Clinically relevant factors impacting the efficacy of electromyographic biofeedback in stroke and spinal cord injury rehabilitation

Rehabilitation professionals address upper extremity rehabilitation following a stroke or spinal cord injury by promoting motor recovery and compensatory strategy training. Electromyography biofeedback (EMG BF) interventions have been used to address these goals, though the evidence to support their efficacy is mixed. This review categorizes the literature according to the motor learning principles underlying each intervention. Articles that described EMG BF interventions to address upper extremity deficits in individuals with stroke and spinal cord injury were included in the review. Articles were assessed based on experimental design, type of intervention provided, and results obtained. Twelve studies were identified and reviewed. Synthesis of the literature suggests that EMG BF interventions that provide knowledge of results show different patterns of effectiveness compared to those that provide knowledge of performance. This method of categorizing interventions is not commonly used in the literature and is recommended for rehabilitation professionals to aid in clinical decision-making for upper extremity neurorehabilitation. Implications for rehabilitation The type of feedback provided during a neurorehabilitation task can impact its efficacy. Knowledge of performance may be more effective in the acute and subacute phase after injury, though more work is needed that directly compares feedback related to knowledge of performance versus knowledge of results. More investigation is needed to clarify which approach is most effective during the acute and subacute phase of rehabilitation.