Task-Oriented Biofeedback to Improve Gait in Individuals With Chronic Stroke: Motor Learning Approach

Abstract

Background. Electromyographic biofeedback (EMG-BFB) has shown equivocal benefits on gait retraining after stroke. Objective. The authors evaluated the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis. Methods. They assigned 20 participants randomly to the EMG-BFB group or a control group that received conventional therapy for the same duration. Quantitative gait analysis was performed before and after treatment. The EMG-BFB involved the triceps surae during functional gait activities. Treatment was administered with a fading frequency of BFB application and an increasing variability in gait activities. Both groups had 20 treatment sessions of 45 minutes each, including at least 15 minutes of walking-related therapy for the control group. Follow-up (FU) gait analysis was obtained 6 weeks after training. Results. BFB treatment led to significant increases ( P < .01) in peak ankle power at push-off (from 0.63 W/kg to 1.04 W/kg) in conjunction with significant increases in velocity (from 28.3 %h/s—normalized to percentage height per second—to 39.6 %h/s) and stride length (from 44.5 %h—normalized to percentage height—to 57.6 %h). Increases remained significant at FU. There were no changes in any gait variable in the control group. Conclusion. A task-oriented BFB treatment was effective in increasing peak ankle power, gait velocity, and stride length in a population with hemiparesis. Further studies should compare the combination intervention with either of its components in more impaired patients.