EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study. Rehabilitation therapy for patients with long-term spinal cord injuries. The effects of auditorally augmented feedback on the eye-hand coordination of students with cerebral palsy. Training improves the speed of aimed movements in Parkinson's disease. Positional feedback and electrical stimulation: an automated treatment for the hemiplegic wrist. Effect of Force-Feedback Treatments in Patients with Chronic Motor Deficits After a Stroke Electromyographic biofeedback and physical therapy of the hemiplegic upper limb. Qualitative and quantitative knowledge of results: effects on motor learning. Enhanced physical therapy for arm function after stroke: a one year follow up study. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Overcoming limitations in elbow movement in the presence of antagonist hyperactivity. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Augmented Feedback for Enhanced Skill Acquisition in Individuals with Traumatic Brain Injury Kinesthetic biofeedback: a treatment modality for elbow range of motion in hemiplegia. Myofeedback for muscle retraining in hemiplegic patients. Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind, randomized, controlled trial. The response of manual motor functioning in Parkinsonians to frontal EMG biofeedback and progressive relaxation The role of sensory cues in the rehabilitation of parkinsonian patients: a comparison of two physical therapy protocols. The effectiveness of EMG biofeedback in the treatment of arm function after stroke. Electrical stimulation and biofeedback effect on recovery of tenodesis grasp: a controlled study. Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs. Electromyographic Biofeedback in the Treatment of the Hemiplegic Hand: A Placebo-Controlled Study Biofeedback in strokes.
Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years ; only 4 % to 5 % of patients regain arm function during or after the active rehabilitation phase . This pilot study included 37 patients r and omly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback ( experimental group ) or a st and ard exercise physical therapy program of like duration and intensity ( control group ) . Both groups showed clinical ly significant improvements that exceeded previously reported experience . The experimental technique appears to be more effective when upper limb involvement is not severe in a late case , or when treatment is started early ( within 3 months poststroke ) in a severe case . The rehabilitation community should quickly investigate the improved prospect s of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated . Men and women , aged 18 to 45 years , were assigned to one of four groups using a restricted r and omization process . The training period was divided into two consecutive eight-week time blocks where subjects received either ( 1 ) supervised physical exercise therapy ( PET ) , ( 2 ) neuromuscular stimulation ( NMS ) , or ( 3 ) electromyographic ( EMG ) biofeedback . Group 1 received EMG biofeedback followed by PET ; Group 2 received EMG biofeedback followed by NMS ; Group 3 received NMS followed by PET ; and Group 4 received 16 weeks of PET . Dependent measures ( manual muscle tests , self-care scores , mobility measures , and voluntary EMG activity ) were assessed before training , at eight weeks , and after 16 weeks of training . A significant improvement ( p less than .05 ) across time was found on all dependent measures except voluntary EMG . No difference was found on comparisons between groups To explore the question of whether auditorally augmented feedback can improve the eye-h and coordination of individuals with cerebral palsy , 59 ( cerebral-palsied ) students ( mean chronological age 14 years , 3 months ) were pretested with the Southern California Motor Accuracy Test and then r and omly assigned to three groups . Group 1 performed training exercises-tracing line drawings-while simultaneously receiving auditorally augmented feedback about their efforts . Group 2 performed the same training exercises without the augmented feedback . Group 3 served as controls . All subjects were post-tested with the Southern California Motor Accuracy Test , followed by a second post-test after a 3-month interval . At the first post-test , the performance of the feedback group was significantly superior to that of the other groups . At the second post-test , the performance patterns among the groups were essentially the same as the time of the first post-test , but between-group differences were no longer significant . The results of this study are discussed in both empirical and theoretical terms In this study , the extent to which bradykinesia in patients with idiopathic Parkinson 's disease can be influenced by practice and by specific training strategies was investigated . Fifteen patients with Parkinson 's disease tested after withdrawal of anti-Parkinson medication , and 15 matched control subjects , practised a ballistic aim ing task . Performance was tested before , during and after training and again 1 h later . The Parkinson 's disease patients and control subjects were r and omly assigned to one of two training schedules , practising with or without rhythmic auditory cues . At baseline , the Parkinson 's disease patients showed longer movement times , with a marked decrease in maximum acceleration and deceleration in the initial open-loop phase compared with those of the control subjects . With training , they were able to make significant improvement in the speed of aim ed movements , particularly in the early movement phase , without any deterioration in accuracy . These effects transferred to an untrained limb and were at least partially maintained after a 1-h delay . While patients remained impaired relative to control subjects at all phases of training and follow-up , the patients ' performance at the end of training did not differ significantly from the control subjects ' baseline function . Contrary to expectation , rhythmic auditory cues did not enhance improvement in the speed of aim ed movements in either patients or control subjects . If anything , less improvement was shown in the cued groups , although there were suggestions that the aim ing skill was retained better over the delay period . The results demonstrate preserved abilities to improve speed of single ballistic aim ing movements in Parkinson 's disease patients and the possibility of reducing bradykinesia by training Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision 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 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 OBJECTIVE This study investigated the effects of qualitative and quantitative knowledge of results ( KR ) on the acquisition of a motor skill . It was hypothesized that there would be differences in performance during skill acquisition and retention , depending on the type of feedback given . Qualitative KR was in the form of verbal encouragement and quantitative KR was in the form of an algebraic number representing an error score . METHODS Seventy-seven adults were r and omly assigned to one of four feedback conditions , Quantitative , Qualitative , Quantitative and Qualitative , and no feedback ( Control ) .  Participants learned an isometric force production skill . Data were collected during skill acquisition and retention phases . Computer hardware and custom software were used to collect data and administer the feedback conditions of the independent variable . RESULTS There was a statistically significant difference in the Acquisition Phase for the main effect of Condition F(3,73 ) = 6.35 , p < .05 , and for Block F(9,657 ) = 2.07 , p < .05 , but there was no statistically significant Condition X Block interaction F(27,657 ) = 1.02 , p > .05 . Pair-wise comparisons revealed statistically significant differences between conditions containing qualitative feedback and conditions containing no qualitative feedback ( p < .05 ) . The main effect of condition was significant F(3,73 ) = 3.00 , p < .05 in the retention phase , however there were no significant pair-wise comparisons ( p > .05 ) . CONCLUSION The results of this study suggest that in a healthy adult population , qualitative feedback , by itself and when combined with quantitative feedback , result ed in superior skill acquisition , but not in the retention of that skill . The artificiality of the task along with differing modes of feedback ( audible versus visual ) are two potentially limiting factors to this study . Future research that controls for these factors may yield more definitive findings about the role that qualitative feedback has in improving motor performance and learning Ninety seven patients with stroke who had participated in a r and omised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year . Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life , the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year . This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly . It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment . This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation OBJECTIVE To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke . DESIGN R and omized controlled trial , 6-month follow-up . SETTING A Department of Veterans Affairs rehabilitation research and development center . PARTICIPANTS Consecutive sample of 27 subjects with chronic hemiparesis ( > 6mo after cerebrovascular accident ) r and omly allocated to group . INTERVENTIONS All subjects received twenty-four 1-hour sessions over 2 months . Subjects in the robot group practice d shoulder and elbow movements while assisted by a robot manipulator . Subjects in the control group received neurodevelopmental therapy ( targeting proximal upper limb function ) and 5 minutes of exposure to the robot in each session . MAIN OUTCOME MEASURES Fugl-Meyer assessment of motor impairment , FIMtrade mark instrument , and biomechanic measures of strength and reaching kinematics . Clinical evaluations were performed by a therapist blinded to group assignments . RESULTS Compared with the control group , the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment ( P<.05 ) and also after 2 months of treatment ( P<.05 ) . The robot group had larger gains in strength ( P<.02 ) and larger increases in reach extent ( P<.01 ) after 2 months of treatment . At the 6-month follow-up , the groups no longer differed in terms of the Fugl-Meyer test ( P>.30 ) ; however , the robot group had larger improvements in the FIM ( P<.04 ) . CONCLUSIONS Compared with conventional treatment , robot-assisted movements had advantages in terms of clinical and biomechanical measures . Further research into the use of robotic manipulation for motor rehabilitation is justified Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients BACKGROUND AND PURPOSE A traditional perspective on rehabilitation of patients with abnormal muscular hyperactivity presumes that relaxation should be facilitated prior to recruitment of antagonists , if effective movement about a joint is to occur . The purpose of the study was to determine the effect of training weak triceps brachii muscles , with hyperactivity present in the opposing biceps brachii muscles , on elbow function in individuals at least 1 year poststroke . SUBJECTS Sixteen patients with chronic stroke were r and omly assigned to receive electromyographic biofeedback to retrain the triceps muscle ( n = 8) or to receive conventional movement training ( n = 8) . METHODS Both groups participated in 5 baseline and 10 training sessions involving tasks requiring elbow extension . Preintervention and postintervention measurements included elbow extension range of motion , triceps and biceps muscle electromyographic activity during performance of elbow extension , resisted elbow extension , and a reaching task . RESULTS Two- sample t-test results of between-group comparisons for each variable were not significant . One- sample t-test results of within-group comparisons showed significant increases in triceps muscle mean electromyographic activity during two of the three tasks for the feedback group , but not for the nonfeedback group . Passive and active range of motion in both groups increased significantly , although biceps muscle co-contraction persisted . CONCLUSION AND DISCUSSION These results suggest that functional improvements at the elbow may have been due to biomechanical ( peripheral ) rather than neuromuscular ( central ) changes about the joint . Furthermore , these preliminary data indicate that patients with stroke may be trained to increase movement without first being trained to specifically inhibit hyperactivity in muscles Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Coincident timing by individuals who exhibit traumatic brain injury was measured under conditions of no knowledge of results ( no KR ; n = 12 ) , KR on every trial ( n = 14 ) , summary KR ( n = 13 ) , and average KR ( n = 12 ) . Following acquisition trials , groups performed immediate and longer retention trials without KR . Absolute constant error and variable error , analyzed in separate repeated- measures analyses of variance , indicated that during acquisition trials subjects receiving KR on every trial were the most accurate and the most consistent in their responses ; however , subjects in groups receiving summary and average KR were the most accurate during immediate retention , with the group receiving summary KR being the most accurate during longer retention Two treatment modalities for increasing active elbow extension with hemiplegic subjects were tested . Twenty subjects were r and omly assigned to one of two treatment groups -- an experimental treatment technique using kinesthetic biofeedback , or a control group consisting of an occupational therapy approach aim ed at increasing functional use of the envolved upper extremity . The results indicate that kinesthetic biofeedback was as beneficial as conventional occupational therapy . It was also demonstrated that an individual 's age , sex , or length of time beyond one-year post-CVA did not significantly affect treatment outcome . A majority of subjects in both treatment groups improved in ways not directly related to treatment , which suggests the need for long-term follow up of hemiplegic patients The use of audiovisual displays of myoelectric potentials ( myofeedback ) has been suggested for retraining and strengthening of paretic muscles in patients with hemiplegia from stroke . This controlled study examines the specificity and efficiency of myofeedback in the strengthening of paretic muscles in hemiplegic patients . Eighteen patients with trace to fair-minus grade of deltoid muscle power result ing from strokes that had occurred at least six weeks earlier were r and omly assigned to the six possible orders of accurate ( true ) , positive noncontingent ( placebo ) and no feedback conditions . On three successive days , each patient received one session of each feedback condition , consisting of 20 isometric contractions of five seconds each with ten seconds of intervening rests . In addition , each patient 's motivational level was rated . Averaged myoelectric potentials were quantified for each contraction for analysis . When the data were analyzed without grouping , no statistical differences among the three feedback conditions were noted . However , when the subjects were grouped according to age and motivational level , during true and no feedback sessions , the older and the poorly motivated groups were found to show progressive increment of myoelectric output , whereas the younger and the better motivated showed the opposite results . With placebo feedback , both groups showed progressive decrement of myoelectric output . It is concluded that the effect of myofeedback is nonspecific at least in its short-term application for the retraining of hemiplegically paretic muscles OBJECTIVE To test the efficacy of the arm ability training ( AAT ) on a sample of patients with central arm paresis after traumatic brain injury ( TBI ) or stroke . DESIGN Single-blind , r and omized , controlled trial . SETTING Inpatient rehabilitation center . PATIENTS Consecutive sample of 74 patients of whom 60 ( 45 with stroke , 15 with TBI ) completed the study ; 37 patients received a 1-year follow-up . INTERVENTION Daily AAT with ( n = 20 ) or without ( n = 20 ) knowledge of results , or no AAT ( n = 20 ) during a 3-week intervention period . MAIN OUTCOME MEASURES Summary time scores of the Test Evaluant les Membres superieurs des Personnes Agees (TEMPA)-a test of upper extremity function with daily function-like activities ( focal disability)- and kinematic analysis of aim ed movements . RESULTS Patients with AAT realized superior improvement as compared with controls . Mean improvement in the time needed to perform ( 1 ) all TEMPA tasks was 41.4 versus 12.8 seconds ( p = .0012 ) ; ( 2 ) unilateral TEMPA tasks , 16.5 versus 4.2 seconds ( p = .0036 ) ; and ( 3 ) the ballistic component of aim ed movements , 96 versus 20ms ( p = .0115 ) . Knowledge of result did not substantially modify these effects . A functional benefit existed at 1-year follow-up . CONCLUSION The AAT reduces focal disability among stroke and TBI patients with mild central arm paresis The purpose of the current investigation was to determine the effects of frontal EMG biofeedback and progressive relaxation training on manual motor functioning in Parkinsonians . Twenty patients were matched and r and omly assigned to two groups . All subjects were administered a brief manual motor assessment . The experimental group then underwent weekly sessions of frontal EMG and relaxation training for a period of 15 weeks . At the conclusion of the training period , both experimental and control groups were again administered the manual motor tasks . The results indicated that Parkinsonian patients are capable of significantly lowering frontal EMG activity levels . The motor task results , however , yielded no statistically significant differences between the two groups as a result of the biofeedback training We devised a single-blind study to assess the role of providing external sensory cues in the rehabilitation of patients with idiopathic Parkinson 's disease ( PD ) . Twenty stable , nondemented patients with PD entered a 6-week rehabilitation program and were r and omly assigned to two balanced protocol s which were differentiated by the use of external sensory cues ( " non-cued " vs " cued " ) . Patients were evaluated by a neurologist , who was blind to group membership , with the Unified Parkinson 's Disease Rating Scale ( UPDRS ) at baseline , end of treatment , and after 6 weeks . Patient groups were comparable for age , disease duration , and severity . A significant reduction of UPDRS scores ( activities of daily living and motor sections ) was present after the rehabilitation phase in both groups . However , at follow up , while this clinical improvement had largely faded in the " non-cued " group , mean UPDRS scores of the " cued " group were still significantly lower than baseline values . The incorporation of external sensory cues in the rehabilitation protocol can extend the short-term benefit of physical therapy in moderately disabled patients with PD , possibly as a result of the learning of new motor strategies . " Cued " physical therapy for PD should be targeted to compensate for the defective physiological mechanisms The study was design ed 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 r and omly 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 OBJECTIVE Evaluate the effectiveness of electrical stimulation and biofeedback on the recovery of tenodesis grasp in tetraplegic individuals during the initial phase of acute rehabilitation . DESIGN A 2 x 2 block design was used with subjects r and omized to treatment groups . Forty-five subjects completed the study . SETTING Inpatient occupational therapy department . SUBJECTS In patients with tetraplegia , first admission for rehabilitation after an acute spinal cord injury . INTERVENTIONS The four treatment groups were : conventional treatment , electrical stimulation , biofeedback , and combined electrical stimulation and biofeedback . The treatment period was between 5 and 6 weeks . MAIN OUTCOME MEASURES Manual muscle testing and scoring of activities of daily living performance by a blinded evaluator . RESULTS All four treatment groups showed improvements . No treatment group was superior to the others . CONCLUSIONS Biofeedback and electrical stimulation alone or in combination offer no advantages over conventional rehabilitation treatment of wrist extensors in tetraplegic patients after spinal cord injury 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 r and omly 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 Armagan O , Tascioglu F , Oner C : Electromyographic biofeedback in the treatment of the hemiplegic h and : A placebo-controlled study . Am J Phys Med Rehabil 2003;82:856–861 . Objective To evaluate the efficacy of electromyographic ( EMG ) biofeedback treatment in the functional recovery of the hemiplegic h and . Design A total of 27 patients were r and omly 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 h and , and surface EMG potentials were used for the clinical assessment s. All patients were assessed before treatment and after 20 treatment sessions . Results 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 . Conclusion Our study demonstrates the potential benefits of EMG biofeedback in conjunction with neurophysiologic rehabilitation technique to maximize the h and function in hemiplegic patients The effectiveness of  biofeedback therapy , using the electromyograph , was compared with conventional physiotherapy treatments in eleven hemiparetic patients with severe disability of the upper limb . These were divided r and omly into two groups , a group of six patients receiving biofeedback treatments and five receiving physiotherapy treatments with conventional techniques . The results showed greater improvements in the biofeedback group in most fields of testing , and the patients in this group had a greater degree of control over the patterns of movement in the upper limb and the relaxation of spastic muscle groups . It was concluded that a wide range of hemiparetic patients should benefit in some degree by treatment of this form
OBJECTIVE Assessment of the available evidence regarding the effect of augmented feedback  on motor function of the upper extremity in rehabilitation patients .