foot-drop after stroke compared with standard rehabilitation technique: effects on voluntary control and strength. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement Efficacy of treatment with a kinaesthetic ability training device on balance and mobility after stroke: a randomized controlled study
We are applying robotics and information technology to assist , enhance , and quantify neuro-rehabilitation . Our goal is a new class of interactive , user-affectionate clinical devices design ed not only for evaluating patients , but also-for delivering meaningful therapy via engaging " video games " . Notably , the novel robot MIT-MANUS has been design ed and programmed for clinical neurological applications , and has undergone extensive clinical trials for more than four years at Burke Rehabilitation Hospital - White Plains , NY . This paper will review results of the first clinical trial of 20 patients , which showed that : - Stroke patients treated daily with additional robot-aided therapy during acute rehabilitation had improved outcome in motor activity at hospital discharge , when compared to a control group that received only st and ard acute rehabilitation treatment . - This improved outcome was sustained after three years . - The neuro-recovery process continued far beyond the commonly accepted 3 months post-stroke interval Background and Purpose 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 . Methods 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 . Results 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 . Conclusions 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 OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training A new st and ing biofeedback training device , which includes a height-adjustable work table , weight-bearing sensors , and a real-time visual and auditory feedback system , has been developed for postural training . Sixty persons with hemiplegia after acute stroke or traumatic brain injury were r and omly divided into Group A ( experimental ) and Group B ( control ) . After a training period of 4 weeks , the percentage of postural asymmetry in Group A and Group B was reduced from 17.2 + /- 10.8 % and 17.0 + /- 10.0 % to 3.5 + /- 2.2 % and 10.1 + /- 6.4 percent , respectively ( p = 0.003 ) . There was no significant difference between subjects with right or left hemiplegia .  The results indicated that this device had a positive training effect on stance symmetry in hemiplegic subjects OBJECTIVE To examine the effect of a light touch cue provided through a cane on mediolateral ( ML ) pelvic stability during walking in subjects poststroke . DESIGN Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods . SETTING Physical therapy clinic , tertiary care center . PARTICIPANTS Subacute patients ( N=40 ) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days . The average gait speed with a cane was .13 m/s ( .05-.29 m/s ) . INTERVENTION Using a cane with the force contact and touch contact methods during walking . MAIN OUTCOME MEASURES ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration , muscle activation of bilateral tensor fascia latae ( TFL ) , semitendinosus ( ST ) , and vastus medialis ( VM ) using an electromyography system , and vertical cane force . RESULTS The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N , respectively . A light touch cue through a cane was required only when the paretic leg accepted the body weight , and this cue can provide ML pelvic stability ( .16 g of average pelvic acceleration ) during walking to the same degree as the force contact method of cane use . However , significant increases in single-limb support duration with higher activations of TFL , VM , and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion ( P<.05 ) . CONCLUSIONS A light touch cue can be provided during walking through the use of a cane . This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase Objective : To examine the effects of electromyographic ( EMG ) biofeedback training on the recovery of gait in the acute phase post stroke . Design : Patients were r and omly 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 . Setting : 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 . Interventions : 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 . Outcome measures : 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 . Results : 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 . Conclusions : This study showed no significant differences in the rate of improvement after stroke between the two groups . Although EMG biofeed-back 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 This research provides a preliminary investigation of the relative efficacy of electromyographic ( EMG ) versus a novel biofeedback ( BFB ) approach to improve ankle control and functional gait in stroke patients . A computerized system was design ed to provide audiovisual feedback of either muscle activity or ankle position during dorsiflexion and plantar flexion . The novel approach also included rhythmic pacing to emphasize the rapid timing of ankle motion necessary to switch from stance to swing during walking . Thirty-seven subjects were r and omly assigned to one of the following groups : ( 1 ) no-treatment control , ( 2 ) EMG BFB , and ( 3 ) rhythmic positional BFB . Blind evaluations of ankle performance , gait , and perceived exertion were performed at regular intervals . Analyses of covariance revealed that subjects receiving rhythmic positional BFB significantly increased their walking speeds relative to other groups at posttest ( p = .02 ) and at three-month follow-up ( p = .035 ) , without any increase in subjectively reported energy cost . The ability of positional BFB to emphasize the timing events during walking provided optimistic results for carry-over into gait functioning . The degree of sensorimotor recovery and time since onset of stroke were considered important factors in determining outcomes Bourbonnais D , Bilodeau S , Lepage Y , Beaudoin N , Gravel D , Forget R : Effect of force-feedback treatments in patients with chronic motor deficits after a stroke . Am J Phys Med Rehabil 2002;81:890–897 . Objective To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced . Design The study design was a single-blind , r and omized , controlled trial . Chronic stroke subjects participated in a 6-wk , thrice-weekly , force-feedback program of either the upper paretic limb ( n = 13 ) or the  lower paretic limb ( n = 12 ) . Baseline and postintervention assessment s of the performance of both the upper and the lower limb were measured for each subject , the untreated paretic limb  of each group serving as a control for the other group . Results With the exception of the h and grip force , strength measurements of the treated limb increased after completion of the treatment . The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb . In contrast , gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb , whereas the scores in the Fugl-Meyer test for the lower limb and the timed up- and -go test did not increase for either group after treatment . Conclusion The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity Electromyographic biofeedback was compared with simple exercise therapy as to its effectiveness in improving  foot-drop in 22 stroke patients . The study was design ed 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 OBJECTIVES We tried to examine whether visual biofeedback tracking training ( VBTT ) can improve both the gait performance and cortical activation pattern in chronic stroke patients . DESIGN We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 + /- 5.19 years ) . The patients were r and omly assigned to the training group ( 5 patients ) or the control group ( 5 patients ) . VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer , and the two sine waves should appear as close to overlapping as possible on the PC monitor . The training was performed for 39 minutes/day , 5 days/week , for 4 weeks . Pre-training and post-training accuracy of tracking , functional status of gait , and functional MRI ( fMRI ) were measured . fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate . RESULTS The accuracy of the tracking performance , walking speed , and motor scale for gait improved in the training group . Primary sensorimotor cortex ( SM1 ) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group . CONCLUSIONS We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program . It seems that the cortical reorganization was induced by VBTT Objective : To investigate the effects of balance training , using force platform biofeedback , on quantitative gait characteristics of hemiparetic patients late after stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation ward and gait laboratory of a university hospital . Subjects : Forty-one patients ( mean ( st and ard deviation ; SD ) age of 60.9 ( 11.7 ) years ) with hemiparesis late after stroke ( median time since stroke six months ) were r and omly assigned to an experimental or a control group . Interventions : The control group ( n = 19 ) participated in a conventional stroke inpatient rehabilitation programme , whereas the experimental group ( n = 22 ) received 15 sessions of balance training ( using force platform biofeedback ) in addition to the conventional programme . Main outcome measures : Selected paretic side time-distance , kinematic and kinetic gait parameters in sagittal , frontal and transverse planes were measured using a three-dimensional computerized gait analysis system , one week before and after the experimental treatment programme . Results : The control group did not show any statistically significant difference regarding gait characteristics . Pelvic excursion in frontal plane improved significantly ( P = 0.021 ) in the experimental group . The difference between before-after change scores of the groups was significant for pelvic excursion in frontal plane ( P = 0.039 ) and vertical ground reaction force ( P = 0.030 ) in favour of experimental group . Conclusion : Balance training using force platform biofeedback in addition to a conventional inpatient stroke rehabilitation programme is beneficial in improving postural control and weight-bearing on the paretic side while walking late after stroke BACKGROUND AND PURPOSE Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke , although it is not clear whether functional balance ability also improves . This study compared the relative effectiveness of visual feedback training of center-of-gravity ( CoG ) positioning with conventional physical therapy following acute stroke . SUBJECTS Forty-six people who had strokes within 80 days before the study , result ing in unilateral hemiparesis , and who were in need of balance retraining participated . METHODS AND MATERIAL S Initially , subjects were r and omly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited . The next 14 subjects were assigned to a control group . All subjects received physical therapy and occupational therapy ( regular therapy ) 2 hours a day , and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge . The visual feedback group received information about their CoG position as they shifted their weight during various activities . The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting . Static ( postural sway ) and activity-based measures of balance ( Berg Balance Scale , gait speed , and the Timed " Up & Go " Test ) were contrasted across the 3 groups at baseline , at discharge , and at 1 month following discharge using an analysis of variance for repeated measures . RESULTS All groups demonstrated marked improvement over time for all measures of balance ability , with the greatest improvements occurring in the period from baseline to discharge . No between-group differences were detected in any of the outcome measures . CONCLUSION AND DISCUSSION Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke Electromyographic biofeedback has been used with some success to treat patients with disturbances of muscle tone result ing from neurological disease . The aim of this study was to incorporate electrical myofeedback as an integral part of a physiotherapeutic regime design ed to improve quality of movement and function in limbs weakened or paralysed by stroke . A portable , inexpensive E. M. G. biofeedback machine was used . Stainless steel skin electrodes were applied which needed minimal skin preparation . Twelve adults , ( five male , seven female , mean age 44.2 years and 51.3 years respectively ) who were referred for treatment due to weakness of limb muscles due to disease of the brain or spinal cord , were treated . The mean time from onset of incidence to treatment was 75.5 days . Each patient received six weeks of treatment . This was divided into two phases . Phase 1 , ( weeks 1 , 2 , 3 ) and phase 2 ( weeks 4 , 5 , 6 ) . Physiotherapy , and physiotherapy with biofeedback was r and omly allocated to either phase . Each patient acted as his/her own control . A vali date d assessment was carried out by an independent therapist at the start of treatment , after three weeks and after six weeks of treatment . General function , knee function , range of movement of the affected side and timed tests were measured . Results show an overall improvement in general function . The second phase of treatment was slightly more favourable to improvement , but there was no indication that biofeedback significantly improved the outcome . In three tests it was equally significant to the physiotherapy applied ; in one test it improved the effectiveness of physiotherapy and in one test it reduced the effectiveness of physiotherapy . This suggests that a six week course of physiotherapy improved muscular function and range of movements in patients with weakness due to upper motor neurone disease , but that these effects are not enhanced by myofeedback Objective : To determine ( 1 ) the most effective of three treatment approaches to retrain seated weight distribution long-term after stroke and ( 2 ) whether improvements could be generalized to weight distribution in st and ing . Setting : Inpatient rehabilitation unit . Design : Forty asymmetrical acute stroke subjects were r and omly allocated to one of four groups in this pilot study . Changes in weight distribution were compared between the 10 subjects of each of three treatment groups ( task-specific reach , Bobath , or Balance Performance Monitor [ BPM ] feedback training ) and a no specific treatment control group . One week of measurement only was followed by two weeks of daily training sessions with the treatment to which the subject was r and omly allocated . Measurements were performed using the BPM daily before treatment sessions , two weeks after cessation of treatment and 12 weeks post study . Weight distribution was calculated in terms of mean balance ( percentage of total body weight ) or the mean of 300 balance points over a 30-s data run . Results : In the short term , the Bobath approach was the most effective treatment for retraining sitting symmetry after stroke ( p = 0.004 ) . Training with the BPM and no training were also significant ( p = 0.038 and p = 0.035 respectively ) and task-specific reach training failed to reach significance ( p = 0.26 ) . At 12 weeks post study 83 % of the BPM training group , 38 % of the task-specific reach group , 29 % of the Bobath group and 0 % of the untrained group were found to be distributing their weight to both sides . Some generalization of symmetry training in sitting to st and ing was noted in the BPM training group which appeared to persist long term . Conclusions : Results should be treated with caution due to the small group sizes . However , these preliminary endings suggest that it might be possible to restore postural symmetry in sitting in the early stages of rehabilitation with therapy that focuses on creating an awareness of body position AIM To investigate the effects of balance training , using force platform biofeedback , on motor recovery , mobility and activity level of hemiparetic patients with stroke . METHODS In this r and omized , controlled , assessor-blinded trial 41 in patients [ mean ( + /-SD ) age of 60.9 ( + /-11.7 ) years ] with hemiparesis after stroke ( median time since stroke 6 months ) were r and omly assigned to an experimental or a control group . The control group ( n=19 ) participated in a conventional stroke inpatient rehabilitation program , whereas the experimental group ( n=22 ) received 15 sessions of balance training ( using force platform biofeedback ) in addition to the conventional program . Main outcome measures were motor recovery of the lower extremity ( Brunnstrom staging ) , mobility ( Rivermead Mobility Index , RMI ) and activity level ( Functional Independence Measure , FIM ) that performed one week before and after the experimental treatment program . RESULTS Both groups were similar in terms of baseline clinical characteristics . Motor recovery , mobility and activity level improved significantly in both groups ( P<0.05 ) . Between-group difference of mean change score was not significant for the Brunnstrom stages ( 0.23 vs 0.26 ) , RMI ( 2.9 vs 2.2 ) and FIM score ( 10.7 vs 11.5 ) . CONCLUSION In our group of stroke patients , balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery , mobility and activity level The purpose of this study was to investigate the effect of feedback information about base of support in gait rehabilitation . Sixteen individuals with hemiparesis result ing in narrow base of support , were r and omly placed into two equal groups , experimental and control . The experimental group was provided with a portable device that provided extrinsic auditory feedback information about base of support incorporated in the functional context of conventional gait therapy , whereas the control group received a conventional gait therapy only .  Changes in step width with treatment were assessed with step print technique . The experimental group of subjects improved their step width with treatment from 0.09±0.003 m to 0.16±0.006 m while individuals assigned to the control group showed smaller improvement from 0.099±0.004 m to 0.13±0.003 m. While both groups demonstrated statistically significant improvement ( p<0.05 ) , the level of recovery of step width seen in the experimental group was greater BACKGROUND The purpose of this study was to evaluate the delayed effects of balance training program on hemiplegic stroke patients . METHODS A total of 41 ambulatory hemiplegic stroke patients were recruited into this study and r and omly assigned into two groups , the control group and trained group . Visual feedback balance training with the SMART Balance Master was used in the trained group . Bruunstrom staging of affected limb scores and Functional Independent Measure ( FIM ) scores of each patient were recorded . Quantitative balance function was evaluated using the SMART Balance Master . Data were collected before training and 6 months after completing the training program . RESULTS Significant improvements in dynamic balance function measurements were found for patients in the trained group at 6 months after completing the training program . The ability of self-care and sphincter control also improved for patients in the trained group . On the other h and , no significant differences were found in static balance functions between the trained group and control group at 6 months of follow up . The locomotion and mobility scoring of FIM also revealed no differences between the groups . CONCLUSION Dynamic balance function of patients in the visual feedback training group had significant improvements when compared with the control group . Activities of daily living ( ADL ) function in self-care also had significant improvements at 6 months of follow up in the trained group . The results showed that balance training was beneficial for patients after hemiplegic stroke A computer-assisted feedback system was developed to present to walking subjects instantaneous feedback of their muscle activity or joint angular excursions during gait . Targets for muscle activity or joint motion were displayed on the feedback screen along with timing cues that prompted muscle activity or joint flexion/extension at specific times during the gait cycle . The purpose was to compare the effectiveness of joint angle and electromyographic ( EMG ) feedback to a focused program of physical therapy for gait . Eight hemiplegic stroke patients were treated with ankle joint angle feedback , EMG biofeedback from the soleus muscle , and conventional physical therapy for gait in a three-period crossover design . PT was given either first or last in the sequence of treatments . Gait analysis prior to and following each type of treatment revealed that the feedback treatments result ed in significant increases in stride length and walking velocity and in positive changes in push-off impulse , gait symmetry , and st and ing weight-bearing symmetry , as evaluated in a general linear model and paired t-tests . Overall , physical therapy produced no significant changes . However , when physical therapy was the first treatment of the sequence , significant increases in stride length and velocity were observed . When physical therapy was last , there were significant negative changes in gait symmetry and st and ing weight-bearing symmetry , and negative trends in stride length , walking velocity , and push-off impulse . It is concluded that computer-assisted feedback is an effective tool for retraining gait in stroke patients AIMS To compare , in post-acute hemiparetic patients , gait improvement after conventional physical therapy alone or with a specialised balance retraining program . PATIENTS Twenty-six patients within 3 months of onset of stroke were r and omised to receive physical therapy ( control group ) or therapy and retraining ( experimental group ) , most of the patients in both groups with left hemiplegia . The experimental group was significantly older than the control group . METHOD Thirteen patients received early conventional therapy  , and 13 received therapy combined with st and ing balance training by biofeedback ( BPM Monitor ) . Clinical measures were collected at entry ( J0 ) , once when subjects began to walk ( JM ) and 30 days later ( JM + 30 ) . Gait spatiotemporal parameters were collected by use of the Vicon system at JM and JM + 30 . RESULTS Whatever the method of rehabilitation , the clinical scores improved significantly between J0 and JM + 30 , except for spasticity . The time between stroke and the beginning of walking was not significantly different between both groups . Gait velocity increased significantly between JM and JM + 30 in both groups , with no difference between groups . The walking pattern was improved for both groups , with a significant increase of the duration of the paretic limb single stance . The experimental group significantly improved the duration of the reception double stance on the paretic limb between JM and JM + 30 compared with the control group ( P = 0.03 ) . CONCLUSION Both groups demonstrated improvement in the rehabilitation unit . The benefits of visual biofeedback by forceplate system training suggest particular improvement of anticipation equilibrium with conventional therapy A force platform with an auditory output consisting of two electronic balances was used to reinforce symmetrical body-weight distribution in stroke patients . Forty patients r and omly assigned to an experimental group or a control group practised rising and sitting down for 15 min , thrice daily , 5 days a week for 6 weeks . The experimental group but not the control group received ground reaction force feedback through the auditory output .  Vertical ground reaction forces under each foot were measured with two force plates . Mean difference in improvement of body weight distribution on the paretic leg was 13.2 + /- 10.7 ( M , SD ) per cent total body weight in the experimental group and 5.1 + /- 6.7 per cent in the control group in rising ( p < 0.01 ) and 12.7 + /- 7.5 per cent total body weight and 4.6 + /- 6.6 per cent in sitting down tests ( p < 0.001 ) . The patients in the experimental group achieved in average close to a symmetrical body-weight distribution while rising and sitting down . Improvements in physical performance and sit-st and tests were greater in the experimental group ( p < 0.05 and p < 0.01 , respectively ) . No differences were seen in improvement in performance of activities of daily living . Symmetry in body-weight distribution in rising and sitting down correlated with high scores in physical performance , motor function in rising , and with functional ability OBJECTIVE The aim of this study was the assessment of visual biofeedback  in the management of  balance disorders after stroke . MATERIAL AND METHODS This is a prospect i ve r and omised trial , which compares visual biofeedback training and traditional balance training .  Twenty-seven patients took part in this study : 13 in the first group and 14 in the second group . The rehabilitation program in the first group consists in an association of visual biofeedback and traditional training during 3 weeks . For the second group traditional training was used alone . Clinical , functional and forceplate assessment s were performed before and after the program of rehabilitation . RESULTS All the patients had a clinical and functional improvement . However , patients who have benefited from biofeedback training had a significant improvement of the forceplate parameters with closed eyes . DISCUSSION AND CONCLUSION Those results confirm the interest of rehabilitation in balance disorders after stroke . The use of biofeedback training incorporated into functional physiotherapy affords added benefits probably by a best integration of proprioceptive informations OBJECTIVE To determine the role of symmetrical body-weight distribution training in preventing falls among patients with hemiplegic stroke . DESIGN A prospect i ve study using a st and ing biofeedback trainer . SETTING Hospital-based rehabilitation units . PATIENTS Fifty-four patients with hemiplegic stroke ( 30 in the training group , 24 in the control group ) . INTERVENTIONS Conventional stroke rehabilitation program , plus symmetrical st and ing training and repetitive sit-to-st and training , with a st and ing biofeedback trainer . Training effect was evaluated by assessing the sit-to-st and performance and comparing the occurrence of falls in the 2 groups at a 6-month follow-up . MAIN OUTCOME MEASURES Occurrence of falls , sit-to-st and performance , including body-weight distribution , rate of rise in force , and sway in center of pressure ( COP ) . RESULTS Significant improvement in sit-to-st and performance was found in patients in the training group . Body weight was distributed more symmetrically in both legs , with less mediolateral sway in the COP when rising and sitting down . The mean difference in body-weight distribution between the left and right legs while subjects were rising from a chair significantly decreased , from 49.5 % + /- 18.9 % to 38.6 % + /- 15.8 % of body weight ( BW ) ( p < .005 ) . The rate of rise in force while rising from a chair significantly increased , from 28.3 % + /- 13.5%BW/s to 53.6 % + /- 20.5%BW/s ( p < .001 ) . At the 6-month follow-up , 10 of 24 patients ( 41.7 % ) in the control group had fallen , compared with only 5 of 30 patients ( 16.7 % ) in the training group ( p < .05 ) . CONCLUSIONS Symmetrical body-weight distribution training may improve sit-to-st and performance and , consequently , decrease the number of falls by stroke 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 prospect i ve , controlled , r and omized 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 r and omized 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 result ed 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 BACKGROUND AND PURPOSE Visual biofeedback/forceplate systems are often used for treatment of balance disorders . In this study , the research ers investigated whether the addition of visual biofeedback/forceplate training could enhance the effects of other physical therapy interventions on balance and mobility following stroke . SUBJECTS The study included a sample of convenience of 13 out patients with hemiplegia who ranged in age from 30 to 77 years ( mean=60.4 , SD=15.4 ) and were 15 to 538 days poststroke . METHODS Subjects were assigned r and omly to either an experimental group or a control group when the study began , and their cognitive and visual-perceptual skills were tested by a psychologist . Subjects were also assessed using the Berg Balance Scale and the Timed " Up & Go " Test before and after 4 weeks of physical therapy . Both groups received physical therapy interventions design ed to improve balance and mobility 2 to 3 times per week . The experimental group trained on the NeuroCom Balance Master for 15 minutes of each 50-minute treatment session . The control group received other physical therapy for 50 minutes . RESULTS Following intervention , both groups scored higher on the Berg Balance Scale and required less time to perform the Timed " Up & Go " Test . These improvements corresponded to increased independence of balance and mobility in the study population . However , a comparison of mean changes revealed no differences between groups . DISCUSSION AND CONCLUSION Although both groups demonstrated improvement following 4 weeks of physical therapy interventions , no additional effects were found in the group that received visual biofeedback/forceplate training combined with other physical therapy Background . Electromyographic biofeedback ( EMG-BFB ) has shown equivocal benefits on gait retraining after stroke . Objective . The authors evaluated the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis . Methods . They assigned 20 participants r and omly to the EMG-BFB group or a control group that received conventional therapy for the same duration . Quantitative gait analysis was performed before and after treatment . The EMG-BFB involved the triceps surae during functional gait activities . Treatment was administered with a fading frequency of BFB application and an increasing variability in gait activities . Both groups had 20 treatment sessions of 45 minutes each , including at least 15 minutes of walking-related therapy for the control group . Follow-up ( FU ) gait analysis was obtained 6 weeks after training . Results . BFB treatment led to significant increases ( P < .01 ) in peak ankle power at push-off ( from 0.63 W/kg to 1.04 W/kg ) in conjunction with significant increases in velocity ( from 28.3 % h/s — normalized to percentage height per second — to 39.6 % h/s ) and stride length ( from 44.5 % h — normalized to percentage height — to 57.6 % h ) . Increases remained significant at FU . There were no changes in any gait variable in the control group . Conclusion . A task-oriented BFB treatment was effective in increasing peak ankle power , gait velocity , and stride length in a population with hemiparesis . Further studies should compare the combination intervention with either of its components in more impaired patients 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 implication s of the results for the employment of EMG feedback and other therapeutic procedures in motor rehabilitation are discussed Background . Feedback about performance may optimize motor relearning after stroke . Objectives . Develop an international collaboration to rapidly test the potential efficacy of daily verbal feedback about  walking speed during inpatient rehabilitation after stroke , using a protocol that requires no research funds . Methods . This phase 2 , single-blinded , multicenter trial r and omized in patients to either feedback about self-selected fast walking speed ( daily reinforcement of speed , DRS ) immediately after a single , daily 10-m walk or to no reinforcement of speed ( NRS ) after the walk , performed within the context of routine physical therapy . The primary outcome was velocity for a 15.2-m ( 50-foot ) timed walk at discharge . Secondary outcomes were walking distance in 3 minutes , length of stay ( LOS ) , and level of independence ( Functional Ambulation Classification , FAC ) . Results . Within 18 months , 179 participants were r and omized . The groups were balanced for age , gender , time from onset of stroke to entry , initial velocity , and level of walking-related disability . The walking speed at discharge for DRS ( 0.91 m/s ) was greater ( P = .01 ) than that for NRS ( 0.72 m/s ) . No difference was found for LOS . LOS for both DRS and NRS was significantly shorter , however , for those who had mean walking speeds > 0.4 m/s at entry . The DRS group did not have a higher proportion of FAC independent walkers ( P = .1 ) and did not walk longer distances ( P = .09 ) . Conclusions . An Internet-based collaboration of 18 centers found that feedback about performance once a day produced gains in walking speed large enough to permit unlimited , slow community ambulation at discharge from inpatient rehabilitation A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke , an associated improvement in function has been demonstrated . This study examines this promising technique further using a single-blind controlled trial . Twenty-six patients were recruited from a register of consecutive admissions and r and omized into treatment and control groups . Both groups received additional therapy , only the treatment group received visual feedback . Assessment s were carried out independently . Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function . Between group differences had disappeared at three months . The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway . Transfer of training was indicated by improvements in ADL and gross motor function . Three months later the improvement was maintained , but did not automatically continue without treatment The effectiveness of biofeedback training was compared to conventional physical therapy training in 20 adult hemiparetic patients with chronic foot-drop . They were r and omly placed into two groups of ten patients each : the first group treated over five weeks with therapeutic exercise and the second group treated over five weeks with therapeutic exercise plus biofeedback training . In the second group receiving the biofeedback training the increase in both strength and range of motion was approximately twice as great as in the first group . The improvement displayed by even the first group of patients suggests that a potential for functional improvement exists that is often unexploited . The addition of biofeedback facilitates the process . Four patients in the biofeedback group achieved and retained conscious control of dorsiflexion ; three of them are now able to walk without the use of the short leg brace Objective : To demonstrate the effect of rhythmical auditory stimulation in a musical context for gait therapy in hemiparetic stroke patients , when the stimulation is played back measure by measure initiated by the patient 's heel strikes ( musical motor feedback ) . Does this type of musical feedback improve walking more than a less specific gait therapy ? Design : The r and omized controlled trial considered 23 registered stroke patients . Two groups were created by r and omization : the control group received 15 sessions of conventional gait therapy and the test group received 15 therapy sessions with musical motor feedback . Setting : Inpatient rehabilitation hospital . Subjects : Median post-stroke interval was 44 days and the patients were able to walk without technical aids with a speed of approximately 0.71 m/s . Main outcome measures : Gait velocity , step duration , gait symmetry , stride length and foot rollover path length ( heel-on – toe-off distance ) . Result : The test group showed more mean improvement than the control group : stride length increased by 18 % versus 0 % , symmetry deviation decreased by 58 % versus 20 % , walking speed increased by 27 % versus 4 % and rollover path length increased by 28 % versus 11 % . Conclusion : Musical motor feedback improves the stroke patient 's  walk in selected parameters more than conventional gait therapy . A fixed memory in the patient 's mind about the song and its timing may stimulate the improvement of gait even without the presence of an external pacemaker Objective : To investigate whether the addition of a kinaesthetic ability training device could enhance the effect of a conventional rehabilitation programme on balance and mobility in hemiparetic patients late after stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : The rehabilitation ward of a university hospital . Thirty hemiparetic patients ( mean age ( SD ) of 57.4 ( 8.1 ) years ) late after stroke ( mean time since stroke ( SD ) 545.2 ( 99.9 ) days ) were assigned r and omly to an experimental or a control group . Interventions : The control group ( n = 15 ) participated in a conventional rehabilitation programme . The experimental group ( n = 15 ) participated in balance training with a kinaesthetic ability training device in addition to a conventional rehabilitation programme for four weeks , five days a week . Outcome measures : Kinaesthetic ability training static and dynamic balance indices , balance and lower extremity subscores of the Fugl-Meyer Stroke Assessment Instrument ( FMA ) , total motor and locomotor subitem scores of the Functional Independence Measure ( FIM ) were evaluated at baseline and after treatment . Results : The experimental group had greater improvement in measures of balance including static ( P = 0.045 ) and dynamic balance index ( P = 0.001 ) and FMA balance score ( P = 0.001 ) than the control group . No between-group differences were detected in subscore of FMA , total motor and locomotor subscores of FIM . There were significant improvements in balance subscores of FMA , static and dynamic balance indexes in the experimental group and in sub-item scores of FIM and lower extremity scores of FMA in both groups . Conclusion : Kinaesthetic ability training in addition to a conventional rehabilitation programme is effective in improving balance late after stroke . However , this improvement is not reflected in individual functional status
QUESTION Is biofeedback during the practice of lower limb activities after stroke effective in improving performance of those activities , and are any benefits maintained after intervention ceases ?