The Effect of Biofeedback on the Motor– Muscular Situation in Rehabilitation of Stroke Patients: a Randomized Controlled Trial

So it is a promising modality. Where is the protocol for use? 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029654/

J Caring Sci. 2018 Jun; 7(2): 89–93.

Published online 2018 Jun 1. doi:  10.15171/jcs.2018.014

Zohre Najafi, ¹ Fariborz Rezaeitalab, ² Mohsen Yaghubi, ³ and Zahra Sadat Manzari ^{4 ,*}

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Abstract

Introduction: Stroke is the most common debilitating neurological disease in adults. Therefore, rehabilitation is a major consideration to reduce costs and relief disabilities. Biofeedback, a newly recommended method is claimed to be able to improve the consequences following stroke by enhancing the understanding of the psychological functions of the body. The purpose of this study was to investigate the effects of biofeedback on the motor– muscular situation in balance and ability to walk, muscle stiffness (spasticity), hand muscles strength of stroke patients.

Methods: The present study was a randomized clinical trial done in 2016. The participants were randomly divided into 2 groups (case and control group). In the intervention group, biofeedback was performed. The check list of main variables, including balance and ability to walk, muscle stiffness (spasticity) and hand muscles strength was completed by a physician before the intervention and at the end of the intervention (16th session). The statistical analysis was conducted, using SPSS version 13.

Results: The mean score of balance in intervention group versus control group showed significant differences. The results showed that by eliminating the effects of muscular strength before the intervention, this variable had made improvements and significant differences in both intervention and control groups after the intervention. Comparison of the average spasticity showed that spasticity evaluation score before and after the intervention revealed no significant difference between the two groups.

Conclusion: Biofeedback therapy is a promising treatment modality for improving the motor–muscular situation of patients after stroke.

Keywords: Biofeedback, Stroke, Rehabilitation

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Introduction

Stroke is the most common debilitating neurological disease in adults and the third leading cause of death worldwide after cardiovascular diseases and cancer.¹ A statistical analysis revealed that>50% of patients who survive a cerebrovascular accident experience long-term disabilities.

One hundred and thirty-two people out of every 100,000, suffer their first stroke annually in Iran- a rate which is considerably higher than that in developed countries.,³

After a stroke, patients who lack independence may be affected with musculoskeletal, swallowing, and bowel and bladder dysfunction, loss of skin integrity, and self-care inability.^4,5 All of these problems can impair a patient’s self-image and decrease their quality of life and performance.⁶ The most common and worst complication of stroke‏ consists of motor disabilities, such as hemiplegia, hemiparesis, partial or complete loss of limb muscle force on one side of the body.^7,8 Post-stroke spasticity results in decreased flexibility, limb deformities, reduced motor function, joint pain, and further decreases in motor function.¹ Also, 55–75% of stroke patients have limited upper-limb function and mobility .⁹

Because of complications caused by functional disorders in stroke patients, cerebrovascular diseases require prolonged hospitalization and home care, which yield huge economic and social challenges.¹⁰ Therefore, rehabilitation is a major consideration to relieve costs and minimize disability. The purpose of rehabilitating patients with hemiplegia following stroke is to enable patients to achieve maximum functional capacity and independence as soon as possible.¹¹ Accurate and timely rehabilitation can reduce the degree of disability. Studies revealed that within 6 months of stroke, 64% of patients are able to walk without help versus 22% who are not able to walk. Upper- and lower-limb motion can be recovered within 3–6 months in approximately 80% of patients.¹² In recent years, a new method known as functional movement therapy has gained popularity for treating hemiplegia. This method consists of a combination of traditional methods and functional movements, involving weight-bearing or no weight-bearing types to increase joint mobility and reduce hyper tonicity in the affected limbs. Several methods including acupuncture, electrical and functional stimulation, training methods of evolution in the motor nerves, and biofeedback for rehabilitation are available and used for this purpose.¹³

Biofeedback is a treatment technique by which individuals are trained to improve their health through using their physical signs.¹⁴ One of the aims of biofeedback is to enhance the understanding of the body’s psychological functions. The main goal of biofeedback training sessions is to train individuals to self-regulate their psychological processes. Biofeedback process includes 3 cognitive methods in the rehabilitation of stroke patients; first, the data are obtained from sensory electrodes and then, biofeedback augmented this signals and finally, this signal is interpreted as a warn to increase or decrease biological function for medical groups. Biofeedback is reportedly able to improve the consequences of stroke, including memory deficits, headache, dizziness, confusion, and distraction as well as lower-extremity motor dysfunction.^9,14

The ability of biofeedback to improve the lower-limb motor function and walking performance in stroke patients has been investigated in other studies.⁹ These authors have reported that, after a 4-week rehabilitation program, the walking ability, walking speed, and lower-limb motor function in the intervention group were not significantly improved. Maciaszek et al.,¹³ investigated the effect of biofeedback training performed on a balance plate on the dynamic balance of stroke patients. In the final study follow-up, relative improvements in balance were seen in intervention group.

In the past two decades, biofeedback has been used as a clinical patient training technique for regaining muscle control. Today, with the advent of new therapeutic methods, mortality rates have been reduced, but the demand for rehabilitation has increased. However, the absolute efficacy of biofeedback to improve motor function in patients after stroke is unclear and the few available studies have reported paradoxical results. 

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