Use of EMG biofeedback for basic activities of daily living training in stroke patients. Pilot randomized clinical trial

Maricel Garrido-Montenegro,Sebastián Vergara-Ruiz,Evelyn Álvarez-Espinoza

doi:10.15446/revfacmed.v64n3.56213

Abstract

Introduction: Sequels in stroke patients include hemiparesis and dependency for performing basic activities of daily living (BADL). EMG biofeedback has yielded some benefits but has been limited to repetitive movement, therefore, it is insufficient for current task-oriented neurorehabilitation paradigms.Objective: To assess whether the application of EMG biofeedback in upper limbs during BADL training improves motor, occupational and satisfaction performances compared to BADL training without this feedback.Materials and methods: A pilot randomized clinical trial was conducted with stroke patients of more than six months of evolution, who showed hemiparesis and no cognitive deterioration. These patients were randomly classified into two groups: control group, who underwent conventional occupational therapy (COT), and experimental group, who underwent COT+EMG-BF. Patients were given 10 therapy sessions. Entry, evaluation and data analysis were masked.Results: Seven patients were included in each group, showing the same initial clinical and demographic characteristics (p>0.05). The group that underwent COT+EMG-BF showed a significantly better performance in all assessments. For example, the Barthel scale obtained a median of 100 points [85-100] for the COT+EMG-BF group versus 85 [80-90] for the control group (p<0.05), whereas ARAT score was 42 [40-47] points versus 20 [15-38] (p=0.03), respectively.Conclusion: The combination of COT+EMG-BF for BADL may be considered as an alternative for treatment of stroke patients.

Highlights

Sequels in stroke patients include hemiparesis and dependency for performing basic activities of daily living (BADL)
Independence in BADL is a relevant parameter to be assessed during rehabilitation studies after a stroke [3,4]; the sample size was calculated based on this variable and on another study of Electromyographic biofeedback (EMG-BF) for which the Barthel index was used [6]
The use of the EMG-BF technique during the execution of a significant BADL was a major contribution to increasing independence, which achieved better results than those obtained in another study of EMG-BF in upper limbs [6]

Summary

Introduction

Sequels in stroke patients include hemiparesis and dependency for performing basic activities of daily living (BADL). Most of the patients who survive have an incomplete motor recovery after six months; the main sequel is hemiparesis (50%), followed by cognitive, gait, affective, sensory and language deficits [2]. A year after the stroke, 60% of patients present some kind of dependence. This figure increases to 66% at three years [3], which affects both families and the State socially and economically. Changes in basic activities of daily living (BADL), which consist of body self-care tasks, show a dependence rate of 58.6% at six months and 50% at one year. For occupational therapists, training in BADL is paramount, but there is little evidence of techniques or tools that can facilitate this process

Methods

Results

Discussion

Conclusion