Biofeedback techniques provide information to the patient in order to enhance appropriate responses, specifically gait movements in this chapter. Biofeedback techniques in publications include those based on EMG recordings of muscle activation or position or force sensors that provide feedback on joint motion or functional attributes such as weight-shifting.
In the study by Govil & Noohu (2013), biofeedback was provided in the form of EMG from the gluteus maximus muscle. Participants (N=30) were randomized into 2 groups either receiving biofeedback and gait rehabilitation or just gait rehabilitation. Both groups significantly improved from baseline in EMG amplitude, walking velocity and step length but the group receiving biofeedback improved by more. The biofeedback group also had significantly higher walking cadence. In the Tamburella et al. (2013) study, the visual biofeedback group experienced significant improvement in balance and gait measures which were maintained at follow-up.
[su_spoiler title=”Effect Size Forest Plots of RCTs with Available Data” style=”fancy”][su_row]Click on the image to enlarge[/su_row]
[su_lightbox type=”image” src=”/wp-content/uploads/Forest_LLimb_Govil_2013.gif”][image_with_animation image_url=”/wp-content/uploads/Forest_LLimb_Govil_2013.gif” alt=”Effect size SMD forest plot for Govil & Noohu 2013, EMG biofeedback”][/su_lightbox]
There is level 2 evidence (1 low quality RCT) (Govil & Noohu 2013) that EMG biofeedback may improve gait outcomes in patients with SCI.
There is Level 2 evidence that lower limb training augmented by biofeedback of ankle and knee movements can improve gait, balance, and muscle strength (Villiger et al., 2015).
There is level 4 evidence that virtual games (i.e., Nintendo Wii Fit) can enhance gait speed and functional reach and that these gains can be maintained at a 4 week follow-up (Wall et al., 2015).