Effect of myofeedback on the threshold of the stretch reflex response of post-stroke spastic patients

Abstract

Purpose We propose a visual myofeedback protocol as a coadjuvant therapy to standard rehabilitation of post-stroke spastic patients. We also argue in favor of the tonic stretch reflex threshold (TSRT) as a more sensitive unit for quantifying subtle changes in the spastic response that may be induced by biofeedback training. Method Sixteen volunteers with ischaemic stroke were divided into an experimental group (EG), subjected to myofeedback training in parallel with conventional physical therapy and a control group (CG), receiving only conventional physical therapy. The EG subjects underwent a six-week myofeedback training, with two sessions weekly. Both groups followed the same treatment schedule for physical therapy. The TSRTs of the volunteers' spastic muscles were assessed before the beginning of the experimental protocol and 3 weeks after it ended. Results Both groups showed some degree of improvement in the level of spasticity when the final TSRT values were compared to the initial values. However, the percentage of improvement (after-before) of the experimental group (38.59%) was significantly higher than that in the control group (18.58%). Conclusion The myofeedback training provided a significant contribution to conventional treatment, allowing for a better improvement of the spastic condition. Implications for rehabilitation Biofeedback is an effective means of improving motor control of post-stroke spastic patients. The Tonic Stretch Reflex Threshold is a more sensitive quantitative measure to assess upper-limb post-stroke spasticity. Spastic patients who participate in myofeedback training along with physical therapy can improve faster then those who participate only in traditional physical therapy rehabilitation protocols.

Knee Muscle Stretch Reflex Responses After an Intrathecal Baclofen Bolus in Neurological Patients With Moderate-to-Severe Hypertonia

“…For each subject, a regression line was fitted to the angle‐velocity data and extrapolated to the zero velocity (angle intercept) to arrive at the “static stretch reflex threshold angle.” The static stretch reflex threshold angle was found to be moderately correlated with the clinical spasticity score in stroke but not in cerebral palsy (CP) . This angle was later renamed the tonic stretch reflex threshold (TSRT) and applied to the elbow muscles in stroke and Parkinson's disease and the ankle plantar flexors in stroke and CP . Instead of a random order, Marques et al recommended stretching at increasing velocities when using TSRT to assess post‐stroke elbow flexor spasticity.…”

Effects of vibration rolling on ankle range of motion and ankle muscle stiffness in stroke patients: a crossover study

“…Spasticity can be de ned as a sensorimotor disorder related to some level of involuntary muscle activation, and it is a consequence of upper motor neuron syndrome [6,7]. Physical therapy, such as static stretching, transcutaneous electric nerve stimulation, extracorporeal shock wave therapy, electromyography biofeedback, and vibratory stimulation, can be used to treat post-stroke spasticity [8][9][10][11][12]. However, among the various treatment methods, most vibration stimulation studies have been wholebody vibration studies, and local vibration studies are lacking.…”

Low-Cost 2-Channel Electromyography Telemeter using a Personal Computer Microphone Port

“…In stroke patients with spasticity or motor paralysis, it is possible to follow functional changes by using EMG to clarify characteristics of standing and standing-up in hemiplegic stroke patients [7][8][9][10]. It is also possible to observe characteristics of posture in those with Parkinson's disease via EMG [11].…”