p




  

Ric, Julie, Francesca

 p




 

M echnique enabling the individual to readily determine

the activity levels of a particular physiological process,
and with training learn to control this process with an
internalized mechanism.
M Results must require an effort from the patient.
M
uscle electrical signals (E
 record) translated to
audio and visual stimuli through the use of a brain
computer interface (BCI) or thought translation device.
°p


 p


M isual and auditory stimuli are controlled through gain settings
and thresholds.
High gain settings = Sensitive (see results, and lower frustration)
Low gain settings = Less Sensitive
M reatment of paralysis often involves both settings
M hresholds allow for therapists to control how much E

activity must be present for activation of biofeedback.
-paralyzed muscle tissue often shows small E

activity; high gain settings coupled with the use of
thresholds prevent biofeedback signal from this
activity
 


 
M E
 has been used since early 60·s to help diagnose and
treat neuromuscular disorders such as paralysis.
M herapists integrate E
 with other interventions for best
results
M dvantages:
- Increase self reliance of patient during rehab
(empowerment)
- Inexpensive ² 1st session = $300 dditional
sessions = $150
- Non-
Non-invasive
 p
 
M Surface electrodes record broad activity
M istant muscle signal is lessened due to impedance of
muscle fibers
M roximity is important but it is impossible to know exactly
what muscle fibers are being recorded (often placed 2··
apart parallel to dominant muscle fiber)
M Improved technology allows for more accurate readings as
low as .08µ
.08µ (myoscan and myotrac)
 p
  
M CNS:
- 


-- results from stroke causing paralysis in
one side of the body
- 


 




 results from nerve
damage or severe injury to CNS causing paralysis in
extremities
-!"

#$!"#% ² wasting away
of muscle due to inactivity and scaring of motor neurons
-& 


& 

 paralysis resulting from brain injury
before, during, or shortly after birth
M eripheral:
-'

'
 facial paralysis resulting from damaged
neurons
- (
 ( any damage of peripheral neurons resulting
from injury
 

#$ (%
M r. Brucker (1996)-
(1996)- 100 long term spinal cord injury patients
with no improving muscle activity in triceps (within subjects
design)
M ll patients received 45 mins of BF for tricep extensions
-75 of 100 receive additional treatments
M E
 data shows significant improvement after 1 session and
increased improvement with each subsequent treatment
M Biofeedback is effective for increasing voluntary E
 responses
in this sample.
 !"#
M Lou ehrig·s isease ² progressive neurodegenerative disease
effecting motor neurons in CNS
M
ind often remains unaffected but can no longer control motor
functions (lack of myelin sheath)
*

  
   

  
 

 

  

 
 
! 
"


 

 !"#

  

!"#
M E
 useful for diagnosis, problematic for
rehabilitation
M amage of nerve cells prevents E
 improvement
without some miracle drug« biofeedback cannot
repair such a problem
M Fortunately, LS doesn·t invade the mind. his means
EE biofeedback can be used to translate thoughts
 & 




M Non-
Non-degenerative chronic disorder impairing muscle
control
M hysical and occupational therapy allow for
independence of patient
M E
 biofeedback used for speech improvement and
better control of voluntary movements
M Like LS, biofeedback is not sufficient in recovery
 &  


p

M ncommon neuro-
neuro-dysfunctional condition resulting
from psychological conflict in stress and sporadic
episodes
M atient convinces himself that an extremity has no
sensation or movement.
M reatment:
- Fishbain (1988) 4 patients with conversion
paralysis were successfully treated with BF
-E
 record showed significant improvement
of functional capacity in afflicted extremities

 
sfour, S., Fishbain, ., oldberg,
., & Khalil, . (1988). tility of electromyographic

biofeedback for the treatment of conversion paralysis. _





 
 ..

ol 145(12), 1572-
1572-1575
Berkow, Robert (1997). 

 
   .
 . New York: ocket Books.

Brucker BS and Bulaeva N (1996). Biofeedback effect on electromyography responses in

patients with spinal cord injury. _ 

 133

133--7.
he LS ssociation. (2006) <http://www.alsa.org/>

Elder, S. . (1982) myotrophic lateral sclerosis:  challenge for biofeedback. _





 

 
  

!"#$
 

!"#$#!

http://www.electrotherapy.org/electro/biofeedback/biofeed1.htm

http://www.bio--medical.com/news_display.cfm?mode=E
&newsid=26
http://www.bio
 ë


)






 
 p

  
M eneral information about E


M Facial aralysis Rehabilitation

M ocal aralysis Rehabilitation

M Interesting pplications of E
 biofeedback in

relation to paralysis
 p
   
M wo
ethods
² Subdermal Needle E
 & Surface E

M sed in oluntary
uscle Control
² Reduction of activity and restoration of activity
M sed to alleviate muscle tension
M pplications for migrane headaches
 ë





M reatment echniques:
exercise, electrical stimulation, biofeedback, and
neuromuscular retraining for facial paresis
M Sunderland third-
third-degree injuries benefit most
from E
 therapy
M
uscle re-
re-education using surface E

biofeedback and home exercises is efficient in
treatment of facial palsies
 ë





M E
 treatments also useful for:
poliomyelitis
cerebrovascular accidents
torticollis
nerve injury
temporomandibular joint syndrome
bruxism and other disorders
 ë





M   




    

 






² ested 24 patients over a 2 year period
² fter retraining using E
 stimulation, facial
muscle control improved by 2 levels.
² Concluded:
facial retraining exercises and p
are effective for
improving facial movements post paralysis
 ë





M p


 

  

  





 




 

*



² 30 patients with no facial muscle control

² eveloped 6 point grading scale established to assess
improvement
² en patients (33%) achieved the highest possible grading (II)
with symmetry and synchrony of function and spontaneity of
expression; 17 (57%) reached grade III, which allowed
voluntary control of eye and mouth function; 3 (10%)
showed minimal gains lasting between 3 and 18 months
 ë





M ë




 +, 



°
ë

!

°
ë


!

² Classically managed with HF but this has negative side
effects
² he JIHF with gold weight lid implantation and (E
)
rehabilitation offered as alternative
² 18 JIHF patients compared with 30 HF with E

patients
² JIHF resulted in substantial facial reinnervation in 83.3%
of the patients without hemilingual sequelae which was seen
in 45% of the HF patients
 )


-+
.
M ocal fold paralysis and paresis result from abnormal
nerve input to the voice box muscles (laryngeal
muscles).
M aralysis is the total interruption of nerve impulse
resulting in no movement of the muscle
M aresis (also possible) is the partial interruption of
nerve impulse resulting in weak or abnormal motion of
laryngeal muscle(s).
 )



M hat nerves are involved?

M #"
 
/$#"/%- carries signals to
the cricothyroid muscle which adjusts vocal cord
tension for high/low pitches

M
 "
 
/$
"/%- signals to
different voice box muscles responsible for opening
vocal folds (as in breathing, coughing), closing vocal
folds for vocal fold vibration during voice use, and
closing vocal folds during swallowing.
 )



M Not simply inability to speak

Can also affect: ability to swallow

cause shortness of breath
noisy breathing
hoarseness
unclear breathy voice
breath use in sound production
 )



How is it diagnosed?

¢%


  %&¢ ' measures electrical currents in

voice box muscles resulting from nerve input information.

easuring and looking at patterns in electrical currents show
whether there is repair of nerve inputs (re-
(re-innervation) and
the extent of the nerve lesion or problem. It works through the
insertion of small needles that can measure electrical currents in
the vocal cord muscles. In LE
 testing, patients perform a
number of tasks that would normally produce typical activity in
the vocal muscles.
 )



So, the E
 technique is useful in evaluating patients
with vocal cord paralysis
M Can pinpoint specific lesioning in unexplained vocal
paralysis
M lso can be used with other vocal disorders such as
spasmodic dysphonia, vocal tremors, and the symptoms
of progressive neurological diseases such as myasthenia
gravis.
 )



M p

 

² Laryngeal E
 functions as a prognostic tool in the
evaluation of vocal fold paralysis, as a guide for therapeutic
injections into the laryngeal muscles, and as an assessment
tool in the evaluation of the causes of vocal fold paresis
² Laryngeal p
in the paralyzed vocal fold can guide
diagnosis and treatment by pointing to the site of the lesion
² uides management of and evaluation of motion disorders
of larynx.
   !
 
M he utilization of E
 biofeedback for the
treatment of periorbital facial muscle tension
² Reduced firing in upper and lower eye, reported
reduced tension after 20 sessions
² 3 months later, subjects reported complete
elimination of all muscle tension in orbital area
   !
 
M Crocodile ear Syndrome
²  0 
  p



² Rare complication of facial paralysis
² carry out the injection of botulinum toxin under
E
 guidance in order to inject botulinum toxin
selectively into the lacrimal gland to protect
palpebral, lateral rectus, and superior rectus muscles.
 #

Cronin  . (2003). ë


(

 




% 
)


  %&&
 * % +
,
-
%
 %&&
 * % +
,
-
% .#
.#
_ ..$/#01!$1
_  ..$/#01!$10
Brundy, J., Hammerschlag E, Cohen NL, Ransohoff J. (2002).
Electromyographic rehabilitation of facial function and introduction of a
facial paralysis grading scale for hypoglossal-
hypoglossal-facial nerve anastomosis.
2
&
 
 

",
)3 4(
-  


Hammerschlag, aul E.
 (1999) Facial Reanimation ith Jump
Interpositional raft Hypoglossal Facial nastomosis and Hypoglossal Facial
nastomosis: Evolution in
anagement of Facial aralysis. ¢%  &
 109
¢%  &
109
(2, art 2) SLE
EN NO. 90: 11--23.
aniel B, uitar B. (1978). E
 Feedback and Recovery of facial and speech
gestures following neural anastomosis. -&

+
%2 
 Feb:
-&

+
%2 
Feb:
43(1): 9-
9-20.
 #
Novak C. (2004). Rehabilitation Strategies for Facial Nerve
Injuries. -
 -
%
18:
 -
%
18: 47-
47-51.
Sulica L. (2004). Electromyography and the immobile vocal field.
37(1): 59-
* % , _ 37(1): 59-74.

iller S. (2004). oice herapy for ocal Fold aralysis.
37(1):105--19
* % , _ 37(1):105
aniello RC. (2004). Laryngeal Reinnervation. * % 
37(1): 161-
, _ 37(1): 161-81.
Kizkin S. (2005). Crocodile ears Syndrome: Botulinum oxin
reatment under E
 uidance. 5
,

  % 20(1): 35-
5
,

  %20(1): 35-7.
 #
M Ischemic ~ 80% of all strokes
² Blood vessel blocked
M hrombotic
M Embolic
M Systematic Hypoperfusion
M enous hrombosis
M Hemorrhagic
² Blood vessel ruptures
M Intracerebral
M Subarachnoid
 


M Hemiplegia
² aralysis on one side of body
² Lesion in corticospinal tract
² Contralateral motor control
M Hemiparesis
² eakness or partial paralysis
² Less severe than Hemiplegia
 p

M Only 5% regain full motor control
M 20% don·t regain any function
M Significantly lower E
 in agonistic muscles
groups
² No difference in antagonistic muscles
² reatment should target motor neuron recruitment
 p


M isual or auditory signals
M Computer games
M Strengthen agonist
muscle groups
M Relax/inhibit antagonist
muscle groups
M ait training
 #
 
M

otor copy· biofeedback training
² E
 biofeedback from


 muscles
² rain patients to produce matching activity in paretic
muscles
² Longer-
Longer-lasting results than typical biofeedback group
 #
 
M Constraint-
Constraint-induced
movement therapy
² Restrain functional limb
so that patient is forced to
retrain weak muscles
² rogress monitored by

S mapping of primary
motor cortex
² Combined with E

Stimulation
 ë 
 

 
M Helps patients regain
hand function
M Current studies
monitoring cortical
reorganization
M Incorporate E

recording to measure
improvement?

 
Fritz, S. L., Chiu, Y.,
alcolm,
.., atterson, .S. and Light, K.E.. (2005) Feasibility of
electromyography--triggered neuromuscular stimulation as an adjunct to constraint-
electromyography constraint-induced
movement therapy. ë
& 85.5: 428-
428-443.
Barker, E. (2005). New hope for stroke patients: a new therapy offers hope that movement will be
restored to weakened limbs following a stroke. , 68.2: 3838--44.
owland, C., deBruin, H., Basmajian, J. ., lews, N., and Burcea, I. gonist and antagonist activity
during voluntary upper-
upper-limb movement in patients with stroke. ë
& 72.n9 624-
624-634.
" Rehab Revolution," Stroke Connection
agazine, September/October 2004
http://www.strokeassociation.org/presenter.jhtml?identifier=3029938
http://en.wikipedia.org/wiki/Stroke#Signs_and_symptoms