Stroke. 2007;38:1999-2000
Published online before print April 19, 2007,
doi: 10.1161/STROKEAHA.107.482687
(Stroke. 2007;38:1999.)
© 2007 American Heart Association, Inc.
Electromyographic Biofeedback for the Recovery of Motor Function After Stroke
Henry J. Woodford, BSc, MRCP
Christopher Price, MD, MRCP
From the Cumberland Infirmary (H.J.W.), Cumbria, UK; and the Northumbria Healthcare Trust (C.P.), Northumberland, UK.
Correspondence to Henry J. Woodford, Cumberland Infirmary, Newtown Rd, Carlisle, Cumbria, UK CA2 7HY. E-mail henry.woodford{at}ncumbria-acute.nhs.uk
Graeme J. Hankey MD, FRCP Section Editor:
Key Words: biofeedback • EMG • physiotherapy • rehabilitation • stroke • stroke recovery
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Introduction
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The specific objective of this review was to determine the efficacy
of any form of electromyographic biofeedback (EMG-BFB) used
after a stroke in order to aid motor function recovery.
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Search Strategy
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We searched the Cochrane Stroke Group Trials Register (last
searched March 30, 2006), the Cochrane Central Register of Controlled
Trials (CENTRAL; The Cochrane Library Issue 4, 2005), MEDLINE
(1966 to November 2005), EMBASE (1980 to November 2005), CINAHL
(1983 to November 2005), PsycINFO (1974 to November 2005) and
First Search (1966 to November 2005). We scanned reference lists
for relevant articles and contacted equipment manufacturers
and distributors
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Selection Criteria
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Randomized and quasirandomized studies comparing EMG-BFB with
control for motor function recovery in stroke patients.
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Data Collection & Analysis
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Two review authors independently assessed trial quality and
extracted data. Where possible we contacted study authors for
further information. Any reported adverse effects were noted.
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Main Results
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Thirteen trials involving 269 people were included. All trials
compared EMG-BFB plus standard physiotherapy to standard physiotherapy
either alone or with sham EMG-BFB. Only 1 study used a motor
strength assessment scale for evaluation of patients, which
indicated benefit from EMG-BFB (weighted mean difference 1.09;
95% CI, 0.48 to 1.70). EMG-BFB did not have a significant benefit
in improving range of motion through the ankle (standardized
mean difference 0.05; 95% CI, –0.36 to 0.46), knee or
wrist joints. However, 1 trial suggested a benefit in range
of motion at the shoulder (standardized mean difference 0.88;
95% CI, 0.07 to 1.70). Change in stride length or gait speed
was not improved by EMG-BFB. Two studies used different assessment
scores to quantify gait quality. One of these suggested a beneficial
effect of EMG-BFB (standardized mean difference 0.90; 95% CI,
0.01 to 1.78). Most of the studies examining functional outcomes
used different assessment scales, which made meta-analysis impossible.
Two studies that used the same scale did show a beneficial effect
(standardized mean difference 0.69; 95% CI, 0.15 to 1.23;
Figure).
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Implications for Practice
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When all the available data are combined, EMG-BFB does not appear
to have any positive benefit for recovery after stroke. It cannot
be recommended as a routine treatment. A small amount of evidence
from individual studies suggests that using EMG-BFB in combination
with standard physiotherapy regimes may result in improvements
in motor power, range of motion at the shoulder, functional
recovery and gait quality beyond those of standard physiotherapy
alone. Because there were no reported adverse effects, it would
seem reasonable for EMG-BFB to be considered as a cautious treatment
approach for individual patients whose circumstances match the
inclusion criteria of the studies included in this review.
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Implications for Research
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There is need for a randomized clinical trial with adequate
power, using standardized assessment scales and robust adverse
event reporting, to assess the effectiveness of EMG-BFB.
Received January 23, 2007;
revision received February 23, 2007;
accepted March 1, 2007.
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Introduction
Search Strategy