Excerpted from the article, "A Rehab Revolution," Stroke Connection Magazine, September/October 2004
Jump to 2006 update
Rehab centers across the country are using innovative advances in rehab science. These therapies can either supplement or replace traditional therapy.
Traditional therapy is intended to progress very slowly to prevent abnormal movement. The new therapies are aggressive, focusing on forced movement, repetition and intensity. They also rely on technological advances.
The concept of biofeedback is as simple as looking in the mirror to watch yourself move your arm or leg. It’s a visual reinforcement that you are moving your limbs in a desired way.
“After a stroke, it is common for survivors to move their arms or legs abnormally,” says Dr. Richard L. Harvey, medical director of the Stroke Rehabilitation Center at the Rehabilitation Institute of Chicago. “Biofeedback can train a survivor to move more naturally.”
In biofeedback, a wire electrode connected to a metal plate is attached to the skin over an arm or leg muscle. When the survivor moves this muscle, an electrical signal travels from the electrode to an attached monitor, where it produces a particular image. The survivor gets reinforcement every time he or she moves the muscle and creates this image. Biofeedback gives a visual cue that the survivor is moving muscles in a desired way.
After his stroke in 1995, Dr. Howard Rocket of Toronto, Ontario, had left-side paralysis. In rehab, a therapist attached an electrode to the bicep muscle in his arm and attached the wire to a monitor. When Rocket moved that muscle, a line would move up on a graph on the monitor screen. The more he moved the bicep muscle, the higher the line climbed on the screen.
“It was like making a cursor move on a computer screen,” he says.
Biofeedback is helpful in isolating which muscle to use when two opposing muscles are working against each other after a stroke. For example, a survivor may not be able to open his fist if one muscle in his hand is working to open the hand but an opposing muscle is overactive.
After isolating which muscle needs to be relaxed in order to allow the opposing muscle to do its job, the therapist attaches an electrode to the overactive muscle. Every time that muscle relaxes, an image appears on a screen. The survivor receives visual feedback that teaches him to relax the correct muscle.
Biofeedback has been used for pain management for years. “There are no risks with biofeedback,” says Dr. Harvey. “It can train a survivor to open his or her hand by extending the fingers and relaxing the finger flexors. Its main drawback is it’s usually not helpful for learning a functional task like drinking from a cup. So biofeedback can improve motor control but does not focus on improved functional use.”
A biofeedback session usually lasts an hour, is billed like a regular hour of physical therapy, and is reimbursable by Medicare.
Biofeedback has not been a focus of research in the past two years. Although it is helpful in training survivors to open a hand, it does not help survivors develop functional skills. According to Dr. Richard Harvey, medical director at the Rehabilitation Institute of Chicago, “No one’s really pursuing new research in biofeedback these days.”