ch 15 1020

Objectives of EMG Biofeedback

  • Define electromyographic (EMG) biofeedback.
  • Describe the physiological effects of EMG biofeedback.
  • Explain clinical indications and contraindications.
  • Select equipment and treatment parameters for EMG biofeedback.
  • Apply neuromuscular electrical stimulation safely and effectively.
  • Document treatment with EMG biofeedback accurately.
  • Rationalize the use of Combo US/E-stim for indicated conditions.
  • Understand parameters for Combo US/E-stim for various conditions.

Biofeedback History

  • Initially used for musculoskeletal conditions.
  • Expanded to include psychological and autonomic processes.
  • Examples:
    • Heart Rate Monitors
    • Surface EMG
    • Needle EMG
    • Electro goniometers
    • Force plates
    • Diagnostic ultrasound.

Types of Biofeedback

  • Direct Biofeedback: Provides real-time measurements of vitals (e.g., pulse rate).
  • Transformed Biofeedback: Represents actions goal-oriented, such as surface EMG readings.

Understanding EMG Biofeedback

  • Unique from other physical agents as it involves no energy transfer.
  • Detects electrical (ionic) activity in muscles and converts it to signals (visual, auditory, or haptic).
  • Measures ionic activity in microvolts (μV), not motor unit recruitment.

Surface EMG Biofeedback Configuration

  • Consists of three electrodes: two active, one reference.
  • New pads may be used; proper skin preparation (cleaning and applying gel) is necessary.
  • Electric devices and tissue considerations (hair and adipose) affect signal quality.

Parameters for Measuring Biofeedback

  • Measurable via both auditory and visual formats.
  • Key metrics include:
    • Microvolts (μV) measurements (1-2000)
    • Peak amplitude
    • Contraction latency
    • Return latency
    • Hold capacity
    • Threshold settings.

Effects of EMG Biofeedback

  • Neuromuscular Facilitation: Increases muscle strength and function; reduces inhibition of motor signals.
  • Neuromuscular Inhibition: Reduces myoelectric activity for pain relief and increased ROM.
  • Neuromuscular Coordination: Enhances timing and intensity of motor unit firing for specific tasks.

Clinical Indications for Biofeedback

  • Hemiplegia: Helpful for conditions like foot drop and shoulder subluxation.
  • Headaches: Effective for tension-type headaches, EMG biofeedback outperformed placebo.
  • Pelvic Floor Disorders: Biofeedback for Kegel exercises improves conditions like urinary incontinence.
  • Chronic Pain Management: Aims to reduce muscle tone and restore motion, offers short-term pain relief benefits.

Contraindications and Precautions

  • Applied in the presence of:
    • Acute inflammation
    • Tissue injury
    • Fractures
    • Post-operative conditions.
  • Risks include increased pain, rashes, or skin irritation.

Application Technique for EMG Biofeedback

  1. Instruct patient on goals (facilitation, inhibition, coordination).
  2. Clean the skin and position electrodes appropriately.
  3. Set up baseline and threshold levels for treatment.
  4. Document treatment results.

Documentation of EMG Biofeedback Treatment

  • Document goals, area treated, patient preparation, and electrode placement metrics.
  • Record peak amplitudes, net changes, and patient response.

Combo US/E-stim Overview

  • Combines ultrasound effects with electrical stimulation targeting muscle contraction.
  • Parameters are set with ultrasound first and electrical stimulation second.

Indications for Combo Treatment

  • Useful for trigger points, improving blood flow, and superficial pain.

Effects of Combo Treatment

  • Provides pain relief, promotes tissue healing, enhances circulation, and reduces muscle spasms.

Application of Combo US/E-Stim

  1. Ensure appropriateness and rule out contraindications.
  2. Prepare the treatment area and patient.
  3. Set parameters for both ultrasound and electrical stimulation according to treatment goals.
  4. Document patient outcomes post-treatment.