Yoo Ji Won, Lee Dong Ryul, Cha Young Joo, You Sung Hyun
Department of Physical Therapy, The Graduate School Yonsei University, Wonju, Republic of Korea.
Department of Physical Therapy, Honam University, Gwangju, Republic of Korea.
NeuroRehabilitation. 2017;40(2):175-185. doi: 10.3233/NRE-161402.
The purpose of the present study was to compare therapeutic effects of an electromyography (EMG) biofeedback augmented by virtual reality (VR) and EMG biofeedback alone on the triceps and biceps (T:B) muscle activity imbalance and elbow joint movement coordination during a reaching motor taskOBJECTIVE: To compare therapeutic effects of an electromyography (EMG) biofeedback augmented by virtual reality (VR) and EMG biofeedback alone on the triceps and biceps muscle activity imbalance and elbow joint movement coordination during a reaching motor task in normal children and children with spastic cerebral palsy (CP).
18 children with spastic CP (2 females; mean±standard deviation = 9.5 ± 1.96 years) and 8 normal children (3 females; mean ± standard deviation = 9.75 ± 2.55 years) were recruited from a local community center. All children with CP first underwent one intensive session of EMG feedback (30 minutes), followed by one session of the EMG-VR feedback (30 minutes) after a 1-week washout period. Clinical tests included elbow extension range of motion (ROM), biceps muscle strength, and box and block test. EMG triceps and biceps (T:B) muscle activity imbalance and reaching movement acceleration coordination were concurrently determined by EMG and 3-axis accelerometer measurements respectively. Independent t-test and one-way repeated analysis of variance (ANOVA) were performed at p < 0.05.
The one-way repeated ANOVA was revealed to be significantly effective in elbow extension ROM (p = 0.01), biceps muscle strength (p = 0.01), and box and block test (p = 0.03). The one-way repeated ANOVA also revealed to be significantly effective in the peak triceps muscle activity (p = 0.01). However, one-way repeated ANOVA produced no statistical significance in the composite 3-dimensional movement acceleration coordination data (p = 0.12).
The present study is a first clinical trial that demonstrated the superior benefits of the EMG biofeedback when augmented by virtual reality exercise games in children with spastic CP. The augmented EMG and VR feedback produced better neuromuscular balance control in the elbow joint than the EMG biofeedback alone.
本研究旨在比较虚拟现实（VR）增强的肌电图（EMG）生物反馈与单纯EMG生物反馈对伸手运动任务期间肱三头肌和肱二头肌（T:B）肌肉活动失衡及肘关节运动协调性的治疗效果。
比较虚拟现实（VR）增强的肌电图（EMG）生物反馈与单纯EMG生物反馈对正常儿童和痉挛型脑瘫（CP）儿童伸手运动任务期间肱三头肌和肱二头肌肌肉活动失衡及肘关节运动协调性的治疗效果。
从当地社区中心招募了18名痉挛型CP儿童（2名女性；平均±标准差=9.5±1.96岁）和8名正常儿童（3名女性；平均±标准差=9.75±2.55岁）。所有CP儿童首先接受一次强化的EMG反馈训练（30分钟），在1周的洗脱期后，再接受一次EMG-VR反馈训练（30分钟）。临床测试包括肘关节伸展活动范围（ROM）、肱二头肌力量以及积木测试。分别通过EMG和三轴加速度计测量同时确定肱三头肌和肱二头肌（T:B）肌肉活动失衡及伸手运动加速协调性。在p<0.05时进行独立t检验和单因素重复方差分析（ANOVA）。
单因素重复方差分析显示在肘关节伸展ROM（p=0.01）、肱二头肌力量（p=0.01）和积木测试（p=0.03）方面有显著效果。单因素重复方差分析还显示在肱三头肌肌肉活动峰值方面有显著效果（p=0.01）。然而，单因素重复方差分析在复合三维运动加速协调性数据方面无统计学意义（p=0.12）。
本研究是第一项临床试验，证明了在痉挛型CP儿童中，虚拟现实运动游戏增强的EMG生物反馈具有更大的益处。增强的EMG和VR反馈比单纯的EMG生物反馈在肘关节产生了更好的神经肌肉平衡控制。
