Effect of EMG biofeedback to improve upper extremity in children with cerebral palsy: A randomized controlled trail

Abstract

Background : Cerebral palsy has pathology in immature brain problem; ischemic brain, and hypoxic brain. The cause of the pathology can be prenatal, perinatal and postnatal. EMG biofeedback is a muscles training program using electrical stimulation modality to train specific weakness of the muscles or pathologic side. Feedback response to the patients by visual or evidence supporting sound can assist the patients to train themselves specifically. However, there are few evidences that support the efficacy of electromyographic (EMG) biofeedback in training of muscles in cerebral palsy.

Objective : To study the effect of electromyographic biofeedback on upper extremities to improve hand function in children with cerebral palsy.

Methods : Forty children with cerebral palsy who have impairment of the upper extremity and hand functions. The children were randomly assigned into two groups. Biofeedback group consisted of 20 patients that each received
EMG biofeedback training of 3 muscles for 30 minutes plus three-task training for 30 minutes. The conventional group consisted of 20 patients that received three-task training for 60 minutes. The upper extremity and
hand functions were evaluated before starting the training, and then at 4 weeks and 8 weeks.

Results : Biofeedback group displayed statistically significant improvement regarding 3 subtests of Jebsen hand function test (JHFT) (P = 0.004, P = 0.017, P = 0.004). Comparing with before starting training, mean decreasing of time spending at 4^th week were 15.03  4.01, 232.42  74.52 and 14.24  3.80, and at 8^th week were 13.32  2.70, 251.85  80.25 and 10.34  3.28. Conventional group displayed statistically significant improvement regarding 1 subtest of JHFT (P = 0.006). Comparing with before starting training, the mean decreased of time spent at 4^th week
were 174.90  49.20. Biofeedback group showed statistically significant progress over the conventional group in 1 subtest of JHFT (P = 0.002, P = 0.005).

Conclusion : Effect of EMG biofeedback on upper extremity and hand functions in children with cerebral palsy especially in large muscles trained by EMG biofeedback is superior to the conventional therapy.