Ride the Wave: A Guide for Implementing Biofeedback in Occupation-Based Interventions in a Rehabilitation Setting

Historical and current research studying EMG biofeedback has shown this method to be an effective adjunct to occupational therapy intervention. Utilizing EMG biofeedback has been shown through research as effective in improving functional gains. The use of biofeedback allows an individual to visualize unseen physiological processes which are unique to each individual and provide better understanding of otherwise unseen functions (Laurenção, Battistella, Moran de Britto, Tsukimoto, & Mayizaki, 2008). An extensive literature review and students’ observations of clinical occupational therapy practice led the investigators to conclude that EMG biofeedback was a viable treatment method which has not been utilized to the full potential. The purpose of the scholarly project was to determine the effectiveness of EMG biofeedback through research and develop a resource guide for occupational therapists interested in implementing this method into treatment in a rehabilitative setting. The product developed consisted of eight sections which were selected to provide an overview of EMG biofeedback information and pertinent resources to assist an individual in determining how this method could be implemented during occupation-based interventions

Clinical Features to Predict the Use of a sEMG Wearable Device (REMO®) for Hand Motor Training of Stroke Patients: A Cross-Sectional Cohort Study

After stroke, upper limb motor impairment is one of the most common consequences that compromises the level of the autonomy of patients. In a neurorehabilitation setting, the implementation of wearable sensors provides new possibilities for enhancing hand motor recovery. In our study, we tested an innovative wearable (REMO®) that detected the residual surface-electromyography of forearm muscles to control a rehabilitative PC interface. The aim of this study was to define the clinical features of stroke survivors able to perform ten, five, or no hand movements for rehabilitation training. 117 stroke patients were tested: 65% of patients were able to control ten movements, 19% of patients could control nine to one movement, and 16% could control no movements. Results indicated that mild upper limb motor impairment (Fugl-Meyer Upper Extremity 18 points) predicted the control of ten movements and no flexor carpi muscle spasticity predicted the control of five movements. Finally, severe impairment of upper limb motor function (Fugl-Meyer Upper Extremity > 10 points) combined with no pain and no restrictions of upper limb joints predicted the control of at least one movement. In conclusion, the residual motor function, pain and joints restriction, and spasticity at the upper limb are the most important clinical features to use for a wearable REMO® for hand rehabilitation training

Effectiveness and safety of Nintendo Wii Fit PlusTM training in children with migraine without aura: a preliminary study

Background: Migraine without aura (MoA) is a painful syndrome, particularly in childhood; it is often accompanied by severe impairments, including emotional dysfunction, absenteeism from school, and poor academic performance, as well as issues relating to poor cognitive function, sleep habits, and motor coordination. Materials and methods: The study population consisted of 71 patients affected by MoA (32 females, 39 males) (mean age: 9.13±1.94 years); the control group consisted of 93 normally developing children (44 females, 49 males) (mean age: 8.97±2.03 years) recruited in the Campania school region. The entire population underwent a clinical evaluation to assess total intelligence quotient level, visual-motor integration (VMI) skills, and motor coordination performance, the later using the Movement Assessment Battery for Children (M-ABC). Children underwent training using the Wii-balance board and Nintendo Wii Fit Plus™ software (Nintendo Co, Ltd, Kyoto, Japan); training lasted for 12 weeks and consisted of three 30-minute sessions per week at their home. Results: The two starting populations (MoA and controls) were not significantly different for age (P=0.899) and sex (P=0.611). M-ABC and VMI performances at baseline (T0) were significantly different in dexterity, balance, and total score for M-ABC (P,0.001) and visual (P=0.003) and motor (P,0.001) tasks for VMI. After 3 months of Wii training (T1), MoA children showed a significant improvement in M-ABC global performance (P,0.001), M-ABC dexterity (P,0.001), M-ABC balance (P,0.001), and VMI motor task (P,0.001). Conclusion: Our study reported the positive effects of the Nintendo Wii Fit PlusTM system as a rehabilitative device for the visuomotor and balance skills impairments among children affected by MoA, even if further research and longer follow-up are needed

Evidence for early physiotherapy after acute stroke: a scoping review

Neuroscience evidence indicates that early rehabilitation can guarantee better outcomes and quicker cortical re-organization after lesion. Although there are some studies related to the acute stroke physiotherapy intervention, it seems that few consider the evidence that link neuroplasticity and neurorehabilitation. Therefore, understanding the current state of the art of physiotherapy intervention is vital to potentialize the intervention so the enhance neuroplastic window is properly explored. To analyze the physiotherapy's intervention on acute stroke patients, so it reveals the underlined evidence for the selection of the approach and if the neurophysiological mechanisms are associated. This scoping review's methodology follows the Joanna Briggs Institue. A main search was conducted across Pubmed, PEdro and Web of science in December 2020, including only studies in Portuguese or English. Studies included focused on the concept of physiotherapy's intervention in a population of adult acute stroke patients, in an acute care context. Were identified 14 categories of interventions in 37 studies. 62% of studies didn't give any justification for the choic of method and the ones who did, weren't focused on neurophysiological knowledge. A wide range of interventions was found in which only 38% showed justifications that were considered insufficient and imprecise

Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation.

After an initial period of recovery, human neurological injury has long been thought to be static. In order to improve quality of life for those suffering from stroke, spinal cord injury, or traumatic brain injury, researchers have been working to restore the nervous system and reduce neurological deficits through a number of mechanisms. For example, neurobiologists have been identifying and manipulating components of the intra- and extracellular milieu to alter the regenerative potential of neurons, neuro-engineers have been producing brain-machine and neural interfaces that circumvent lesions to restore functionality, and neurorehabilitation experts have been developing new ways to revitalize the nervous system even in chronic disease. While each of these areas holds promise, their individual paths to clinical relevance remain difficult. Nonetheless, these methods are now able to synergistically enhance recovery of native motor function to levels which were previously believed to be impossible. Furthermore, such recovery can even persist after training, and for the first time there is evidence of functional axonal regrowth and rewiring in the central nervous system of animal models. To attain this type of regeneration, rehabilitation paradigms that pair cortically-based intent with activation of affected circuits and positive neurofeedback appear to be required-a phenomenon which raises new and far reaching questions about the underlying relationship between conscious action and neural repair. For this reason, we argue that multi-modal therapy will be necessary to facilitate a truly robust recovery, and that the success of investigational microscopic techniques may depend on their integration into macroscopic frameworks that include task-based neurorehabilitation. We further identify critical components of future neural repair strategies and explore the most updated knowledge, progress, and challenges in the fields of cellular neuronal repair, neural interfacing, and neurorehabilitation, all with the goal of better understanding neurological injury and how to improve recovery

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude