Abstract
Objectives To investigate the effects of practice variability combined with task-oriented electromyographic biofeedback (EMGBFB) on strength and balance in people with chronic stroke. Methods Thirty-three participants were randomly assigned into the constant force EMGBFB tibialis anterior (TA) exercise (constant) group, the variable force EMGBFB tibialis anterior exercise (variable) group, or the upper extremity exercise without EMGBFB (control) group. Subjects in each group received 6 weekly sessions of exercise training (18 sessions, 40 minutes each). Motor outcomes were TA strength, balance (anteroposterior sway amplitude defined by limits of stability test in dynamic posturography), walking speed, Timed Up and Go test (TUGT), and six-minute walk test (6MWT). Data were measured at baseline, 1 day, 2 weeks, and 6 weeks posttraining. Results TA strength increased significantly in both the constant and variable groups after training. Balance significantly improved only in the variable group. All participants showed improvements in walking speed, TUGT, and 6MWT. Conclusions Task-oriented EMGBFB-assisted TA exercise training improved muscle strength in people with chronic stroke. Practicing to reach varying force levels during EMGBFB-assisted tibialis anterior exercises facilitated improvements in the ability to sway in the anteroposterior direction while standing. Our findings highlight the importance of task-oriented and motor learning principles while using the EMGBFB as an adjunct therapy in stroke rehabilitation. This trial was registered with trial registration number NCT01962662.
Highlights
Up to 72% of stroke survivors suffer from lower limb weakness [1], and the ankle muscles tend to be more affected than the hip and knee muscles [2]
Evidence supporting the effects of tibialis anterior muscle (TA) muscle exercise training on enhancing strength or improving lower limb motor function is scarce in the stroke literature [9, 17]
Our study demonstrated that the combined use of a portable electromyographic biofeedback (EMGBFB) system and leg (TA) muscle active exercises, administered during task-related activities and following motor learning principles, improved TA muscle strength in patients with chronic stroke
Summary
Up to 72% of stroke survivors suffer from lower limb weakness [1], and the ankle muscles tend to be more affected than the hip and knee muscles [2]. Muscle strength training was effective in improving muscle strength following stroke [10], but conflicting results were showed regarding the transfer effect of lower extremity strength gains on functional outcome [11,12,13]. TA muscle exercise training with task-oriented training is an essential part of stroke rehabilitation; it is difficult to execute exercise training for the TA muscle due to substantial weakness and insufficient muscle recruitment in patients with different severities [16]. Evidence supporting the effects of TA muscle exercise training on enhancing strength or improving lower limb motor function is scarce in the stroke literature [9, 17]
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