Abstract
People with spasticity, i.e., stretch hyperreflexia, have a limited functional independence and mobility. While a broad range of spasticity treatments is available, many treatments are invasive, non-specific, or temporary and might have negative side effects. Operant conditioning of the stretch reflex is a promising non-invasive paradigm with potential long-term sustained effects. Within this conditioning paradigm, seated participants have to reduce the mechanically elicited reflex response using biofeedback of reflex magnitude quantified using electromyography (EMG). Before clinical application of the conditioning paradigm, improvements are needed regarding the time-intensiveness and slow learning curve. Previous studies have shown that gamification of biofeedback can improve participant motivation and long-term engagement. Moreover, quantification of reflex magnitude for biofeedback using reflexive joint impedance may obtain similar effectiveness within fewer sessions. Nine healthy volunteers participated in the study, split in three groups. First, as a reference the “Conventional” group received EMG- and bar-based biofeedback similar to previous research. Second, we explored feasibility of game-based biofeedback with the “Gaming” group receiving EMG- and game-based biofeedback. Third, we explored feasibility of game- and impedance-based biofeedback with the “Impedance” group receiving impedance and game-based biofeedback. Participants completed five baseline sessions (without reflex biofeedback) and six conditioning sessions (with reflex biofeedback). Participants were instructed to reduce reflex magnitude without modulating background activity. The Conventional and Gaming groups showed feasibility of the protocol in 2 and 3 out of 3 participants, respectively. These participants achieved a significant Soleus short-latency (M1) within-session reduction in at least –15% in the 4th–6th conditioning session. None of the Impedance group participants showed any within-session decrease in Soleus reflex magnitude. The feasibility in the EMG- and game-based biofeedback calls for further research on gamification of the conditioning paradigm to obtain improved participant motivation and engagement, while achieving long-term conditioning effects. Before clinical application, the time-intensiveness and slow learning curve of the conditioning paradigm remain an open challenge.
Highlights
Spasticity is a common symptom after brain and neural injuries, like spinal cord injury, stroke, and cerebral palsy (1)
As potential improvements for stretch reflex conditioning, we propose the use of gamification and reflexive joint impedance biofeedback
The goal of this study is to explore the feasibility of two forms of biofeedback within the stretch reflex down-conditioning paradigm: (1) gamification of the biofeedback and (2) impedance based biofeedback
Summary
Spasticity is a common symptom after brain and neural injuries, like spinal cord injury, stroke, and cerebral palsy (1). Spasticity is defined as the exaggerated stretch reflex response, i.e., stretch hyperreflexia (2). Patients with spasticity are limited in functional independence and mobility and often experience substantial pain. A broad range of spasticity treatments is available, including physical therapy, oral medication, interventional procedures, and surgical treatments (3). Current treatments are invasive, non-specific, or temporary and might have negative side effects (3). There is a clinical need for a non-invasive spasticity treatment with long-term sustained effect
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