Electromyographic Biofeedback Training Research Articles

Study on the treatment of dysphagia after stroke with electromyographic biofeedback intensive training.

Dysphagia, or swallowing disorder, is a common complication following stroke, significantly impacting patients' quality of life. Electromyographic biofeedback (EMGBF) therapy has emerged as a potential rehabilitation technique to improve swallowing function, but its efficacy in comparison with conventional treatments remains to be further explored. To investigate the effects of different treatment intensities of EMGBF on swallowing function and motor speed after stroke. The participants were divided into three groups, all of which received routine neurological drug therapy and motor function rehabilitation training. On the basis of routine swallowing disorder training, the EMGBF group received additional EMGBF training, while the enhanced EMGBF group received two additional training sessions. Four weeks before and after treatment, the degree of swallowing disorder was evaluated using the degree of swallowing disorder score (VGF) and the Rosenbek penetration-aspiration scale (PAS). Initially, there was no significant difference in VGF and PAS scores among the groups (P > 0.05). After four weeks, all groups showed significant improvement in both VGF scores and PAS scores. Furthermore, the standardized swallowing assessment and videofluoroscopic dysphagia scale scores also improved significantly post-treatment, indicating enhanced swallowing function and motor function of the hyoid-bone laryngeal complex, particularly in the intensive EMGBF group. EMGBF training is more effective than traditional swallowing training in improving swallowing function and the movement rate of the hyoid laryngeal complex in patients with post-stroke dysphagia.

Effectiveness of Electromyographic (EMG) Biofeedback in Osteoarthritis of the Knee joint: A Brief Narrative Review

Introduction: After knee osteoarthritis (OA), the patient will have a varying degree of quadriceps weakness, affecting the joint range of motion and physical function. Therefore, effective physical therapy is a common therapy for clinicians. Recently, there has been increased interest in the use of biofeedback approaches in rehabilitation interventions, and it is progressively being regarded as a helpful strategy to reduce pain and boost the effectiveness of major therapies. Methodology: Studies on the topic of the effect of using EMG biofeedback (EMGBF) in osteoarthritis of the knee joint were reviewed so the findings of those articles were used to explore the additive effect of EMG biofeedback training that would affect quadriceps pain and Vastus medialis Oblique (VMO) thickness in patients with osteoarthritis of the knee joint. Results: In terms of the results of this approach in patients with knee OA, some studies have discovered that it has a favorable impact on pain alleviation, function, and muscular strength in patients treated with exercise with Electromyographic (EMG) biofeedback, while others have found that it has no extra effects on patients. Conclusion: Employing EMGBF has certain benefits, and the decision to utilize it or not is based on its ease of access, cost-effectiveness, and physician-patient desire

Evaluation of the effectiveness of electromyographic biofeedback training in patients with patellofemoral pain syndrome

Evaluation of the effectiveness of electromyographic biofeedback training in patients with patellofemoral pain syndrome

Efficacy of Patellar Taping and Electromyographic Biofeedback Training at Various Knee Angles on Quadriceps Strength and Functional Performance in Young Adult Male Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

Background The severity of the articular lesion is the single most essential element in investigating the extent of flexion that is required for activities. However, a prior study found no differences in muscle strength gains of quadriceps muscles at different knee angles in people with patellofemoral pain syndrome (PFPS). Objective The effects of patellar taping and electromyographic biofeedback (EMG-BF)-guided isometric quadriceps strengthening at different knee angles (e.g., 30°, 60°, and 90° of knee flexion) on quadriceps strength and functional performance in people with PFPS were compared in this single-blind randomized controlled parallel trial. Methods Sixty adult male athletes with PFPS (age: 26.9 ± 1.4 years) were randomly divided into two groups. The experimental group (n = 30) received patellar taping and EMG-BF-guided isometric contraction exercise at 30°, 60°, and 90° angles, and the control group (n = 30) received sham patellar taping without EMG-BF-guided exercises for six weeks. Pain intensity, knee function, muscle strength, and the single-leg triple hop (SLTH) test were assessed. Results The pain intensity and SLTH scores between the groups were significantly different at the end of the trial (p ≤ 0.001). The EMG-BF and control groups had mean pain scores of 1.3 (0.8) and 4.5 (0.8), respectively. The EMG-BF and control groups had mean functional scores of 80.4 (5.1) and 69.1 (6.1), respectively. The mean SLTH score for the EMG-BF group was 540.7 (51.2) and for the control group it was 509.4 (49.8) after the trial. Quadriceps muscle strength was significantly higher in those who performed quadriceps strength training at 60° of knee flexion after six weeks than in those who performed strength training at 30° or 90° of knee flexion. Conclusion The findings indicated that individuals who trained their quadriceps at a 60° knee angle had significantly stronger quadriceps muscles than individuals who trained at 30° or 90° of knee flexion. Trial Registration. This trial is registered at Clinical Trials.gov under the identifier NCT05055284.

EFFECTS OF ELECTROMYOGRAPHIC BIOFEEDBACK ON THE PERFORMANCE OF VASTUS MEDIALIS OBLIQUE MUSCLE IN KNEE OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Background: Knee osteoarthritis is a common musculoskeletal disorder, enhancing performance of Vastus Medialis Oblique (VMO) can reduce the symptoms. Objective: The study objective was to determine the effects of Electromyographic Biofeedback (EMG BF) on the performance of VMO in patients with knee osteoarthritis (OA). Methods: A Randomized Controlled Trial (RCT) was conducted at Pakistan Railway General Hospital, Rawalpindi from July to December 2019. In this study, n=30 patients with a diagnosis of knee OA were recruited with the age ranging from 50 to 65 years. The participants were randomly allocated to two groups. Group A has received isometric exercises with Electromyographic Biofeedback (EMG BF) training and Group B has received only isometric exercises for 6 weeks. The Assessments were taken at the baseline and after 6th week of intervention. The outcome measure of vastus medialis oblique (VMO) performance was maximum voluntary isometric contraction (MVIC), measured by an EMG BF device, and one-repetition maximum (1RM)). The VMO muscle thickness was measured by musculoskeletal ultrasound. SPSS version 21 was used for data analysis. Results: The mean age of the group A was 58.94±3.1 years and of group B was 59.44±2.9 years. There was found significant between-group improvement (p<0.001) in VMO thickness and 1RM. But for MVIC between-group difference was not significant (p>0.05). Within-group analysis for all variables was statistically significant (p 0<.001) in both experimental and control groups. Conclusion: It is concluded that VMO training with an EMG BF device is more effective to enhance VMO thickness and strength in terms of 1RM in patients with knee osteoarthritis. Keywords: Osteoarthritis, Electromyography Biofeedback, One repetition maximum

The Impact of Electromyography Biofeedback Training on Myofascial Pain on Patients with Bruxism

The Impact of Electromyography Biofeedback Training on Myofascial Pain on Patients with Bruxism

Effect of electromyography biofeedback training of the abdominal muscles on bladder function in paraplegic spinal cord injury patients

IntroductionTo investigate the efficacy of biofeedback abdominal muscles training on the bladder control and the quality of life in paraplegic patients.MethodsOverall, 60 male and female paraplegic patients aged 20–40 years were randomly divided into 2 groups. The patients in the study group were treated with abdominal muscles biofeedback strength training, and the control group received pelvic floor biofeedback strength training 2 times per week. The subjects in both groups were evaluated before and after the treatment by (1) measuring post-void urine residual volume, (2) overactive bladder questionnaire, the Arabic version.ResultsThere was a significant difference between the 2 groups. In the study group, the urine residual volume decreased to the normal range and the quality of life questionnaire score decreased, which showed good improvement. In the control group, there was no significant difference, with minimal changes: the urine residual volume was still high and the quality of life questionnaire score remained high.ConclusionsAbdominal muscles biofeedback training must be a main point in the bladder rehabilitation program for paraplegic patients as it decreases the urine residual volume and optimizes quality of life.

Efficacy of Electromyographic-Biofeedback Supplementation Training with Patellar Taping on Quadriceps Strengthening in Patellofemoral Pain Syndrome among Young Adult Male Athletes

This study compares the effects of electromyographic-biofeedback (EMG-BF)-guided isometric quadriceps strengthening with patellar taping and isometric exercise alone in patellofemoral pain syndrome (PFPS) among young adult male athletes. Sixty young adult male athletes with PFPS participated in the study. Participants were randomly divided into two groups: (1) EMG-BF-guided isometric exercise training with patellar taping (experimental group, n = 30), and (2) sham EMG-BF training with an isometric exercise program (control group, n = 30). Participants conducted their respective exercise programs for five days per week across four weeks. Study outcomes were pain (measured by the visual analog scale), functional disability (measured by the Kujala Anterior Knee Pain scale), and quadriceps strength (measured by an ISOMOVE dynamometer). Measurements were taken at baseline, Week 2, Week 4, and during a follow-up at Week 6. The experimental group demonstrated significantly lower VAS score at Weeks 2 and 4 compared to that of the control group (p = 0.008 and 0.0005, respectively). The score remained significantly lower at the Week 6 follow-up compared to the control group (p = 0.0005). There were no differences in knee function at Weeks 2 and 4 between the two groups (p = 0.086 and 0.171, respectively); however, the experimental group showed significantly better knee function at Week 6 compared to the control group (p = 0.002). There were no differences in quadriceps strength at Week 2 between the two groups (p = 0.259); however, the experimental group demonstrated significantly higher quadriceps strength at Weeks 4 and 6 compared to the control group (p = 0.0008). Four weeks of EMG-BF supplementation training with patellar taping demonstrated significant improvements in pain intensity, functional disability, and quadriceps muscle strength in young adult male athletes with PFPS.

Effect of electromyographic biofeedback training on motor function of quadriceps femoris in patients with incomplete spinal cord injury: A randomized controlled trial.

Electromyographic biofeedback (EMG BF) training is an effective method of promoting motor learning and control in neurorehabilitation, but its effect on quadriceps femoris muscle in individuals with spinal cord injury (SCI) is unknown. The aim of the study was to investigate the therapeutic effect of EMG BF training on motor function of quadriceps femoris in patients with incomplete SCI. Thirty-three incomplete paraplegic patients with quadriceps femoris strength ranging grade 1 to grade 3 less than 6 months post-injury were enrolled. Control group (n = 16) received conventional physical therapy to enhance quadriceps femoris strength, while intervention group (n = 17) was treated with conventional physical therapy and EMG BF training. All received treatment once a day for 30 days. Surface electromyograph (sEMG), muscle strength and thigh circumference size were assessed to evaluate motor function of quadriceps femoris. Activities of daily living (ADL) was evaluated by Modified Barthel Index (MBI). All the measures evaluated three times in total. Compared to the control group, intervention group significantly improved on sEMG values and strength of quadriceps femoris (PsEMG < 0.001, Pstrength < 0.05). sEMG values of quadriceps femoris increased earlier than strength of quadriceps femoris in intervention group (Prest = 0.07, Pactive = 0.031). There were no statistical differences in thigh circumference size and ADL scores between groups (Pthigh > 0.05, PADL = 0.423). EMG BF training appeared to be a useful tool to enhance motor function of quadriceps femoris in patients with incomplete SCI. sEMG could quantify the changes of single muscle myodynamia precisely before visible or touchable changes occur.

An electroencephalography (EEG) study of short-term electromyography (EMG) biofeedback training in patients with myofascial pain syndrome in the upper trapezius.

[Purpose] In the present study, electroencephalography was used to explore neural activity related to electromyography biofeedback training, focusing on pain perception before and after electromyography biofeedback. [Participants and Methods] Twenty-seven participants (female=23; mean age: 28.85 ± 4.99 years) with mild-to-moderate myofascial pain syndrome in the upper trapezius were recruited for this study. All participants underwent electroencephalography recording before, during, and after (0 and 15 min) electromyography biofeedback training. Quantitative electroencephalography analysis was performed to obtain the absolute power of the four main frequency bands. Pain scores before and after electromyography biofeedback were also evaluated by subjective rating. [Results] Electromyography biofeedback increased alpha power and decreased delta power 15 minutes after training, suggestive of relaxation. However, although a tendency for scores to decrease was observed, no significant improvements in pain scores were observed following the intervention. Such results may be due to the short duration of the biofeedback session and the subjective nature of pain assessments. [Conclusion] Despite no obvious changes in pain perception, brief electromyography biofeedback training may induce relaxation in patients with myofascial pain syndrome of the upper trapezius muscle.

Single-Session Video and Electromyography Feedback in Overhead Athletes With Scapular Dyskinesis and Impingement Syndrome.

Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. Randomized controlled clinical trial. Research laboratory. Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). Three-dimensional kinematics and EMG were recorded before and after feedback training. Lower trapezius muscle activity increased (4.2%-18%, P < .011) and UT/LT decreased (0.56-1.17, P < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, P = .024). The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. ClinicalTrials.gov: NCT03252444.

Transcranial Direct Current Stimulation Combined with Action Observation and Electromyographic Biofeedback Training in a Patient with Writer's Cramp.

We present a 47-year-old right-handed woman with a 15-year history of writer’s cramp who was provided with six sessions of cathodal transcranial direct current stimulation (tDCS) combined with observation of writing actions performed by a healthy subject and electromyographic (EMG) biofeedback training to decrease EMG activities in her right forehand muscles while writing for 30 min for 4 weeks. She showed improvement in dystonic posture and writing speed after the intervention. The writing movement and writing speed scores on a writer’s cramp rating scale decreased, along with writing time. Our findings demonstrated that cathodal tDCS combined with action observation and EMG biofeedback training might improve dystonic writing movements in a patient with writer’s cramp.

Effect of Respiratory Muscle Training Combined with Electromyographic Biofeedback Training on Swallowing Function and Aspiration Pneumonia after Stroke

Effect of Respiratory Muscle Training Combined with Electromyographic Biofeedback Training on Swallowing Function and Aspiration Pneumonia after Stroke

Effect of isokinetic training on quadriceps muscle strength in osteoarthritis of knee

The aim of the present study was to investigate the role of Isokinetic Training and Electromyography biofeedback training in improving strength of the quadriceps femoris in participants with Osteoarthritis of knee. Fifty four participants (male and female) in the age range of 50–63 years with knee Osteoarthritis of Grade II and III (Kellgren-Lawrence criteria) severity were recruited from the Department of Orthopedics, Hospital Universiti Sains Malaysia. The selected participants were taken to the Exercise and Sports science laboratory and the laboratory of School of Medical Sciences, Universiti Sains Malaysia for baseline assessment. Extent of muscle strength was assessed employing the isokinetic device BIODEX 4 System Pro. On completion of the baseline assessment the participants were randomly categorized into three groups (Gr.) (Viz. Gr. A, Gr. B, Gr. C and Gr. D) and thus each group consisted of 18 participants. Gr. A participants received Conventional Physiotherapy consisting of strengthening exercises; stretching exercises and range of motion exercises. Gr. B received Isokinetic Training at velocities of 90° and 150°/second. Gr. C participants received EMG Biofeedback training with Mega ME 6000 device. All the interventions were imparted for 25–30 minutes per session; 2 sessions per week for10 weeks (20 sessions). Mid intervention assessment was done after 5th week followed by the post intervention assessment after 10th week following baseline assessment protocol. After the post intervention assessment, the participants were instructed not to attend the training session for the next 8 weeks and not to get engaged in any sort of physical training, exercise or sport programme. The issue of sustainability was also verified by the post-follow-up assessments of the all of the variables following identical assessment protocols after 14th and 18th week of completion. Repeated measure of ANOVA revealed that, Isokinetic Training was beneficial in enhancing muscle-strength of quadriceps femoris (p<.05).

Effects of game-based surface electromyograhic biofeedback training on dysphagia caused by brainstem injury

Objective To explorer the effectiveness of game-based surface electromyographic biofeedback training (GBsEMGBF) on dysphagic brainstem injury patients. Methods Thirty-six brainstem injury dysphagic patients were randomly and evenly divided into a treatment group and a control group, both of 18, by using a random number table. Both groups were given conventional swallowing rehabilitation including oral sensory and motor training, Mendelsohn swallowing training and balloon dilatation of the cricopharyngeal muscle. The treatment group was additionally provided with GBsEMGBF training. All the treatments were provided 5 times per week for 5 weeks. Both groups were assessed using the functional oral intake scale (FOIS), penetration-aspiration scale (PAS), hyoid anterior movement (HAM), hyoid superior movement (HSM) and upper esophageal sphincter opening (UO) before and after the intervention. Results Before the treatment there were no significant differences between the two groups in all the measurements. After the treatment, there was a significant improvement in the average FOIS, PAS, HAM and HSM scores in both groups, but with significantly greater improvement in the treatment group. Significant improvement was observed in the average UO score after the intervention, but without significant differences between the two groups. Conclusion GBsEMGBF can significantly improve the swallowing function and hyoid motor function in dysphagic patients caused by brainstem injury. Key words: Game-based surface electromyograhic biofeedback; Brainstem injury; Dysphagia; Balloon dilatation

EMG biofeedback training in adult attention-deficit/hyperactivity disorder: An active (control) training?

ObjectiveThe present study aimed at revealing neurophysiological effects induced by electromyography (EMG) based biofeedback, considered as a semi-active control condition in neurofeedback studies, in adult attention-deficit/hyperactivity disorder (ADHD) patients. Methods20 adult ADHD patients trained their muscle activity in the left and right supraspinatus muscle over the course of 30 EMG biofeedback sessions. Changes induced by the EMG feedback were evaluated at a clinical and neurophysiological level; additionally, the relation between changes in EEG activity recorded at the vertex over the training course and changes of symptom severity over the treatment course were assessed in order to investigate the mechanisms underlying clinical effects of EMG biofeedback. ResultsParticipants showed significant behavioral improvements on a self-rating scale. There was a significant increase in alpha power, but no significant changes in the delta frequency range; changes in the theta and beta frequency range were not significant after adjustment for multiple comparisons. No statistically significant correlation was found between changes in EEG frequency bands and changes in ADHD symptoms. ConclusionsThe current results assessed by means of a single-electrode EEG constitute a starting point regarding a clearer understanding of mechanisms underlying clinical effects of EMG biofeedback. Although we did not reveal systematic effects induced by EMG feedback on brain activity it remains an open question whether EMG biofeedback induces changes in brain regions or parameters we did not gather in the present study (e.g. motor cortex).

STRES ÜRİNER İNKONTİNANSLI KADINLARDA PELVİK TABAN KAS EĞİTİMİNE EK OLARAK UYGULANAN ELEKTROMYOGRAFİK BİOFEEDBACK EĞİTİMİNİN ETKİNLİĞİNİN İNCELENMESİ

Aim: The aim was to investigate the effects of electromyography biofeedback training applied in addition to pelvic floor muscle training on the quality of life, amount of urine leakage and pelvic floor muscle strength in women with stress urinary incontinence. Materials and Methods: 52 women with stress urinary incontinence included in the study. The patients were divided into two groups. First group received pelvic floor muscle training (n= 27) and the other group received electromyography biofeedback training in addition to pelvic floor muscle training (n= 25). The perceived quality of life and dryness sensation of the women were assessed by using a visual analog scale. The pelvic floor muscle strength was evaluated by a vaginal pressure manometer. Their amount of urine leakage was evaluated by a 1-hour pad test. The evaluations were performed before the treatment and after an 8 weeks treatment. Results: Pelvic floor muscle training and electromyographic biofeedback training in addition to pelvic floor muscle training showed improvement in dryness sensation, perceived quality of life, pelvic floor muscle strength and amount of urine leakage before and after treatment in intra-group analyzes (p<0.05). The assessments showed that there was no difference between the groups (p>0.05) . Discussion and Conclusion: The electromyography biofeedback training in addition to pelvic floor muscle training did not show an additional healing effect in the treatment of women with stress urinary incontinence.

The effects of training using EMG biofeedback on stroke patients upper extremity functions.

[Purpose] While electromyography (EMG) biofeedback has been recently used in diverse therapeutic interventions for stroke patients, research on its effects has been lacking. Most existing studies are confined to functions of the lower extremities, and research on upper extremity functional recovery using EMG biofeedback training is limited. Therefore, this study examined the effects of training using EMG biofeedback on stroke patients’ upper extremity functions. [Subjects and Methods] The subjects of this study included 30 hemiplegia patients whose disease duration was longer than six months. They were randomly divided into a control group (n=15) receiving traditional rehabilitation therapy and an experimental group (n=15) receiving both traditional rehabilitation therapy and training using EMG biofeedback. The program lasted for a total of four weeks. In order to examine the subjects’ functional recovery, the author measured their upper limb function using the Fugl-Meyer Assessment and Manual Function Test, and activities of daily living using the Functional Independence Measure before and after training. [Results] A comparison of the study groups revealed that those in the experimental group experienced greater improvement in upper extremity function after training in all tests compared to the control group; however, there was no significant difference in terms of the activities of daily living between the two groups. The results of this study were as follows. [Conclusion] Thus, stroke patients receiving intensive EMG biofeedback showed more significant upper extremity functional recovery than those who only received traditional rehabilitation therapy.

Effect of Electromyographic Biofeedback Training on Pain, Quadriceps Muscle Strength, and Functional Ability in Juvenile Rheumatoid Arthritis.

To investigate the effects of electromyographic (EMG) biofeedback training on pain, quadriceps strength, and functional ability in juvenile rheumatoid arthritis (JRA). This is a randomized controlled study; 36 children (11 boys and 25 girls) with polyarticular JRA, with ages ranging from 8 to 13 years, were selected and assigned randomly, using computer-generated random numbers, into 2 groups. The control group (n = 18) received the conventional physical therapy program, whereas the study group (n = 18) received the same program as the control group in addition to EMG biofeedback-guided isometric exercises for 3 days a week for 12 weeks. Pain, peak torque of quadriceps strength, and functional ability were evaluated before, after 6 weeks, and at the end of 12 weeks of the treatment program. By 6 weeks, significant differences were observed in the study group (P < 0.05) in all measured variables except pain levels, whereas nonsignificant differences were observed in all measured variables in the control group. By 12 weeks, each group demonstrated significant improvements in pain, quadriceps strength, and functional ability (P < 0.05), with significantly greater improvements seen in the study group compared to the control group (P < 0.05). Both groups showed significant improvement at 12 weeks compared to that at 6 weeks. Electromyographic biofeedback may be a useful intervention modality to reduce pain, improve quadriceps strength, and functional performance in JRA.

Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis.

Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear. The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP. MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014. The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure. Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded. Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=-0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category. Gait speed was the only outcome measure analyzed. Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.