Rehabilitation of upper extremity nerve injuries using surface EMG biofeedback: protocols for clinical application
File(s)Sturma_2018_sEMG_rehab_afterNerveInjuries.pdf (5.56 MB)
Published version
Author(s)
Sturma, Agnes
Hruby, Laura A
Prahm, Cosima
Mayer, Johannes A
Aszmann, Oskar C
Type
Journal Article
Abstract
Motor recovery following nerve transfer surgery depends on the successful re-innervation of the new target muscle by regenerating axons. Cortical plasticity and motor relearning also play a major role during functional recovery. Successful neuromuscular rehabilitation requires detailed afferent feedback. Surface electromyographic (sEMG) biofeedback has been widely used in the rehabilitation of stroke, however, has not been described for the rehabilitation of peripheral nerve injuries. The aim of this paper was to present structured rehabilitation protocols in two different patient groups with upper extremity nerve injuries using sEMG biofeedback. The principles of sEMG biofeedback were explained and its application in a rehabilitation setting was described. Patient group 1 included nerve injury patients who received nerve transfers to restore biological upper limb function (n = 5) while group 2 comprised patients where biological reconstruction was deemed impossible and hand function was restored by prosthetic hand replacement, a concept today known as bionic reconstruction (n = 6). The rehabilitation protocol for group 1 included guided sEMG training to facilitate initial movements, to increase awareness of the new target muscle, and later, to facilitate separation of muscular activities. In patient group 2 sEMG biofeedback helped identify EMG activity in biologically "functionless" limbs and improved separation of EMG signals upon training. Later, these sEMG signals translated into prosthetic function. Feasibility of the rehabilitation protocols for the two different patient populations was illustrated. Functional outcome measures were assessed with standardized upper extremity outcome measures [British Medical Research Council (BMRC) scale for group 1 and Action Research Arm Test (ARAT) for group 2] showing significant improvements in motor function after sEMG training. Before actual movements were possible, sEMG biofeedback could be used. Patients reported that this visualization of muscle activity helped them to stay motivated during rehabilitation and facilitated their understanding of the re-innervation process. sEMG biofeedback may help in the cognitively demanding process of establishing new motor patterns. After standard nerve transfers individually tailored sEMG biofeedback can facilitate early sensorimotor re-education by providing visual cues at a stage when muscle activation cannot be detected otherwise.
Date Issued
2018-12-04
Date Acceptance
2018-11-19
Citation
Frontiers in Neuroscience, 2018, 12
ISSN
1662-4548
Publisher
Frontiers Media
Journal / Book Title
Frontiers in Neuroscience
Volume
12
Copyright Statement
© 2018 Sturma, Hruby, Prahm, Mayer and Aszmann. This is an openaccess
article distributed under the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or reproduction in other forums is permitted,
provided the original author(s) and the copyright owner(s) are credited and that the
original publication in this journal is cited, in accordance with accepted academic
practice. No use, distribution or reproduction is permitted which does not comply
with these terms.
article distributed under the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or reproduction in other forums is permitted,
provided the original author(s) and the copyright owner(s) are credited and that the
original publication in this journal is cited, in accordance with accepted academic
practice. No use, distribution or reproduction is permitted which does not comply
with these terms.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30564090
Subjects
nerve reconstruction
nerve transfer
neuro-rehabilitation
prosthetic rehabilitation
surface electromyography
upper extremity rehabilitation
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
ARTN 906