Feedback of ankle joint angle and soleus electromyography in the rehabilitation of hemiplegic gait.

A computer-assisted feedback system was developed to present to walking subjects instantaneous feedback of their muscle activity or joint angular excursions during gait. Targets for muscle activity or joint motion were displayed on the feedback screen along with timing cues that prompted muscle activity or joint flexion/extension at specific times during the gait cycle. The purpose was to compare the effectiveness of joint angle and electromyographic (EMG) feedback to a focused program of physical therapy for gait. Eight hemiplegic stroke patients were treated with ankle joint angle feedback, EMG biofeedback from the soleus muscle, and conventional physical therapy for gait in a three-period crossover design. PT was given either first or last in the sequence of treatments. Gait analysis prior to and following each type of treatment revealed that the feedback treatments resulted in significant increases in stride length and walking velocity and in positive changes in push-off impulse, gait symmetry, and standing weight-bearing symmetry, as evaluated in a general linear model and paired t-tests. Overall, physical therapy produced no significant changes. However, when physical therapy was the first treatment of the sequence, significant increases in stride length and velocity were observed. When physical therapy was last, there were significant negative changes in gait symmetry and standing weight-bearing symmetry, and negative trends in stride length, walking velocity, and push-off impulse. It is concluded that computer-assisted feedback is an effective tool for retraining gait in stroke patients.