EMG Biofeedback in Clinical Practice
Surface Electromyography (sEMG) is used by Allied Health Practitioners to assess the health of muscles and the neural pathways that control them. It can help reveal nerve dysfunction and muscle atrophy in your patients.
EMG biofeedback is the most widely investigated method of biofeedback and appears to be effective in the treatment of musculoskeletal conditions. It allows us to identify the reasons behind intentional and reactive muscle motor behaviours. Using sEMG, we can determine the intensity and velocity of muscle contraction and muscle fatigue, as well as compare activity of two different muscle groups, to determine when they firing or not firing in relation to one another.
One study has identified that EMG biofeedback improved performance of activities following a stroke more than usual therapy. Read summary of study below.
Read summary of study here
Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review.
Stanton R, Ada L, Dean CM, Preston E
J Physiother. 2017 Jan;63(1):11-16.
Place of origin
The University of Sydney, Australia.
Previous reviews of the effect of biofeedback in stroke have been favourable, but have included trials with low methodological quality and trials where the amount of therapy time in the biofeedback and control group were not matched.
To investigate through a systematic review whether biofeedback during the practice of lower limb activities after stroke is more effective than usual therapy in improving those activities, and whether there are any benefits maintained beyond the intervention.
Study design & methods
Systematic review with meta-analysis.
Studies & methods: randomised trials with a PEDro score > 4, that compared Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking, with the same amount of practice without biofeedback.
- 18 trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10.
- 3 trials (Pedro score 6-7) used sEMG Biofeedback.
- The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used.
Biofeedback versus usual therapy during the same activity.
- Measures of lower limb activity (sitting, standing up, standing or walking)
- Measures congruent with the activity trained
- Measures of activity must involve movement
- Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70).
- Biofeedback is likely to be more effective than therapist communication due to the objective and accurate information feedback available to the patient during practice.
- The longer term effects are less clear. Only 4 of the 18 trials measured outcomes at follow-up which was unsufficient to perform a meta-analysis.
Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice.
This meta-analysis provides a robust estimate that biofeedback has a greater benefit on the performance of lower limb activities than usual rehabilitation.
In this particular case, we look at how sEMG can improve glute activation by providing real-time information to clinicians to identify those muscle movement patterns.
What is glute activation?
Glute activation refers to the firing up of the glute muscles during exercise in order to strengthen them and reduce stress on compensating muscles.
What is the importance of glute activation?
Glute activation is critical as the glutes provide support to overall core and body strength, and pelvis and hip stabilization. Inactive and weak glutes are unable to support the alignment of our pelvis and femur, resulting in other muscles to compensate. This imbalance of muscle use can lead to gait issues, putting further pressure and stress onto joints. Alongside this, we see an influx of lower back and hip pain, muscle and nerve pain and poor posture.
Some of the associated injuries with weak gluteal muscles include patellofemoral pain syndrome, iliotibial band syndrome, patellar tendinitis, Achilles tendonitis, plantar fasciitis and others.
Our sedentary lifestyle and under-use of glute muscles provides the main cause for glute inactivation, and results in the gluteal muscles atrophying.
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