[EMG biofeedback training at home for patient with chronic facial palsy and defective healing]. / EMG Biofeedback Training zuhause zur Therapie der Defektheilung bei chronischer Fazialisparese.

BACKGROUND: There is no standard for the adjuvant treatment of patients with chronic facial palsy and defective healing. There is a lack of standard for mimic training programs with biofeedback technique. The advantages of modern EMG based biofeedback training have not been evaluated yet. MATERIAL AND METHODS: After detailed instruction 8 patients with facial palsy tested several types of electrodes and different EMG biofeedback programs without and with electrostimulation for selected mimic muscle activation, muscle relaxation, coordinated movements with the healthy contralateral side, as well as synchronous activation and relaxation of synkinetic muscle pairs at home. Feasibility, practical handling, training intensity and compliance were evaluated. RESULTS: Because of the mobility of the facial skin connected to the mimic muscles and the smallness of the muscles on the other hand, only one type of electrodes and one size was suitable. A step-wise treatment algorithm for the use of the different EMG biofeedback program was developed supporting the patient to specifically exercise deficits of defective healing at home. CONCLUSION: The proposed standardized algorithm to treat facial defective healing with EMG biofeedback is the basis for the evaluation of its efficacy in a subsequent clinical trial.

Postural responses without versus with acute external cervical spine fixation: a comparative study in healthy subjects and patients with acute unilateral vestibular loss.

Using a diagnostic prospective cohort single center study design, the influence of a cervical collar on standing balance during dynamic postural perturbations in healthy adults and patients with acute unilateral vestibular dysfunction was measured in 31 healthy subjects and 27 patients with acute unilateral vestibular loss. The main outcome measures were completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest(®) computerized posturography platform measured without and with acute cervical fixation, respectively. Paired t test showed no significant difference during the six conditions of neither the SOT scores nor analyzing the SOT strategies or during the MCT between the non-fixed and fixed neck in healthy subjects and in the patients (all p > 0.05). Older healthy subjects showed decreased SOT scores but equal MCT results. The age effect was more dominant in the patients when wearing the collar. Gender had no influence whether in healthy individuals nor in patients. In almost all conditions of the SOT but only in some MCT subtests patients had significantly lower scores than healthy subjects without collar and with collar (all p < 0.05). In conclusion, the SOT but only some subtest of the MCT could clearly distinguish between healthy adults and patient with acute unilateral vestibular loss. Equilibrium scores did not change significantly when the cervical spine was fixed with a collar. Acute fixation of the neck with a collar seems not to affect standing balance, even not when vestibular, visual and/or somatosensory input are also reduced.