Applicability of Mobile Based Electromyography Visual Biofeedback Training to Improvement of Muscle Activity and Joint Range of Motions of Stroke Patients: A Pilot Study

Abstract

Background Recently, a lot of visual feedback training equipment using the electromyography in a mobile environment has been developed. These devices are small, easy to use, and inexpensive. Despite the various advantages of such equipment, it is still not widely used in the clinical field, and research on it is lacking.

Objective The purpose of this study is to introduce the mobile-based electromyography visual feedback training equipment and evaluate the usability for the muscle activity improvements in stroke patients.

Methods This study was conducted in 12 patient with chronic stroke. To evaluate the usability of mobile-based electromyography training equipment, this research compared the immediate effects of the traditional tactile feedback training and the mobile-based electromyography training on 12 stroke patients. The MVIC muscle activity of the tibialis anterior, quadriceps femoris and gluteus maximus as well as the range of motion of the ankle dorsiflexion, hip joint extension and knee joint extension were measured before and after intervention.

Resutls As a result of this study, the tibialis anterior, quadriceps femoris, and gluteus maximus muscle activity were all significantly different in mobile-based electromyography visual feedback training. In the comparison of the effects on the range of motion, there was a significant difference in mobile-based electromyography visual feedback training only in the knee extension.

Conclusions Mobile-based electromyography visual feedback training is expected to be able to improve muscle activity and range of motion in stroke patients more effectively than conventional tactile training.

Zusammenfassung

Hintergrund In letzter Zeit wurden viele Trainingsgeräte für visuelles Feedback entwickelt, die die Elektromyographie in einer mobilen Umgebung verwenden. Diese Geräte sind klein, einfach zu bedienen und kostengünstig. Trotz der verschiedenen Vorteile solcher Geräte ist sie im klinischen Bereich noch nicht weit verbreitet, und es fehlt die Forschung dazu.ZIEL  Das Ziel dieser Studie ist es, das mobilbasierte elektromyographische visuelle Feedback-Trainingsgerät vorzustellen und die Anwendbarkeit für die Verbesserung der Muskelaktivität bei Schlaganfallpatienten zu bewerten.

Methoden Diese Studie wurde bei 12 Patienten mit chronischem Schlaganfall durchgeführt. Um die Benutzerfreundlichkeit von mobilbasierten Elektromyographie-Trainingsgeräten zu bewerten, wurden in dieser Studie die unmittelbaren Auswirkungen des traditionellen taktilen Feedback-Trainings und des mobilbasierten Elektromyographie-Trainings bei 12 Schlaganfallpatienten verglichen. Die MVIC-Muskelaktivität des M. tibialis anterior, des Quadrizeps femoris und des Gluteus maximus sowie der Bewegungsumfang der Knöcheldorsalflexion, Hüftgelenkstreckung und Kniegelenkstreckung wurden vor und nach der Intervention gemessen.

Ergebnisse Als Ergebnis dieser Studie waren die Muskelaktivität des Tibialis anterior, des Quadrizeps und des Gesäßmuskels beim mobilbasierten visuellen Feedback-Training mit Elektromyographie signifikant unterschiedlich. Im Vergleich der Effekte auf den Bewegungsumfang zeigte sich ein signifikanter Unterschied beim mobilbasierten elektromyographischen visuellen Feedback-Training nur in der Kniestreckung.

Schlussfolgerungen Es wird erwartet, dass mobilbasiertes elektromyographisches visuelles Feedback-Training die Muskelaktivität und den Bewegungsumfang bei Schlaganfallpatienten effektiver verbessern kann als konventionelles taktiles Training.

Key words

Visual Feedback - Sensory Feedbacks - stroke - Electromyography - Mobile Health Units

Schlüsselwörter

Visuelles Feedback - Sensorische Rückmeldungen - Schlaganfall - Elektromyographie - Mobile Gesundheitseinheiten

Publication History

Received: 30 July 2021

Accepted: 02 May 2022

Article published online:
26 July 2022

• References

• 1 Fatahzadeh M, Glick M. Stroke: epidemiology, classification, risk factors, complications, diagnosis, prevention, and medical and dental management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 180-191 Epub 2006/08/01
• 2 Khademi-Kalantari K, Rahimi F, Hosseini SM, Baghban AA, Jaberzadeh S. Lower limb muscular activity during walking at different speeds: Over-ground versus treadmill walking: A voluntary response evaluation. Journal of bodywork and movement therapies 2017; 21: 605-11.
• 3 Mauritz KH. Gait training in hemiplegia. Eur J Neurol 2002; 9: 23-29 dicussion 53–61. Epub 2002/03/29
• 4 Mauritz KH. Gait training in hemiplegia. Eur J Neurol 2002; 1: 23-29
• 5 Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture 2010; 31: 241-246 Epub 2009/11/26
• 6 Bohannon RW. Muscle strength and muscle training after stroke. Journal of rehabilitation medicine 2007; 39: 14-20 Epub 2007/01/17
• 7 Wist S, Clivaz J, Sattelmayer M. Muscle strengthening for hemiparesis after stroke: A meta-analysis. Ann Phys Rehabil Med 2016; 59: 114-124
• 8 Kondo K, Noonan KM, Freeman M, Ayers C, Morasco BJ, Kansagara D. Efficacy of Biofeedback for Medical Conditions: an Evidence Map. J Gen Intern Med 2019; 34: 2883-93.
• 9 Stanton R, Ada L, Dean CM, Preston E. Biofeedback improves activities of the lower limb after stroke: a systematic review. Journal of physiotherapy. 2011; 57: 145-155 Epub 2011/08/17
• 10 Ploughman M, Shears J, Quinton S, Flight C, O’Brien M, MacCallum P. et al. Therapists’ cues influence lower limb muscle activation and kinematics during gait training in subacute stroke. Disabil Rehabil 2018; 40: 3156-3163
• 11 Afzal MR, Pyo S, Oh MK, Park YS, Yoon J. Evaluating the effects of delivering integrated kinesthetic and tactile cues to individuals with unilateral hemiparetic stroke during overground walking. J Neuroeng Rehabil 2018; 15: 018-0372.
• 12 Van Peppen RP, Kortsmit M, Lindeman E, Kwakkel G. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. Journal of rehabilitation medicine 2006; 38: 3-9 Epub 2006/03/22
• 13 Zhang JJQ, Fong KNK, Welage N, Liu KPY. The Activation of the Mirror Neuron System during Action Observation and Action Execution with Mirror Visual Feedback in Stroke: A Systematic Review. Neural plasticity. 2018; 2018: 2321045 Epub 2018/06/02
• 14 Tornbom K, Danielsson A. Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury – A qualitative study. PLoS One 2018; 13: e0209214 Epub 2018/12/15
• 15 Tamburella F, Moreno JC, Herrera Valenzuela DS, Pisotta I, Iosa M, Cincotti F. et al. Influences of the biofeedback content on robotic post-stroke gait rehabilitation: electromyographic vs joint torque biofeedback. J Neuroeng Rehabil 2019; 16: 019-0558.
• 16 Tsaih PL, Chiu MJ, Luh JJ, Yang YR, Lin JJ, Hu MH. Practice Variability Combined with Task-Oriented Electromyographic Biofeedback Enhances Strength and Balance in People with Chronic Stroke. Behav Neurol. 2018 26. (7080218)
• 17 Chung E, Lee BH, Hwang S. Core stabilization exercise with real-time feedback for chronic hemiparetic stroke: a pilot randomized controlled trials. Restorative neurology and neuroscience 2014; 32: 313-321 Epub 2014/01/09
• 18 Rayegani SM, Raeissadat SA, Sedighipour L, Rezazadeh IM, Bahrami MH, Eliaspour D. et al. Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients. Top Stroke Rehabil 2014; 21: 137-151
• 19 Dawes J, Brian M, Bialek H, Johnston ML. Wireless Smartphone Control using Electromyography and Automated Gesture Recognition. Conf Proc IEEE Eng Med Biol Soc 2018; 10: 8513640
• 20 Weon J-H, Kwon O-Y, Cynn H-S, Lee W-H, Kim T-H, Yi C-H. Real-time visual feedback can be used to activate scapular upward rotators in people with scapular winging: an experimental study. Journal of physiotherapy 2011; 57: 101-107
• 21 Crowell HP, Milner CE, Hamill J, Davis IS. Reducing impact loading during running with the use of real-time visual feedback. J Orthop Sports Phys Ther 2010; 40: 206-213
• 22 Booth AT, Buizer AI, Harlaar J, Steenbrink F, van der Krogt MM. Immediate effects of immersive biofeedback on gait in children with cerebral palsy. Archives of Physical Medicine and Rehabilitation 2019; 100: 598-605
• 23 Hald RD, Bottjen EJ. Effect of visual feedback on maximal and submaximal isokinetic test measurements of normal quadriceps and hamstrings. J Orthop Sports Phys Ther 1987; 9: 86-93
• 24 Xu L, Hwang B, Kim T. The Effect of postural correction and visual feedback on muscle activity and head position change during overhead arm lift test in subjects with forward head posture. The. Journal of Korean Physical Therapy 2019; 31: 151-156
• 25 Chuang L-L, Chen Y-L, Chen C-C, Li Y-C, Wong AM-K, Hsu A-L. et al. Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: a randomized controlled trial. Journal of neuroengineering and rehabilitation 2017; 14: 1-12.
• 26 E C. Cram’s introduction to surface electromyography: Jones & Bartlett Learning; 2 edition; 2010
• 27 Herrington L, Pearson S. Does level of load affect relative activation levels of vastus medialis oblique and vastus laterialis?. J Electromyogr Kinesiol 2006; 16: 379-383 Epub 2005/11/04
• 28 Bishop BN, Greenstein J, Etnoyer-Slaski JL, Sterling H, Topp R. Electromyographic Analysis of Gluteus Maximus, Gluteus Medius, and Tensor Fascia Latae During Therapeutic Exercises With and Without Elastic Resistance. Int J Sports Phys Ther 2018; 13: 668-675 Epub 2018/08/25
• 29 Wasaka T, Kakigi R. Conflict caused by visual feedback modulates activation in somatosensory areas during movement execution. Neuroimage. 2012; 59: 1501-1507 Epub 2011/09/06
• 30 Shu X, Chen S, Meng J, Yao L, Sheng X, Jia J. et al. Tactile Stimulation Improves Sensorimotor Rhythm-based BCI Performance in Stroke Patients. IEEE Trans Biomed Eng. 2018 Epub 2018/11/20
• 31 Weakley JJS, Wilson KM, Till K, Read DB, Darrall-Jones J, Roe GAB. et al. Visual Feedback Attenuates Mean Concentric Barbell Velocity Loss and Improves Motivation, Competitiveness, and Perceived Workload in Male Adolescent Athletes. Journal of strength and conditioning research 2019; 33: 2420-2425 Epub 2017/07/14
• 32 Del Din S, Bertoldo A, Sawacha Z, Jonsdottir J, Rabuffetti M, Cobelli C. et al. Assessment of biofeedback rehabilitation in post-stroke patients combining fMRI and gait analysis: a case study. Journal of neuroengineering and rehabilitation 2014; 11: 53
• 33 Zhu RH, Yang M, Dai JL, Zhu XH, Bi H, Sun L. et al. Treatment of Stroke Patients with Shoulder-wrist Syndrome by Acupoint Catgut Embedding and Surface Electromyogram Biofeedback Therapy. Zhen ci yan jiu=Acupuncture research 2018; 43: 380-383 Epub 2018/08/10
• 34 Vattanasilp W, Ada L, Crosbie J. Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke. Journal of neurology, neurosurgery, and psychiatry 2000; 69: 34-39 Epub 2000/06/23