ABSTRACT
BACKGROUND: Electromyographic biofeedback (EMG-BFB) has shown equivocal benefits on gait retraining after stroke. OBJECTIVE: The authors evaluated the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis. METHODS: They assigned 20 participants randomly to the EMG-BFB group or a control group that received conventional therapy for the same duration. Quantitative gait analysis was performed before and after treatment. The EMG-BFB involved the triceps surae during functional gait activities. Treatment was administered with a fading frequency of BFB application and an increasing variability in gait activities. Both groups had 20 treatment sessions of 45 minutes each, including at least 15 minutes of walking-related therapy for the control group. Follow-up (FU) gait analysis was obtained 6 weeks after training. RESULTS: BFB treatment led to significant increases (P < .01) in peak ankle power at push-off (from 0.63 W/kg to 1.04 W/kg) in conjunction with significant increases in velocity (from 28.3 %h/s--normalized to percentage height per second--to 39.6 %h/s) and stride length (from 44.5 %h--normalized to percentage height--to 57.6 %h). Increases remained significant at FU. There were no changes in any gait variable in the control group. CONCLUSION: A task-oriented BFB treatment was effective in increasing peak ankle power, gait velocity, and stride length in a population with hemiparesis. Further studies should compare the combination intervention with either of its components in more impaired patients.
Subject(s)
Biofeedback, Psychology/methods , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/rehabilitation , Physical Therapy Modalities , Stroke/complications , Aged , Analysis of Variance , Biomechanical Phenomena , Chronic Disease , Female , Follow-Up Studies , Gait/physiology , Humans , Knee/innervation , Male , Middle Aged , Outcome Assessment, Health Care , Reflex/physiology , Retrospective StudiesABSTRACT
OBJECTIVE: The impact of electromyographic biofeedback (EMG BFB) applied during functional gait activities and employed in accord with theories on motor learning was investigated in a chronic hemiplegic patient. METHODS: A single-subject A-B design was used. EMG BFB was applied to the triceps surae during gait. A rehabilitation program with a fading frequency of BFB application and an increasing variability in the task training was implemented. Responses to the rehabilitation program were documented via multiple quantitative gait analyses, performed during a baseline, treatment, and at follow-up 6 weeks after the end of treatment. RESULTS: From baseline to end of treatment, there were significant changes in ankle power at push-off, both in amplitude and timing, as well as onset of ankle power at push-off relative to heel strike of the healthy leg. There was a significant increase in gait velocity, step length of the healthy side, stride length, and stride frequency. At follow-up, changes were still significantly different from baseline and the patient had reduced the use of the cane in activities of daily living. CONCLUSIONS: BFB appears to have been effective in promoting positive changes in gait in this pilot study. The rehabilitation protocol also appeared to be effective in promoting learning and the incorporation of trained activities into daily activities.
