EMG Biofeedback Research Articles

Comparative study on the Impact of Transcranial Magnetic stimulation and Bio-feedback on overactive bladder in multiple sclerosis patients: a Randomized Clinical Trial.

Overactive bladder (OAB) is a common clinical presentation in patients with multiple sclerosis. The purpose of this study was to compare the effects of transcranial magnetic stimulation (TMS) and biofeedback on overactive bladder in patients with multiple sclerosis. This research included 45 individuals with multiple sclerosis of both sexes. We randomly divided them into three equal groups (A, B, and C). Patients in group A got biofeedback training and pelvic floor exercise (PFME); patients in group B had transcranial magnetic treatment and PFME; and patients in group C had PFME. Urodynamic measurements were utilized to determine bladder parameters (detrusor pressure at maximum flow rate, bladder volume at initial desire to empty, maximum cystometric capacity, detrusor pressure, and maximum flow rate) for all groups before and after a six-week training interval (the end of therapy). There was a statistically significant improvement in all urodynamic measurement parameters within the groups (Groups A, B and C). Except for the maximal cystometric capacity and detrusor pressure were non-significant improvement in B before and after therapy. However, there was no significant difference between the three groups following therapy. Transcranial magnetic stimulation and biofeedback improved bladder function in patients with multiple sclerosis. These approaches have a high level of safety and effectiveness, but EMG biofeedback has superiority.

Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials

The aim of this study is to compare the efficacy of different exercise interventions for adult flexible flatfoot. Nine databases (PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PRDro, Google Scholar, China National Knowledge Infrastructure(CNKI) and Wanfang data) were systematically searched from their inception until February 2024. The search resulted in 2112 records, with 11 studies included. All networks revealed low heterogeneity and non-significant inconsistency (I2 ≤ 25.0%). Three network plots were formed for navicular drop. Firstly, compared with the control group, strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE (MD: 3.32, 95% CI: 1.78, 4.89), PNF (MD: 1.81, 95%CI: -0.05, 3.70), SFE (MD: 1.23, 95%CI: 1.02, 1.44) all showed better effects. And strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE exercise is considered to be the most effective intervention, with SUCRA of 0.97. Secondly, compared with the control group, hip-focused neuromuscular exercise (MD: 6.22, 95% CI: -1.69, 14.12), SFE with EMG biofeedback (MD: -0.81, 95%CI: -1.59, 3.21) all showed better effects. And hip-focused neuromuscular exercise is considered to be the most effective intervention, with SUCRA of 0.92. Thirdly, the internal foot muscle training combined with gluteus muscle strengthening is significantly better than the other two groups, with SUCRA of 0.99. For the foot posture index, comprehensive reinforcement (MD: 1.95, 95% CI − 0.19, 4.03) showed better effects compared with the control group. In the probability ranking table, comprehensive reinforcement is significantly better than the other two groups, with SUCRA of 0.98. For the foot function index, orthoses wear + stretching + eccentric progressive resistive exercise of tibialis posterior is significantly better than the other two groups, with SUCRA of 0.92. In conclusion, various exercise therapies improve the arch shape and function of patients with flexible flatfoot, particularly hip muscle and lower limb overall muscle training.

Impact of Physiotherapy in the Treatment of Pain in Cervical Dystonia.

Cervical dystonia (CD) is the most common form of focal dystonia in adults. Studies show that physiotherapy (PT) in combination with BoNT has an effect on pain in cervical dystonia. We intended to test this hypothesis in a real-world setting to answer the question of whether pain is a good target symptom for prescribing PT. We also aimed to assess which form of PT is most appropriate for the treatment of pain. Study design: cross-sectional survey-based study of 91 patients with a confirmed diagnosis of cervical dystonia. The survey consisted of a questionnaire on type, frequency and content of physiotherapy, an assessment of quality of life with the Craniocervical Dystonia Questionnaire 24 (CDQ 24) and subjective pain scores. 53.8% of patients received physiotherapy, mostly a mixture of exercises to either correct the abnormal posture or to reduce the muscle tone. Additional therapies included stress-reducing exercises (14.3%), psychotherapy (9.9%) and EMG biofeedback (2.2%). Patients who received PT showed a non-significant tendency towards higher pain scores. The severity of dystonia-associated pain was significantly associated with the patients' quality of life (F (1,54) = 22.9, adjusted R2 = 0.286, p < 0.001). Pain is a frequent problem in patients with CD and severely affects quality of life. Physiotherapy could therefore be a valuable treatment option for patients with CD and pain. Our uncontrolled study illustrates the high frequency of physiotherapy in addition to BoNT treatment in a real-life cohort of patients with cervical dystonia. We were able to show that PT reduces patients' perceived pain in a patient reported outcome measure. This highlights the importance of PT in reducing CD-related pain, which considerably impairs quality of life.

The Role of Biofeedback in Patellofemoral Pain Conservative Treatment: A Systematic Review.

This paper aims to investigate the effectiveness and the outcomes of the association between different types of biofeedback techniques and therapeutic exercises in the conservative treatment of patellar femoral pain (PFP). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines have been used and followed the Cochrane Handbook for Systematic Reviews of Interventions. Between April and June 2023, the following electronic databases were searched: PubMed, ScienceDirect, BIOMED Central, Cochrane Library, and PEDro. Only randomized controlled trials (RCTs) were selected. Following the search, 414 records were found, and after using strict inclusion and exclusion criteria, 12 RCTs were retrieved to include in this systematic review, assessing 513 patients. The association between biofeedback and therapeutic exercise may be beneficial for pain, function (AKPS), extensor muscle strength, reduction of the dynamic knee valgus and vastus medialis (VM) and vastus lateralis (VL) (EMG) optimization. All these results were valued in the short term. Regarding the intervention type, it was possible to correlate the EMG biofeedback with the benefits of the knee extensor strength and the EMG activity of VM and VL. Conversely, using mirror, verbal, and somesthetic (hands and band) feedback seems to be linked to the reduction of the knee dynamic valgus.

Investigation Of Factors Affecting Motor Competence In Early Adolescents

Aim: This study aims to retrospectively evaluate the fundamental motor competence of early adolescents and to examine the affecting factors. Methods: 89 children aged 11.33±0.95 were included in the study. Minnesota Manual Dexterity Test (MMDT) for manual dexterity, 9-Hole Peg Test (9-HPT) for finger dexterity, Korebalance™ Premiere for balance, manual muscle strength measurement device for quadriceps muscle strength, hand dynamometer for hand grip strength, EMG Biofeedback for muscle activation was used. Results: Compared by gender, there was a statistically significant difference in the right and left-hand placing of MMDT and 9-HPT (p=0.004, p=0.041, p=0.004, respectively). Comparison’s of age groups, there was a statistically significant difference in the left-hand placing and turning subtests of MMDT and left grip strength (p=0.010, p=0.048, p=0.025, respectively). In a correlation analyses, age had a correlation with the left-hand placing of MMDT (r=-0.336,p=0.001); and left grip strength (r=0.219,p=0.039). Height and weight had a correlation with dynamic balance (r=-0.242,p=0.022; r=-0.244,p=0.021). Weight and BMI had a correlation with static balance (r=0.342,p=0.001; r=0.305,p=0.004) and EMG Biofeedback score (r=0.237,p=0.025; r=0.212,p=0.046). Conclusion: Manual dexterity and hand grip strength develop with age in children, and girls' manual and finger dexterities are better than boys. While the increase in BMI and weight affect static balance negatively, the increase in height and weight affect dynamic balance positively. It is thought that investigating the factors affecting motor competence will be important in evaluating the development of children and directing them to appropriate sports.&#x0D; Keywords: Balance, Manual dexterity, Finger dexterity, Muscle activation

Headaches treatment with EMG biofeedback: a focused systematic review and meta-analysis.

The aim of this paper was to present an up-to-date evaluation of the efficacy of EMG-biofeedback (EMG-BFB) for primary headaches and to address possible mediators of outcome. PubMed, Scopus, Embase and Pedro databases were searched from inception to May 1, 2023. All randomized controlled trials (RCT) studies using an EMG-BFB to treat headache have been included in this systematic review. The current systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in the PROSPERO database (CRD42022312827). Methodological quality was assessed through the Risk of Bias tool 2 (RoB 2). The effect sizes and 95% confidence interval (CI) were calculated by random-effect models on frequency, intensity, and duration variables. Egger regression and the Begg-Mazumdar rank correlation test were used for publication bias. A total of 3059 articles were identified through the database searches. 29 articles, involving 1342 participants, met the inclusion criteria for the systematic review; of them, 4 were included in the meta-analysis. Ten studies reported a significant improvement in the EMG-BFB group with respect to the control group. Meta-analyses show a reduction in the intensity of attacks in patients subjected to EMG-BFB (ES 0.21 [(95% CI=-0.02; 0.44), P value=0.07] based on 293 patients). EMG-BFB represents a non-pharmacological approach to headache treatment as shown via qualitative synthesis, despite not impressive results, this technique can be particularly useful in paediatric or in adult patients who cannot undergo drug therapies. Quantitative synthesis revealed a promising effect in the intensity of headaches attacks. Moreover, no significant effect was found about the effectiveness of EMG-BFB in the reduction of frequency and durations of headache attacks. Future studies with new multimodal technologic assessment and following RCT guidelines can unmask the potentiality of EMG-BFB in the treatment of headache.

Enhancing Functional Ability in Chronic Nonspecific Lower Back Pain: The Impact of EMG-Guided Trunk Stabilization Exercises.

Nonspecific lower back pain (NSLBP) is described as pain that is not caused by an identifiable, well-known disease, such as infection, tumor, osteoporosis, fracture, structural deformity, inflammatory condition, radicular syndrome, or cauda equina syndrome. The aim of this study was to determine the effect of EMG-guided trunk stabilization exercises on functional disability associated with LBP. A single-blinded pre- and post-test experimental comparative design was used for this study. Fifty individuals with chronic NSLBP were screened for inclusion criteria. Of these, forty were randomly grouped into the EMG group receiving trunk-stability exercises with electromyography biofeedback and non-EMG group receiving trunk-stabilization exercises without EMG biofeedback. Participants performed five trunk-stability exercises 3 days a week for 4 weeks. The intensity of pain, range of motion, functional disability, and balance were measured at baseline and after 4 weeks. Both techniques indicated a significant effect on chronic NSLBP; however, trunk-stability exercises combined with EMG biofeedback produced better results in alleviating the intensity of pain, increasing the range of motion, and improving functional disabilities and static balance. The present study confirms that trunk-stability exercises with EMG biofeedback can be practiced safely, contributes to a greater boost in neuromuscular efficiency in the lumbar flexors and extensors, and is effective in modifying functional disability for patients with NSLBP.

Nonlinear Mapping From EMG to Prosthesis Closing Velocity Improves Force Control With EMG Biofeedback.

When using EMG biofeedback to control the grasping force of a myoelectric prosthesis, subjects need to activate their muscles and maintain the myoelectric signal within an appropriate interval. However, their performance decreases for higher forces, because the myoelectric signal is more variable for stronger contractions. Therefore, the present study proposes to implement EMG biofeedback using nonlinear mapping, in which EMG intervals of increasing size are mapped to equal-sized intervals of the prosthesis velocity. To validate this approach, 20 non-disabled subjects performed force-matching tasks using Michelangelo prosthesis with and without EMG biofeedback with linear and nonlinear mapping. Additionally, four transradial amputees performed a functional task in the same feedback and mapping conditions. The success rate in producing desired force was significantly higher with feedback (65.4±15.9%) compared to no feedback (46.2±14.9%) as well as when using nonlinear (62.4±16.8%) versus linear mapping (49.2±17.2%). Overall, in non-disabled subjects, the highest success rate was obtained when EMG biofeedback was combined with nonlinear mapping (72%), and the opposite for linear mapping with no feedback (39.6%). The same trend was registered also in four amputee subjects. Therefore, EMG biofeedback improved prosthesis force control, especially when combined with nonlinear mapping, which showed to be an effective approach to counteract increasing variability of myoelectric signal for stronger contractions.

Peroneal muscle response to single-leg drop-jump and unexpected leg-drop in young and middle-aged adults before and after one session of neuromuscular training

BackgroundChanges in neuromuscular ability in middle age (MA) may lead to deterioration of postural control. The aim of this study was to investigate the anticipatory response of the peroneus longus muscle (PL) to landing after a single-leg drop-jump (SLDJ), and its postural response after an unexpected leg-drop in MA and young adults. A second aim was to investigate the influence of neuromuscular training on PL postural responses in both age groups.MethodsTwenty-six healthy MA (55.3 ± 4 years) and 26 healthy young adults (26.3 ± 3.6 years) participated in the study. Assessments were performed before (T0) and after (T1) PL EMG biofeedback (BF) neuromuscular training. Subjects performed SLDJ, and PL EMG activity in preparation for landing (% of flight time) was calculated. To measure PL time to activation onset and time to peak activation in response to an unexpected leg-drop, subjects stood on a customized trapdoor device that produced a sudden 30° ankle inversion.ResultsBefore training, the MA group showed significantly shorter PL activity in preparation for landing compared to the young adults (25.0% vs. 30.0%, p = 0.016), while after training there was no difference between the groups (28.0% vs. 29.0%, p = 0.387). There were no differences between groups in peroneal activity after the unexpected leg-drop before and after training.ConclusionsOur results suggest that automatic anticipatory peroneal postural responses are decreased at MA, whereas reflexive postural responses appear to be intact in this age group. A short PL EMG-BF neuromuscular training may have an immediate positive effect on PL muscle activity at MA. This should encourage the development of specific interventions to ensure better postural control in this group.Trial registrationClinicalTrials.gov NCT05006547.

The effect of EMG biofeedback training on muscle activation in an impingement population

Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p=0.003) and 90° (p=0.036), LT activity was increased at all measured humeral angles (p<0.0005), and SA muscle activity was increased at 110° (p=0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature.

Is There a Standard Rehabilitation Procedure in Cervical Dystonia?

Introduction: Idiopathic cervical dystonia, also known as spasmodic torticollis, is the most common form of focal dystonia in adults. Cervical dystonia usually appears between the ages of 30 and 50, twice as often in women, and is characterised by uncontrollable painful contractions of the sternocleidomastoid muscle, which results in misalignment of the head and shoulder. Over time, the disease becomes very burdensome for the patient and reduces his/her independence and quality of life; falls happen.Aim: The aim of the article is to present the current state of knowledge on comprehensive rehabilitation in cervical dystonia. Data on the prevalence, symptoms, diagnosis, clinical assessment, pharmacological treatment (including the most commonly used botulinum toxin), neurosurgical treatment and comprehensive rehabilitation are presented.Methods: The applied methods was a narrative critical review of scientific reports.Results: Out of several hundred publications, works worthy of particular attention were selected. In them, are described of conducting exercises, the main goal of which is to stretch and relax the dystonic muscles while strengthening the antagonistic muscles and correcting the position of the head. The selected authors used manual therapy, exercises at the patient's home, EMG biofeedback, magnetic stimulation of the cerebellum, vibration of the neck muscles, functional electrostimulation (FES) of antagonistic muscles, mobilisation of the cervical spine, postural exercises, isometric exercises, muscle relaxation, the PNF method, relaxation training, balance exercises, coordination, corrective exercises, massage, relaxation exercises, stretching and kinesiotaping.Conclusions: The variety of disease forms (10 head positioning patterns are described) and different severity of symptoms make it impossible to draw up a scheme of rehabilitation. In each case, rehabilitation must be tailored individually, and the physiotherapist taking care of the patient should have extensive experience. Physiotherapy can alleviate the disability caused by dystonia, however, due to the many non-motor symptoms, a holistic approach to the patient should also be kept in mind.

Effect of Biofeedback-Based Interventions on the Psychological Outcomes of Pediatric Populations: A Systematic Review and Meta-analysis.

We performed a systematic and meta-analytic review of biofeedback-based interventions on psychological outcomes among pediatric populations. The literature search for this study was conducted in eight databases, including PubMed, the Cochrane Library, Scopus, CINAHL, Embase (OVID), Web of Science, PsycINFO (all via Ovid SP), and Google Scholar. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies that was developed by the Joanna Briggs Institute. We analyzed the effects of biofeedback-based interventions on psychological outcomes in the pediatric population by following the Preferred Reporting System for Systematic Reviews and Meta-Analysis. This systematic review and meta-analysis included nine studies with a total sample size of 658 children. In this study, EEG, EMG, and heart rate variability biofeedback were utilized to treat psychological symptoms in children. All studies focused on anxiety, with only one studying depression. As a result, it was found that all types of biofeedback effectively reduced children's anxiety levels. It was recommended that biofeedback-based interventions should be used to reduce children's anxiety.

Interaction with a Hand Rehabilitation Exoskeleton in EMG-Driven Bilateral Therapy: Influence of Visual Biofeedback on the Users' Performance.

The effectiveness of EMG biofeedback with neurorehabilitation robotic platforms has not been previously addressed. The present work evaluates the influence of an EMG-based visual biofeedback on the user performance when performing EMG-driven bilateral exercises with a robotic hand exoskeleton. Eighteen healthy subjects were asked to perform 1-min randomly generated sequences of hand gestures (rest, open and close) in four different conditions resulting from the combination of using or not (1) EMG-based visual biofeedback and (2) kinesthetic feedback from the exoskeleton movement. The user performance in each test was measured by computing similarity between the target gestures and the recognized user gestures using the L2 distance. Statistically significant differences in the subject performance were found in the type of provided feedback (p-value 0.0124). Pairwise comparisons showed that the L2 distance was statistically significantly lower when only EMG-based visual feedback was present (2.89 ± 0.71) than with the presence of the kinesthetic feedback alone (3.43 ± 0.75, p-value = 0.0412) or the combination of both (3.39 ± 0.70, p-value = 0.0497). Hence, EMG-based visual feedback enables subjects to increase their control over the movement of the robotic platform by assessing their muscle activation in real time. This type of feedback could benefit patients in learning more quickly how to activate robot functions, increasing their motivation towards rehabilitation.

Biofeedback EMG alternative therapy for chronic low back pain (the BEAT-pain study).

The aim of this study was to assess the feasibility and potential effectiveness of an 8-week virtual EMG biofeedback intervention for patients with CLBP. Patients with CLBP completed validated baseline and post-intervention assessments of pain intensity and interference (Brief Pain Inventory), back pain-related disability (Oswestry Disability Index), anxiety and depression (Hospital Anxiety and Depression Scale). Participants underwent a series of Quantitative Sensory Testing (QST) procedures assessing responses to mechanical stimuli during two separate visits (baseline and post-intervention). In addition, we assessed, using surface EMG, the muscle tension in the trapezius, latissimus, and low back muscles at each session. Patients were randomized into the EMG biofeedback intervention or usual care group. Factorial analysis of variance including the interaction between treatment group and time was used to analyze the changes in pain intensity (primary outcome), pain interference, disability (secondary outcomes), anxiety, and depression (secondary outcomes). Compared to the treatment as usual comparison group, patients in the EMG biofeedback group reported lower pain intensity after completing the intervention (mean group difference 0.9, 95% CI -1.07, -0.32; p≤0.01). Compared to baseline, participants in the EMG biofeedback group demonstrated statistically significant reductions in pain interference (mean difference 1.3, 95% CI 0.42, 2.1; p≤0.01), disability (mean difference 4.32, 95% CI 1.2, 7.3; p≤0.01), and significant increases in low back pain thresholds (mean difference 0.5, 95% CI -0.87, -0.05; p≤0.01), assessed by QST. However, no significant group by time effects were observed for secondary outcomes: pain interference, disability, and low back pain thresholds. In addition, significant changes were observed in muscle tension for the trapezius, latissimus, and low back muscles in the EMG biofeedback group (p<0.001). Virtual EMG biofeedback shows promise as a potential therapy for reducing pain and disability in individuals with chronic nonspecific low back pain.

Optimal bipolar system positioning to provide information about the trapezius activity associated with scapular retraction during shoulder exercises for resistance training

Objective. Recently, the use of EMG biofeedback to make subjects aware of the stabilizer activation associated with scapular retraction during exercise has been of interest, and challenges related to EMG detection have been addressed. Whether there is an optimal bipolar positioning that discriminates the stabilizer activation with retraction from a neutral scapular position during resistance exercises is an open issue that we address here by simultaneously mapping different positions using high-density surface electromyography (HD-sEMG). Approach. Sixteen resistance-trained males performed five pulling exercises with and without scapular retraction, namely barbell rows, dumbbell rows, pull-downs at a lat machine, seated rows, and TRX (total resistance exercises) system rows. HD-sEMG was acquired in a monopolar mode from the medial and lower trapezius (8 × 4 electrodes and inter-electrode distance (ied): 10 mm) and different bipolar systems were simulated in terms of positioning, interelectrode distance, and orientation with respect to the spine: longitudinal with three ieds (20 mm, 30 mm, and 40 mm), one transversal, and two diagonals (ied: 20 mm), totalling six EMG sets. To identify the optimal electrode pair that was able to distinguish between the presence or absence of scapular retraction, we computed: (i) the root mean square (RMS) map for each condition and the difference between them, obtaining a differential RMS map per subject; and (ii) the intersection of cumulative maps, by summing the differential (binary) maps from all subjects. Main results. For the lower trapezius, the results revealed that the diagonal direction (45 degrees; ied: 20 mm) obtained the greater occurrence of intersecting segments within and between exercises than the other electrode configurations, showing low variability for the optimal positioning across exercises. Electrode configuration varied within and between the pulling exercises for the medial trapezius. Significance. This study allows us to identify an optimal bipolar positioning (consistent across subjects and exercises) for lower trapezius activity assessment, representing a guideline for electrode positioning when EMG biofeedback is adopted for selective activation of the lower trapezius during pulling exercises.

The Effect of Modified Push-up Exercise Using Electromyography Biofeedback on Selection of Scapular Stabilizing Muscles

Background: The serratus anterior (SA) muscle is an important scapular stabilizer and has a profound role in retaining the scapulohumeral rhythm. Therefore, modified push-up plus (MPUP) has been advised to strengthen this muscle as a closed chain workout. However, few previous studies have reported the possibility of a reparative motion from pectoralis major (PM) that could replace and amend SA's function during push-up plus. Objectives: The current study examined MPUP's effect using biofeedback EMG on some of the selected scapular stabilizers. Methods: Sixteen healthy young subjects voluntarily participated in this study. Each subject performed push-ups, from the quadruped position, under two conditions (i.e., with or without visual and auditory biofeedback). Surface EMG measured pectoralis major, serratus anterior, and upper trapezius activity. A paired t-test was used to determine any statistically significant difference between the two conditions. Additionally, the effect size was calculated to quantify the magnitude of EMG biofeedback in each muscle. Results: MPUP training using biofeedback significantly increased SA muscle activity and decreased PM muscle activity, but there was no significant change in UT activity. Conclusions: Excessive PM activity was repressed because of biofeedback, and the workout was done with the enhancement of SA muscular activity. Thus, including biofeedback while doing MPUPs helps limit PM's supplementary action and enhance SA muscle activity.

Biofeedback EMG alternative therapy for chronic low back pain: Study protocol of a pilot randomized controlled trial

BackgroundChronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Although there is evidence that non-pharmacological therapies seem to be effective for treating low back pain, there is limited evidence of the effectiveness of EMG biofeedback with non-specific chronic low back pain (NCLBP). The purpose of this study is, therefore, to determine the efficacy of a portable EMG biofeedback device on pain in individuals with CLBP. Methods/designThis study is a prospective, single-center, assessor-blind, two-arm, parallel randomized controlled trial to be conducted at Brigham and Women's Hospital, Boston, MA. Eighty patients with CLBP will be randomized in a 2:1 ratio to receive sEMG-BF (surface EMG biofeedback) or continued care (no intervention). All participants will receive treatment virtually weekly for 8 weeks. The primary outcome will be pain intensity (Brief Pain Inventory). The secondary outcomes will include pain interference (Brief Pain Inventory), disability (The Oswestry Disability Index (ODI)), anxiety and depression (Hospital Anxiety and Depression Scale). All outcomes will be assessed at baseline, immediately post-intervention, and 3 months follow-up. ConclusionTo our knowledge, this study will be the first powered randomized controlled trial to compare the effectiveness of a virtual sEMG-BF protocol specifically designed for CLBP. The outcome of the study may provide evidence for the effectiveness of biofeedback using digital therapeutics to relieve pain in individuals with CLBP.Trial registration: Clinical Trials Registry (http://ClinicalTrials.gov Identifier: NCT04607460). Registered on October 29, 2020.

Combined spatial and frequency encoding for electrotactile feedback of myoelectric signals

Electrotactile stimulation has been commonly used in human–machine interfaces to provide feedback to the user, thereby closing the control loop and improving performance. The encoding approach, which defines the mapping of the feedback information into stimulation profiles, is a critical component of an electrotactile interface. Ideally, the encoding will provide a high-fidelity representation of the feedback variable while being easy to perceive and interpret by the subject. In the present study, we performed a closed-loop experiment wherein discrete and continuous coding schemes are combined to exploit the benefits of both techniques. Subjects performed a muscle activation-matching task relying solely on electrotactile feedback representing the generated myoelectric signal (EMG). In particular, we investigated the performance of two different coding schemes (spatial and spatial combined with frequency) at two feedback resolutions (low: 3 and high: 5 intervals). In both schemes, the stimulation electrodes were placed circumferentially around the upper arm. The magnitude of the normalized EMG was divided into intervals, and each electrode was associated with one interval. When the generated EMG entered one of the intervals, the associated electrode started stimulating. In the combined encoding, the additional frequency modulation of the active electrode also indicated the momentary magnitude of the signal within the interval. The results showed that combined coding decreased the undershooting rate, variability and absolute deviation when the resolution was low but not when the resolution was high, where it actually worsened the performance. This demonstrates that combined coding can improve the effectiveness of EMG feedback, but that this effect is limited by the intrinsic variability of myoelectric control. Our findings, therefore, provide important insights as well as elucidate limitations of the information encoding methods when using electrotactile stimulation to convey a feedback signal characterized by high variability (EMG biofeedback).

Effectiveness of functional task training (FTT) versus EMG bio-feedback training to reduce pain, improve strength and functional mobility in knee osteoarthritis

Study design :Quasi –experimental study. Objectives : To compare the effectiveness of Functional task training Versus EMG biofeedback, along with conventional physical therapy in the management of knee osteoarthritis. Background: Osteoarthritis is the most common disease affecting synovial joints characterized by degenerative structural remodeling of joint cartilage and of underlying subchondral bone, which again leads to pain and disability. The aim of the study was to compare the effectiveness of Functional task training Versus EMG biofeedback along with conventional physical therapy to reduce pain, improve strength and functional mobility in knee osteoarthritis Methods: In the 5- week intervention study, 30 participants diagnosed with knee osteoarthritis were divided into two groups by convenience sampling, Group A:(n=15) Functional task training along with conventional exercise program was applied and Group B:(n=15) EMG biofeedback along with conventional exercise program. For both groups, treatment consisted of 1 session/day, 5 days/week for 5 weeks. Data was collected and analyzed using SPSS 23. Results: A significant reduction in pain (p&lt;0.05), improvement in the strength of the quadriceps muscle (p&lt;0.05) and increase in knee function between (p&lt;0.05) pre- and post- treatment stages in both groups.

Effect of EMG, RESP, and TEMP Biofeedback Training to reduce Anxiety among Undergraduate Students

Background: It is evident that anxiety and stress are two of the main predominant issues that cause several mental health problems and disorders in university students, causing a negative impact on this population. Higher educational institutes in Pakistan have limited access and resources to face these issues. It is suggested that biofeedback-aided relaxation training has been effective in alleviating anxiety and stress symptoms among undergraduate students, especially during their examination season. Recent research has proven biofeedback to be effective training for anxious students. The current randomized control trial is planned to investigate the effectiveness of Electromyography-EMG, Respiration Rate-RESP, and Skin Temperature-TEMP biofeedback training for reducing anxiety symptoms among nursing students be receiving 8 sessions for 4 weeks.&#x0D; Methodology: This study is planned to investigate the effectiveness of EMG, RESP, and TEMP Biofeedback Training in reducing symptoms of anxiety among the nursing students from one school, and to determine whether biofeedback training is associated with relaxing the minds and bodies of the anxious nursing students to cope with the distressing situation. Study subjects meeting the eligibility criteria will be randomized into two groups using randomly generated numbers: the Biofeedback training group and the Control group. Biofeedback training will be used as an intervention vs. the control. All the study subjects who give consent to participate will be made to complete the study questionnaires (Demographic, Screening for Anxiety using the State-Trait Anxiety Inventory –STAI) at baseline and post-intervention (after 4 weeks).&#x0D; Discussion: This study might help us determine biofeedback as a possible effective and useful technique in helping nursing students manage their anxiety. Moreover, it is suggested that Individuals receiving biofeedback training tend to show significant changes for the three psychophysiological modalities, i.e., EMG, RESP, and TEMP. This study might also give us insight into the efficacy of biofeedback in the Pakistani population seeking help for stress and anxiety.