Failure of electrical myofeedback to augment the effects of physiotherapy in stroke

Electromyographic biofeedback has been used with some success to treat patients with disturbances of muscle tone resulting from neurological disease. The aim of this study was to incorporate electrical myofeedback as an integral part of a physiotherapeutic regime designed to improve quality of movement and function in limbs weakened or paralysed by stroke. A portable, inexpensive E. M. G. biofeedback machine was used. Stainless steel skin electrodes were applied which needed minimal skin preparation. Twelve adults, (five male, seven female, mean age 44.2 years and 51.3 years respectively) who were referred for treatment due to weakness of limb muscles due to disease of the brain or spinal cord, were treated. The mean time from onset of incidence to treatment was 75.5 days. Each patient received six weeks of treatment. This was divided into two phases. Phase 1, (weeks 1, 2, 3) and phase 2 (weeks 4, 5, 6). Physiotherapy, and physiotherapy with biofeedback was randomly allocated to either phase. Each patient acted as his/her own control. A validated assessment was carried out by an independent therapist at the start of treatment, after three weeks and after six weeks of treatment. General function, knee function, range of movement of the affected side and timed tests were measured. Results show an overall improvement in general function. The second phase of treatment was slightly more favourable to improvement, but there was no indication that biofeedback significantly improved the outcome. In three tests it was equally significant to the physiotherapy applied; in one test it improved the effectiveness of physiotherapy and in one test it reduced the effectiveness of physiotherapy. This suggests that a six week course of physiotherapy improved muscular function and range of movements in patients with weakness due to upper motor neurone disease, but that these effects are not enhanced by myofeedback.