Electromyographic Biofeedback Therapy Research Articles

The effects of electromyographic biofeedback in the treatment of dysphagia after stroke

Objective To investigate the efficacy of electromyographic biofeedback therapy (EMGBFT) in treating dysphagia after stroke.Methods Patients diagnosed with dysphagia after stroke were recruited and randomly divided into a control group (n =22),an electrostimulation group (ES,n =25) and an EMGBFT group (n =23).The control group received conventional treatment,while the patients in the other groups additionally received Vitalstim ES or EMGBFT 5 times per week for 3 weeks.Before and after the trial,deglutition function was evaluated through surface electromyography (sEMG) and using a standardized swallowing assessment (SSA).Results After 3 weeks of treatment,the mean sEMG amplitude,deglutition duration and SSA score and improved significantly in comparison to the baseline in all three groups.All were also significantly better in the two treatment groups than in the control group.Importantly,the mean sEMG amplitude,deglutition duration and SSA score were all significantly better in the EMGBFT group than in the ES group.Conclusion EMGBFT can promote better deglutition among patients with dysphagia after stroke more effectively than ES or conventional treatment. Key words: Stroke ; Dysphagia ; Electromyography, Biofeedback

Effect of Neurofeedback and Electromyographic-Biofeedback Therapy on Improving Hand Function in Stroke Patients

Purpose: The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients. Methods: This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery. Results: Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training. Conclusion: Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial

BackgroundLoss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB) therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated.MethodSixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups:• Control group (8 patients): standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion), electrical stimulation, aquatics and proprioceptive training.• The EMG BFB group (8 patients): EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks.Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD) Test, range of motion (ROM) and integrated EMG (iEMG) for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales.ResultsAt 6 weeks, passive knee extension (p < 0.002) and the HHD Test were significantly (p < 0.01) better in the EMG BFB group compared to controls. Integrated EMG (vastus medialis) of the EMG BFB group also showed a significant increase after 2 (p < 0.01) and 6 (p < 0.01) weeks. At the 6-week follow up, no significant (p > 0.01) differences were found between the two groups for the assessment of knee function, swelling and pain.ConclusionThe results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional therapeutic modalities.

Effect of electromyographic biofeedback therapy on dysphagia in stroke patients

Objective To observe the effect of electromyographic biofeedback therapy(EMGBFT)on dysphagia in stroke patients.Methods Fifty-three stroke patients with dysphagia were divided randomly into an EMGBFT group and a control group.The patients of EMGBFT group were given EMGBFT,electrical stimulation therapy (EST)and dysphagia training,while those in the control group were given EST and dysphagia training.All the patients were assessed with Kubota drinking test before treatment and 30 days after treatment.Results After treatment swallowing function of patients in both groups improved(P ＜0.05).The effective rate was 76.92％ in EMGBFT group and 55.56％ in control group,with statistically significant difference between the two groups(P ＜ 0.05).It showed that the EMGBFT group has significantly better outcome than the control group after treatment(P ＜ 0.05).Conclusions EMGBFT combined with regular rehabilitation therapy can improve patient's motor and swallowing function. Key words: Stroke; Deglutition disorder; Dysphagia; Electromyographic biofeedback

Biofeedback therapy in fecal incontinence and constipation

We examine the collected evidence for efficacy of biofeedback therapy (BFT) in incontinence and constipation by means of meta-analysis of randomized controlled trials. PubMed search was performed to identify treatment trials that match quality criteria (adequate control groups, randomization). They were entered into meta-analyses using fixed effect models and computing odds ratio (OR) and 95% confidence interval (CI) of treatment effects. For constipation, eight BFT trials were identified. In four trials, electromyographic (EMG) BFT was compared to non-BFT treatments (laxatives, placebo, sham training and botox injection), while in the remaining four studies EMG BFT was compared to other BFT (balloon pressure, verbal feedback) modes. Meta-analyses revealed superiority of BFT to non-BFT (OR: 3.657; 95% CI: 2.127-6.290, P < 0.001) but equal efficacy of EMG BFT to other BF applications (OR: 1.436; CI: 0.692-3.089; P = 0.319). For fecal incontinence, a total of 11 trials were identified, of which six compared BFT to other treatment options (sensory training, pelvic floor exercise and electrical stimulation) and five compared one BFT option to other modalities of BFT. BFT was equal effective than non-BFT therapy (OR: 1.189, CI: 0.689-2.051, P = 0.535). No difference was found when various modes BFT were compared (OR: 1.278, CI: 0.736-2.220, P = 0.384). Included trials showed a substantial lack of quality and harmonization, e.g. variable endpoints and missing psychological assessment across studies. BFT for pelvic floor dyssynergia shows substantial specific therapeutic effect while BFT for incontinence is still lacking evidence for efficacy. However, in both conditions the mode of BFT seems to play a minor role.

Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence

The purpose of this study was to compare intra-anal electromyographic biofeedback alone with intra-anal biofeedback that was augmented with electrical stimulation of the anal sphincter in the treatment of postpartum fecal incontinence. A secondary aim was to examine the impact of the treatment on continence-related quality of life. Sixty symptomatic women were assigned randomly to receive intra-anal electromyographic biofeedback or electrical stimulation of the anal sphincter once weekly for 12 weeks and to perform daily pelvic floor exercises between treatments. Therapeutic response was evaluated with a symptom questionnaire to determine continence score, anal manometry, and endoanal ultrasound scanning. Quality of life was assessed before and after treatment with a validated questionnaire. Fifty-four women completed the treatment; 52 women (96%) had ultrasonic evidence of an external anal sphincter defect. After the treatment, both groups demonstrated significant improvement in continence score (P < .001) and in squeeze anal pressures (P < .04). Resting anal pressures did not alter significantly. Quality of life improved after the completion of physiotherapy, but there were no differences in outcome between intra-anal electromyographic biofeedback and electrical stimulation of the anal sphincter. Intra-anal electromyographic biofeedback therapy was associated with improved continence and quality of life in women with altered fecal continence after delivery. The addition of electrical stimulation of the anal sphincter did not enhance symptomatic outcome.

Electromyographic biofeedback can improve subjective and objective measures of fecal incontinence in the short term.

Electromyographic biofeedback therapy has demonstrated subjective improvement in patients with fecal incontinence that is comparable to surgery. We assessed the efficacy of biofeedback therapy in a consecutive heterogeneous group of patients using both subjective and objective assessment criteria. These 28 patients with fecal incontinence were studied retrospectively. Patients were assessed using a quality-of-life questionnaire (QOL), the Vaizey and Wexner incontinence scoring systems, and anorectal manometry for efficacy of treatment, before and after biofeedback therapy. Eighty-six percent of patients completed the study. Median follow-up was 18 months. Eighty percent of patients demonstrated significant improvements in their Vaizey and Wexner scores (P<0.001 and P<0.001, respectively). The mean QOL score improved from 62 to 77 (P<0.01). Significant improvements were also demonstrated in the mean resting pressure (P<0.01), peak amplitude of squeeze (P<0.01), and the duration of squeeze pressure (P<0.05). The deferred 15-minute evacuation time also significantly increased (P<0.001). This study reported significant short-term improvement in fecal incontinence with electromyographic biofeedback therapy using validated subjective and objective scoring systems. Similarly, this treatment also significantly improved anorectal manometric findings. Our data confirm the role of biofeedback therapy in the multimodality approach to patients with fecal incontinence.

Prospective randomized comparison of intra-anal electromyographic biofeedback and intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter

While frank fecal incontinence associated with anal sphincter disruption after vaginal delivery requires surgical repair, intra-anal electromyographic (EMG) biofeedback therapy is a common treatment for less serious symptoms. The aim of this study was to compare prospectively intra-anal EMG biofeedback alone (BA) with intra-anal biofeedback with electrical stimulation of the sphincter (BStim) in the treatment of postpartum fecal incontinence.

Biofeedback Therapy in the Treatment of Tinnitus

Seven patients were treated with electromyographic biofeedback therapy for intractable tinnitus which was supposed to be reinforced by mental distress and muscle tension. Three patients, who succeeded in decreasing electromyographic levels of the frontal muscle, were able to reduce tinnitus and relieve anxiety. One patient could eliminate tinnitus only during biofeedback sessions, but the efficacy was not continuous in daily life. The other three patients, who failed to decrease electromyographic levels, did not obtain favorable results. It is suggested that biofeedback therapy appears to be of greatest benefit when muscle tension and mental distress are the cause of magnification of the tinnitus symptoms.

Characteristics of treatment drop-outs among two samples of chronic headache patients

To examine the psychological characteristics of those who terminate treatment for headaches prematurely, this investigation employed 179 posttraumatic headache patients and 67 nontrauma headache patients who underwent electromyographic (EMG) biofeedback therapy. Dependent variables included the patient's age, socioeconomic status, duration of headache, forehead EMG levels, and MMPI. Multivariate analyses of variance revealed no significant differences between the drop-outs and non-drop-outs among the trauma headache patients, but three MMPI scales (Psychopathic-Deviate, Paranoia, and Mania) were significantly higher among the nontrauma headache patients who dropped out of treatment. These data imply that different characteristics underlie the drop-out behavior for different pain conditions and that efforts to uncover a single drop-out pattern may not be realistic.

Electromyographic biofeedback Therapy for Childhood tic Syndrome (III)

Electromyographic biofeedback Therapy for Childhood tic Syndrome (III)

Effect of electromyographic biofeedback therapy on occlusal contacts

T he technique by which a patient can be made aware of small somatic changes and the effect of self-control on them through various sensory channels is known as biofeedback therapy. The therapy has been tried successfully in many fields and includes the treatment of skeletal muscle disorders.‘-4 We have used auditory feedback (Biofeedback Systems Ltd., Manchester, England) to relax jaw muscles in the treatment of the myofascial pain-dysfunction syndrome.5-‘0 We tried to combine it with yoga2 and transcendental meditation (TM): with the objective of relaxing the neuromuscular system at both peripheral and central levels to study the effects of such relaxation on occlusal contacts. Because the contacts are brought about by the various jaw muscles and the muscle activity changes with physical” and mental stress,‘2p’3 muscle relaxation is expected to modify occlusal contacts when compared with contacts that result from tired and fatigued craniocervical muscles. In previous experiments we observed a progressive decrease in both qualitative and quantitative occlusal contacts associated with an increase in muscular tension and lack of coordination between jaw muscles.14 We conjectured that neuromuscular relaxation at both peripheral and central levels should improve the ability of the teeth to meet evenly and effectively. The present experiment was an outgrowth of this hypothesis and was part of a series of experimentsI in which occlusal contacts recorded at about 4:00 PM were compared with those recorded after M hour of electromyographic (EMG) biofeedback therapy.

Comparison of effects of electromyographic biofeedback and occlusal splint therapy on mandibular dysfunction: Lars Dahlstrom, Gunnar E. Carlsson, and Sven G. Carlsson Scand. J. Dent. Res. 90:151–156, 1982

Comparison of effects of electromyographic biofeedback and occlusal splint therapy on mandibular dysfunction: Lars Dahlstrom, Gunnar E. Carlsson, and Sven G. Carlsson Scand. J. Dent. Res. 90:151–156, 1982