Repurposing an EMG Biofeedback Device for Gait Rehabilitation: Development, Validity and Reliability.

Reza Koiler,Nancy Getchell,Amy Lalime,Dexter Kofa,Elham Bakhshipour,Joseph Glutting

doi:10.3390/ijerph18126460

Abstract

Gait impairment often limits physical activity and negatively impacts quality of life. EMG-Biofeedback (EMG-BFB), one of the more effective interventions for improving gait impairment, has been limited to laboratory use due to system costs and technical requirements, and has therefore not been tested on a larger scale. In our research, we aimed to develop and validate a cost-effective, commercially available EMG-BFB device for home- and community-based use. We began by repurposing mTrigger® (mTrigger LLC, Newark, DE, USA), a cost-effective, portable EMG-BFB device, for gait application. This included developing features in the cellphone app such as step feedback, success rate, muscle activity calibration, and cloud integration. Next, we tested the validity and reliability of the mTrigger device in healthy adults by comparing it to a laboratory-grade EMG system. While wearing both devices, 32 adults walked overground and on a treadmill at four speeds (0.3, 0.6, 0.9, and 1.2 m/s). Statistical analysis revealed good to excellent test–retest reliability (r > 0.89) and good to excellent agreement in the detection of steps (ICC > 0.85) at all speeds between two systems for treadmill walking. Our results indicated that mTrigger compared favorably to a laboratory-grade EMG system in the ability to assess muscular activity and to provide biofeedback during walking in healthy adults.

Highlights

Gait impairment often limits physical activity and negatively impacts the quality of life in individuals with a variety of conditions such as stroke
Studies examining electromyography biofeedback (EMG-BFB) [3,16,17,18,19,20,21,22,23] in stroke gait rehabilitation have reported improved gait speed, step length, ankle power [3,4,5,6,7,8,9,10,11,12,13,14,15,16], muscle strength [17,18,19,20,21], balance [18], higher motivation, reduced spasticity and higher muscle force [19] increased stride length, walking velocity, gait symmetry, and push-off impulse [20] and improved stride length and velocity [22], as well as reduced dependence on assistive devices [23]. These findings suggest that EMG-BFB may be an effective means by which rehabilitation practitioners can improve the characteristics of gait, contingent on the availability of valid and reliable instruments
EMG system during treadmill and overground walking at speeds normally presented by individuals with stroke or older adults. These results suggest that the mTrigger system may be a viable alternative to deliver EMG-BFB in gait rehabilitation, helping individuals with gait impairment increase their daily physical activity by improving walking characteristics

Summary

Introduction

Gait impairment often limits physical activity and negatively impacts the quality of life in individuals with a variety of conditions such as stroke. Any interventions that substantially improve gait characteristics have the potential to increase physical activity. One intervention to improve gait that has been extensively tested within laboratory contexts is electromyography biofeedback (EMG-BFB), a form of neuromuscular biofeedback that uses surface electrodes to detect changes in muscle activity and convey that information back as visual or auditory signals [1]. EMG-BFB is effective in both musculoskeletal and neurological rehabilitation [1], and its feasibility has been demonstrated in many diverse contexts such as anterior cruciate ligament reconstruction [6], arthroscopic partial meniscectomy [7], knee osteoarthritis [8], reduction in muscular tension in the neck [9], improving the gait of children with cerebral

Objectives

Methods

Results

Discussion

Conclusion