Surface electromyography and gamification: Translational research to advance physical rehabilitation

Abstract

Many problems that fall in medical domains of inquiry have behavioral components that can be optimized to increase benefits for patients. For example, although surgical intervention is effective in reducing the pain resulting from osteoarthritis of the knee, patients often struggle to regain complete functional use of the joint. In this translational study, we point to some ways in which behavioral contingencies of reinforcement are compromised, making the recovery process more difficult. We also report on the use of surface electromyography (sEMG) with healthy participants to create supplementary contingencies of reinforcement to support the development and maintenance of clinically relevant exercises. The procedures reported provide a proof-ofconcept and can contribute to an increase in the systematic use of games and feedback in physical rehabilitation in recovery from knee surgery. The results of this translational study suggest an expanded role for applied behavior analysis in the domains of health and medicine.

Surface electromyography‐based biofeedback and knee rehabilitation: A review of the literature

“…The most common method, accounting for 30% of studies, was the instruction‐based MVIC procedure in which a patient is simply asked to ‘flex as hard as possible’. Some evidence suggests that the instruction‐based MVIC procedures fail to identify a participant's actual maximum isometric contraction (Boren et al., 2011; Rutherford et al., 2011, see also Vaidya & Armshaw, 2021). Failure to identify a patient's maximum contraction amplitude may lead to inaccurate baseline comparisons and suboptimal goal selection.…”

“…Vaidya and Armshaw (2021) reported on an adapted MVIC procedure designed to produce a more accurate measure of preintervention response levels. The modified MVIC procedure used a technique that relied on establishing a brief and localized history of reinforcement prior to testing for the maximum contraction under extinction‐like conditions.…”

Maximizing Strength: The Stimuli and Mediators of Strength Gains and Their Application to Training and Rehabilitation

“…For example, although limited research exists in healthy populations, real-time biofeedback through electromyography (EMG, which gives insight into the electrical activity inside the muscle and somewhat approximates force output) enhances forceful muscle contractions during RE and, over time, produces greater strength gains compared with traditional RE without biofeedback (57). Interestingly, "gamification" of the EMG biofeedback (in other words, turning the feedback process into a game-like activity) might further facilitate forceful muscle contractions during RE (95). Noteworthy, the gamified biofeedback was provided through wireless EMG devices connected to a smartphone or tablet, potentially reflecting the future applicability of such an approach for broader populations, especially as the price of wireless EMG devices continues to decrease.…”

Surface electromyography‐based biofeedback can facilitate recovery from total knee arthroplasty

“…The VMO is one of four heads of the quad muscle. Vaidya and Armshaw (2021) offered a behavioral interpretation of some of the difficulties associated with recovery of the VMO and suggested a possible solution. First, they suggested that presurgical pain avoidance strategies used by individuals could contribute to disuse atrophy of the VMO (Pozzi et al, 2013), resulting in an increased effort requirement to voluntarily activate the muscle at levels sufficient for manual detection.…”