Abstract
Electromyographic biofeedback is becoming widely used to help patients regain voluntary control of specific muscles affected by neuromuscular disorders. Electromyographic feedback training has been employed in the rehabilitation of patients affected by poliomyelitis, cerebrovascular accident, torticollis, nerve injury, temporomandibular joint syndrome, bruxism, and other disorders. While EMG biofeedback appears to be a promising treatment technique, the research literature on its effectiveness consists mainly of uncontrolled case reports and clinical trials. It is concluded that new studies with more sophisticated designs and more careful control are needed to demonstrate that EMG biofeedback makes a unique contribution to the treatment of neuromuscular disorders. Research is needed to identify relevant patient characteristics predictive of success, specify appropriate muscle groups for the treatment of particular disorders, determine how feedback can be most efficiently combined with more conventional techniques in achieving a therapeutic effect, and establish meaningful criteria of success in the treatment of neuromuscular disorders.
References
Amato, A., Hermsmeyer, C. A., and Kleinman, K. M. (1973). Use of electromyographic feedback to increase inhibitory control of spastic muscles.Phys. Ther. 53: 1063–1066.
Andrews, J. M. (1957). Electromyography.J. Am. Osteopathol. Assoc. 56: 354–355.
Andrews, J. M. (1964). Neuromuscular re-education of the hemiplegic with the aid of the electromyograph.Arch. Phys. Med. Rehab. 45: 530–532.
Basmajian, J. V. (1963). Control and training of individual motor units.Science 141: 440–441.
Basmajian, J. V. (1976). Facts vs. myths in EMG biofeedback.Biofeed. Self-regul. 1: 369–372.
Basmajian, J. V., Kukulka, C. G., Narayan, M. G., and Takebe, K. (1975). Biofeedback treatment of a foot-drop after stroke compared with standard rehabilitation technique: Effects on voluntary control and strength.Arch. Phys. Med. Rehab. (1969) 56: 231–236.
Booker, H. E., Rubow, R. T., and Coleman, P. J. (1969). Simplified feedback in neuromuscular retraining: An automated approach using electromyographic signals.Arch. Phys. Med. Rehab. 50: 621–629.
Brudny, J., Grynbaum, B. B., and Korein, J. (1974a). Spasmodic torticollis: Treatment by feedback display of EMG.Arch. Phys. Med. Rehab. 55: 403–408.
Brudny, J., Korein, J., Levidow, L., Grynbaum, B. B., Lieberman, A., and Friedmann, L. W. (1974b). Sensory feedback therapy as a modality of treatment in central nervous system disorders of voluntary movement.Neurology 24: 925–932.
Brudny, J., Korein, J., Grynbaum, B. B., Friedmann, L. W., Weinstein, S., Sachs-Frankel, G., and Belandres, P. V. (1976). EMG feedback therapy: Review of treatment of 114 patients.Arch. Phys. Med. Rehab. 57: 55–61.
Carlsson, S. G., Gale, E. N., and Ohman, A. (1975). Treatment of temporomandibular joint syndrome with biofeedback training.J. Am. Dent. Assoc. (1973) 91: 602–605.
Cleeland, C. S. (1973). Behavioral techniques in modification of spasmodic torticollis.Neurology 23: 1241–1247.
Daniels, L., and Worthingham, C. (1972).Muscle Testing: Techniques of Manual Examination, Saunders, Philadelphia.
Eldridge, R. (1970). The torsion dystonias: Literature review and genetic and clinical studies.Neurology Suppl. 1–78.
Ethridge, D. (1968). Comments.Am. J. Occup. Ther. 22: 420–425.
Finley, W. W., Niman, C., Standler, J., and Ender, P. (1976). Frontal EMG biofeedback training of athetoid cerebral palsy patients: A report of six cases.Biofeed. Self-regul. 1: 169–182.
Fish, D., Mayer, N., and Herman, R. Letters to the editor: Biofeedback.Arch. Phys. Med. Rehab. 57: 152.
Gonella, C. (1973). Designs for clinical research.Phys. Ther. 53: 1276–1283.
Hardyck, C., and Petrinovitch, L. (1969). Treatment of subvocal speech during reading.J. Read. 12: 361–368.
Hardyck, C. D., Petrinovitch, L. F., and Ellsworth, D. W. (1966). Feedback of speech muscle activity during silent reading: Rapid extinction.Science 154: 1467–1468.
Harrison, V. F., and Mortensen, O. A. (1962). Identification and voluntary control of single motor unit activity in tibialis anterior muscle.Anat. Rec. 144: 109–116.
Hopkins, H. L. (1971). Occupational therapy management of cerebrovascular accident and hemiplegia. In Willard, H. S., and Spackman, C. S. (eds.),Occupational Therapy, 4th ed., Lippincott, Philadelphia.
Jacobs, A., and Felton, G. S. (1969). Visual feedback of myoelectric output to facilitate muscle relaxation in normal persons and patients with neck injuries.Arch. Phys. Med. Rehab. 50: 34–39.
Johnson, H. E., and Garton, W. H. (1973). Muscle re-education in hemiplegia by use of EMG device.Arch. Phys. Med. Rehab. 54: 322–325.
Keats, S. (1974).Cerebral Palsy, Thomas, Springfield, Ill.
Kukulka, C. B., Brown, D. M., and Basmajian, J. V. (1975). A preliminary report on biofeedback training for early finger joint mobilization.Am. J. Occup. Ther. 29: 469–470.
Kydd, W. L. (1959). Psychosomatic aspects of temporomandibular joint dysfunction.J. Am. Dent. Assoc. 59: 31–44.
Landau, W. M. (1974). Spasticity: The fable of a neurological demon and the emperor's new therapy.Arch. Neurol. 31: 217–219.
Laskin, D. M., and Greene, G. S. (1972). Indifference of the doctor-patient relationship on placebo therapy for patients with myofacial pain-dysfunction (MPD) syndrome.J. Am. Dent. Assoc. 85: 892.
LeBoeuf, A. (1976). The treatment of a severe tremor by electromyogram feedback.J. Behav. Ther. Exp. Psychiat. 7: 59–61.
Macpherson, E. L. R. (1967). Control of involuntary movement.Behav. Res. Ther. 5: 139–142.
Marinacci, A. A. (1955).Clinical Electromyography, San Lucas Press, Los Angeles.
Marinacci, A. A. (1968).Applied Electromyography, Lea and Febiger, Philadelphia.
Marinacci, A. A., and Horande, M. (1960). Electromyogram in neuromuscular reeducation.Bull. Los Angeles Neurol. Soc. 25: 57–71.
McGuigan, F. J. (1971). External auditory feedback from covert oral behavior during silent reading.Psychon. Sci. 25: 212–214.
Meares, R. (1971). Natural history of spasmodic torticollis and effect of surgery.Lancet 2: 149–150.
Moulton, R. E. (1968). Emotional factors in non-organic temporomandibular joint pain. In Schwartz, L., and Chayes, C. M. (eds.),Facial Pain and Mandibular Dysfunction, Saunders, Philadelphia, p. 318.
Netsell, R., and Cleeland, C. S. (1973). Modification of lip hypertonia in dysarthria using EMG feedback.J. Speech Hearing Dis. 38: 131–140.
Salter, N. (1958). Muscle and joint measurement. In Licht, S. H. (ed.),Therapeutic Exercise, E. Licht, New Haven.
Semans, S. (1967). The Bobath concept in treatment of neurological disorders.Am. J. Phys. Med. 46: 732–785.
Solberg, W. K., and Rugh, J. D. (1972). The use of biofeedback devices in the treatment of bruxism.J. S. Calif. Dent. Assoc. 40: 852–853.
Stockmeyer, S. A. (1967). An interpretation of the approach of Rood to the treatment of neuromuscular dysfunctions.Am. J. Phys. Med. 46: 900–956.
Swaan, D., Van Wieringen, P. C. W., and Fokkema, S. E. (1976). Auditory electromyographic feedback therapy to inhibit undesired motor activity.Arch. Phys. Med. Rehab. 57: 9–11.
Takebe, K., and Basmajian, J. V. (1976). Gait analysis in stroke patients to assess treatments of foot-drop.Arch. Phys. Med. Rehab. 57: 305–310.
Takebe, K., Kulkulka, C. G., Narajan, M. G., and Basmajian, J. V. (1976). Biofeedback treatment of foot-drop after stroke compared with standard rehabilitation technique. Part 2. Effects on nerve conduction velocity and spasticity.Arch. Phys. Med. Rehab. 57: 9–11.
Trombly, K. (1976). Personal communication.
Webb, N. C. (1974). The use of myelectric feedback in teaching facial expression to the blind.Res. Bull. Am. Found. Blind 27: 231–262.
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The preparation of this article was supported by NIMH Grant 8881-2 to Elliot Mishler and NIMH Grant 1-R01 MH 24103 to Richard S. Surwit.
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Keefe, F.J., Surwit, R.S. Electromyographic biofeedback: Behavioral treatment of neuromuscular disorders. J Behav Med 1, 13–24 (1978). https://doi.org/10.1007/BF00846583
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DOI: https://doi.org/10.1007/BF00846583