Practice Variability Combined with Task-Oriented Electromyographic Biofeedback Enhances Strength and Balance in People with Chronic Stroke.

OBJECTIVES: To investigate the effects of practice variability combined with task-oriented electromyographic biofeedback (EMGBFB) on strength and balance in people with chronic stroke. METHODS: Thirty-three participants were randomly assigned into the constant force EMGBFB tibialis anterior (TA) exercise (constant) group, the variable force EMGBFB tibialis anterior exercise (variable) group, or the upper extremity exercise without EMGBFB (control) group. Subjects in each group received 6 weekly sessions of exercise training (18 sessions, 40 minutes each). Motor outcomes were TA strength, balance (anteroposterior sway amplitude defined by limits of stability test in dynamic posturography), walking speed, Timed Up and Go test (TUGT), and six-minute walk test (6MWT). Data were measured at baseline, 1 day, 2 weeks, and 6 weeks posttraining. RESULTS: TA strength increased significantly in both the constant and variable groups after training. Balance significantly improved only in the variable group. All participants showed improvements in walking speed, TUGT, and 6MWT. CONCLUSIONS: Task-oriented EMGBFB-assisted TA exercise training improved muscle strength in people with chronic stroke. Practicing to reach varying force levels during EMGBFB-assisted tibialis anterior exercises facilitated improvements in the ability to sway in the anteroposterior direction while standing. Our findings highlight the importance of task-oriented and motor learning principles while using the EMGBFB as an adjunct therapy in stroke rehabilitation. This trial was registered with trial registration number NCT01962662.

Low-intensity task-oriented exercise for ambulation-challenged residents in long-term care facilities: a randomized, controlled trial.

OBJECTIVE: The aim of this study was to investigate the effects of a task-oriented ambulation training program in regaining walking, balance, and activity of daily living performance for ambulation-challenged residents with walking potential in long-term care facilities. DESIGN: Fifty ambulation-challenged residents with walking potential were randomly assigned to an individualized task-oriented ambulation training group (30-45 mins, three times a week) or a routine nursing care control group for 4 wks. Each subject was evaluated by a blind evaluator before and after training. Walking function was assessed using walking speed, the Timed Up and Go Test, and the 6-Minute Walk Test. Balance and activities of daily living were measured using the Berg Balance Scale and the Barthel Index, respectively. RESULTS: The training group showed significantly more improvement in walking speed, time to complete the Timed Up and Go Test, and the total score of Berg Balance Scale from baseline to posttest than the control group did. No significant difference between groups was observed on the 6-Minute Walk Test or the Barthel Index. CONCLUSIONS: Ambulation-challenged residents with walking potential, as defined by slowing of walking speed with concomitant knee muscle weakness and joint range limitation, showed significant improvement in walking function and balance after a 4-wk task-oriented ambulation training in long-term care facilities.

Using Electromyography to Detect the Weightings of the Local Muscle Factors to the Increase of Perceived Exertion During Stepping Exercise.

Rate of perceived exertion (RPE) is a clinically convenient indicator for monitoring exercise intensity in cardiopulmonary rehabilitation. It might not be sensitive enough for clinicians to determine the patients' physiological status because its association with the cardiovascular system and local muscle factors is unknown. This study used the electromyographic sensor to detect the local muscle fatigue and stabilization of patella, and analyzed the relationship between various local muscle and cardiovascular factors and the increase of RPE during stepping exercise, a common exercise program provided in cardiopulmonary rehabilitation. Ten healthy adults (4 males and 6 females) participated in this study. Each subject used their right bare foot to step up onto a 23-cm-high step at a constant speed until the RPE score reached 20. The RPE, heart rate (HR), and surface EMG of the rectus femoris (RF), vastus medialis, and vastus lateralis were recorded at 1-minute intervals during the stepping exercise. The generalized estimating equations (GEE) analysis indicated that the increase in RPE significantly correlated with the increase in HR, and decrease in median frequency (MF) of the EMG power spectrum of the RF. Experimental results suggest that the increase in RPE during stepping exercise was influenced by the cardiovascular status, localized muscle fatigue in the lower extremities. The weighting of the local muscle factors was more than half of the weighting of the cardiovascular factor.