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Biofeedback After a Stroke and the Use of the Tutor System

Posted by handtutorblog in Hand Tutor.

LIVESTRONG.COM features this article By Tamasin Wedgwood on Oct 5, 2011

The American Stroke Association likens biofeedback to looking in a mirror to check that one is moving in the correct way. Electrodes measure bodily functions – heart rate, muscle movements or blood pressure – and the information is fed back to the patient. Biofeedback is mainly used in stress-related conditions, demonstrating to patients how relaxation improves symptoms. Its effectiveness after a stroke is disputed and still experimental. However, there is growing interest in using biofeedback in stroke rehabilitationtherapy.

Biofeedback takes three forms. Thermal biofeedback measures skin temperature. Neurofeedback measures brain activity and electromyography (EMG) measures muscle activity. Measurements captured by the electrodes are displayed on a monitor. A therapist explains this data to the patient. Initially by trial and error, the patient alters his behavior and the resultant readings are displayed on a screen. These changing readings provide visible evidence of how a patient’s reactions are influencing his symptoms or improving his bodily functions. In time patients learn to control their symptoms without needing the monitor.

Biofeedback is a drug-free therapy. It is a treatment that gives patients a sense of control over their own illness and recovery. Visible evidence of improvement is a psychological encouragement. It has the most value in conditions where there is a psychological element rather than a purely physical cause.

Biofeedback has demonstrable value in reducing high blood pressure. Muscle function data is potentially useful since stroke patients have frequently lost the use – or have reduced use – of a limb. EMG feedback is used with physiotherapy to help patients reeducate their limbs in movement. It can also help teach patients how to grip and then release objects in a stroke-impaired hand.

A 2009 article in the Biofeedback Matters newsletter suggested that while physiotherapy alone could improve grip, teaching stroke patients to relax and release objects was harder. Stroke patients’ brains and muscles can be overactive, causing continued muscle tension when a patient desires to release an object. Biofeedback could help because of its proven benefit in teaching relaxation. According to Dr. Richard Harvey of Chicago’s Rehabilitation Institute, biofeedback usefully teaches improved motor control, but it cannot help patients learn new functional tasks.

Early research was promising. A 1989 study at the Stroke Research Unit, Nottingham UK found stroke patients receiving EMG biofeedback regained more arm function than patients who did not. Patients with more extreme impairment showed the most benefit. In 1994, a stroke rehabilitation center in Rome, Italy, showed similar benefits in biofeedback improving leg strength. Unfortunately, many of the studies demonstrating benefits for stroke patients have been criticized for their small sample size and imprecise terminology. As head of Rehabilitation at St. Joseph’s Health Care, London, Ontario, Dr. Robert Teasell reviewed studies performed between the 1960s and 2003. Teasell found that biofeedback did appear more effective than conventional therapies but that larger studies are needed to confirm these results. In 2006, the American Stroke Association updated this information by commenting that in the intervening years since Teasell’s review, essential research into biofeedback and stroke still had not occurred.

The Tutor system established in 2004 with the aim of developing novel occupational and physical therapy rehabilitation equipment based on the proven concepts of active exercise and biofeedback.

The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation for stroke victims and those recovering from brain and spinal injuries,Parkinson’s, MS, CP and other limb movement limitations. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.

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