Effect of electromyographic biofeedback training on motor function of quadriceps femoris in patients with incomplete spinal cord injury: A randomized controlled trial

Abstract

BACKGROUND:

Electromyographic biofeedback (EMG BF) training is an effective method of promoting motor learning and control in neurorehabilitation, but its effect on quadriceps femoris muscle in individuals with spinal cord injury (SCI) is unknown.

OBJECTIVE:

The aim of the study was to investigate the therapeutic effect of EMG BF training on motor function of quadriceps femoris in patients with incomplete SCI.

METHODS:

Thirty-three incomplete paraplegic patients with quadriceps femoris strength ranging grade 1 to grade 3 less than 6 months post-injury were enrolled. Control group (n = 16) received conventional physical therapy to enhance quadriceps femoris strength, while intervention group (n = 17) was treated with conventional physical therapy and EMG BF training. All received treatment once a day for 30 days. Surface electromyograph (sEMG), muscle strength and thigh circumference size were assessed to evaluate motor function of quadriceps femoris. Activities of daily living (ADL) was evaluated by Modified Barthel Index (MBI). All the measures evaluated three times in total.

RESULTS:

Compared to the control group, intervention group significantly improved on sEMG values and strength of quadriceps femoris (P_sEMG < 0.001, P_strength < 0.05). sEMG values of quadriceps femoris increased earlier than strength of quadriceps femoris in intervention group (P_rest = 0.07, P_active = 0.031). There were no statistical differences in thigh circumference size and ADL scores between groups (P_thigh > 0.05, P_ADL = 0.423).

CONCLUSIONS:

EMG BF training appeared to be a useful tool to enhance motor function of quadriceps femoris in patients with incomplete SCI. sEMG could quantify the changes of single muscle myodynamia precisely before visible or touchable changes occur.

Keywords

Spinal cord injury quadriceps femoris electromyographic biofeedback rehabilitation

Get full access to this article

View all access options for this article.

References

Alam,

, Rodrigues,

, Pham,

B. N.

, & Thakor,

N. V.

(2016). Brain-machine interface facilitated neurorehabilitation via spinal stimulation after spinal cord injury: Recent progress and future perspectives. Brain Research, 1646, 25–33.

Anwer,

, Quddus,

, Miraj,

, & Equebal,

(2011). Effectiveness of electromyographic biofeedback training on quadriceps muscle strength in osteoarthritis of knee †. Archives of Physical Medicine & Rehabilitation, 29(2), 86–93.

Armadadasilva,

P. A.

, Pereira,

, Amado,

, & Veloso,

A. P.

(2013). Role of physical exercise for improving posttraumatic nerve regeneration. International Review of Neurobiology, 109(109C), 125–149.

Baumueller,

, Winkelmann,

, Irnich,

, & Weigl,

(2017). Electromyogram Biofeedback in Patients with Fibromyalgia: A Randomized Controlled Trial. Complementary Medicine Research, 24(1), 33–39.

Christanell,

, Hoser,

, Huber,

, Fink,

, & Luomajoki,

(2012). The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial. Sports Med Arthrosc Rehabil Ther Technol, 4(1), 41.

Criswell,

(2010). Cram’s Introduction to Surface Electromyography, 2nd Edition. Physiotherapy, 84(8), 405.

Croce,

R. V.

, & Miller,

J. P.

(2003). The effect of movement velocity and movement pattern on the reciprocal co-activation of the hamstrings. Electromyogr Clin Neurophysiol, 43(8), 451–458.

De Biase,

M. E.

, Politti,

, Palomari,

E. T.

, Barrosfilho,

T. E.

, & De Camargo,

O. P.

(2011). Increased EMG response following electromyographic biofeedback treatment of rectus femoris muscle after spinal cord injury. Physiotherapy, 97(2), 175–179.

Dietz,

, & Curt,

(2006). Neurological aspects of spinal-cord repair: promises and challenges. The Lancet Neurology, 5(8), 688–694.

10.

Durigan,

J. L.

, Delfino,

G. B.

, Peviani,

S. M.

, Russo,

T. L.

, Ramirez,

, Da,

S. G. A.

,... & Salvini,

T. F.

(2014). Neuromuscular electrical stimulation alters gene expression and delays quadriceps muscle atrophy of rats after anterior cruciate ligament transection. Muscle Nerve, 49(1), 120–128.

11.

Eid,

M. A.

, Aly,

S. M.

, & El-Shamy,

S. M.

(2016). Effect of Electromyographic Biofeedback Training on Pain, Quadriceps Muscle Strength, and Functional Ability in Juvenile Rheumatoid Arthritis. Am J Phys Med Rehabil, 95(12), 921–930.

12.

Fauth,

M. L.

, Petushek,

E. J.

, Feldmann,

C. R.

, Hsu,

B. E.

, Garceau,

L. R.

, Lutsch,

B. N.

,... & Ebben,

W. P.

(2010). Reliability of surface electromyography during maximal voluntary isometric contractions, jump landings, and cutting. J Strength Cond Res, 24(4), 1131–1137.

13.

Fu,

, Wang,

, Deng,

, & Li,

(2016). Exercise Training Promotes Functional Recovery after Spinal Cord Injury. Neural Plasticity, 2016, 1–7.

14.

Govil,

, & Noohu,

M. M.

(2013). Effect of EMG biofeedback training of gluteus maximus muscle on gait parameters in incomplete spinal cord injury. Neurorehabilitation, 33(1), 147–152.

15.

Hodson-Tole,

E. F.

, & Wakeling,

J. M.

(2009). Motor unit recruitment for dynamic tasks: current understanding and future directions. J Comp Physiol B, 179(1), 57–66.

16.

Holtermann,

, Mork,

P. J.

, Andersen,

L. L.

, Olsen,

H. B.

, & Sogaard,

(2010). The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance. J Electromyogr Kinesiol, 20(2), 359–365.

17.

Jensen,

M. P.

, Barber,

, Romano,

J. M.

, Hanley,

M. A.

, Raichle,

K. A.

, Molton,

I. R.

,... & Patterson,

D. R.

(2010). Effects of Self-Hypnosis Training and EMG Biofeedback Relaxation Training on Chronic Pain in Persons with Spinal-Cord Injury. International Journal of Clinical and Experimental Hypnosis, 57(3), 239–268.

18.

Jones,

M. L.

, Evans,

, Tefertiller,

, Backus,

, Sweatman,

, Tansey,

,... & Morrison,

(2014). Activity-Based Therapy for Recovery of Walking in Chronic Spinal Cord Injury: Results from a Secondary Analysis to Determine Responsiveness to Therapy. Archives of Physical Medicine & Rehabilitation, 95(12), 2247–2252.

19.

Kesemenli,

C. C.

, Sarman,

, Baran,

, Memisoglu,

, Binbir,

, Savas,

,... & Koc,

(2014). A new isometric quadriceps-strengthening exercise using EMG-biofeedback. International Journal of Clinical & Experimental Medicine, 7(9), 2651–2655.

20.

Kim,

C. M.

, Eng,

J. J.

, & Whittaker,

M. W.

(2004). Level walking and ambulatory capacity in persons with incomplete spinal cord injury: relationship with muscle strength. Spinal Cord, 42(3), 156–162.

21.

Kim,

K. S.

, Seo,

J. H.

, & Song,

C. G.

(2011). Portable measurement system for the objective evaluation of the spasticity of hemiplegic patients based on the tonic stretch reflex threshold. Medical Engineering & Physics, 33(1), 62–69.

22.

Malone,

, Meldrum,

, Gleeson,

, & Bolger,

(2011). Reliability of surface electromyography timing parameters in gait in cervical spondylotic myelopathy. J Electromyogr Kinesiol, 21(6), 1004–1010.

23.

Marder,

, & Bucher,

(2001). Central pattern generators and the control of rhythmic movements. R. Curr Biol, 11(23), 986–996.

24.

Mathur,

, Eng,

J. J.

, & MacIntyre,

D. L.

(2005). Reliability of surface EMG during sustained contractions of the quadriceps. J Electromyogr Kinesiol, 15(1), 102–110.

25.

Nardone,

, Höller,

, Brigo,

, Höller,

, Christova,

, Tezzon,

,... & Trinka,

(2013). Fatigue-induced motor cortex excitability changes in subjects with spinal cord injury. Brain Research Bulletin, 99(5), 9–12.

26.

Petrofsky,

J. S.

(2001). The use of electromyogram biofeedback to reduce Trendelenburg gait. European Journal of Applied Physiology, 85(5), 491–495.

27.

Raineteau,

, & Schwab,

M. E.

(2001). Plasticity of motor system after incomplete spinal injury. Nature Reviews Neuroscience, 2(4), 263–273.

28.

Suzuki,

, Muraoka,

, & Okazaki,

(2017). Development of a low-cost EMG biofeedback device kit as an educational tool for physical therapy students. J Phys Ther Sci, 29(9), 1522–1526.

29.

Watanabe,

, & Akima,

(2011). Validity of surface electromyography for vastus intermedius muscle assessed by needle electromyography. J Neurosci Methods, 198(2), 332–335.

30.

Wyndaele,

, & Wyndaele,

J. J.

(2006). Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 44(9), 523–529.

31.

Zehr,

E. P.

, Balter,

J. E.

, Ferris,

D. P.

, Hundza,

S. R.

, Loadman,

P. M.

,... & Stoloff,

R. H.

(2007). Neural regulation of rhythmic arm and leg movement is conserved across human locomotor tasks. J Physiol, 582(Pt 1), 209–227.