title: Effects of innovative virtual reality game and EMG biofeedback on neuromotor control in cerebral palsy.
abstract: Sensorimotor control dysfunction or dyskinesia is a hallmark of neuromuscular impairment in children with cerebral palsy (CP), and is often implicated in reaching and grasping deficiencies due to a neuromuscular imbalance between the triceps and biceps. To mitigate such muscle imbalances, an innovative electromyography (EMG)-virtual reality (VR) biofeedback system were designed to provide accurate information about muscle activation and motivation. However, the clinical efficacy of this approach has not yet been determined in children with CP. The purpose of this study was to investigate the effectiveness of a combined EMG biofeedback and VR (EMG-VR biofeedback) intervention system to improve muscle imbalance between triceps and biceps during reaching movements in children with spastic CP. Raw EMG signals were recorded at a sampling rate of 1,000 Hz, band-pass filtered between 20-450 Hz, and notch-filtered at 60 Hz during elbow flexion and extension movements. EMG data were then processed using MyoResearch Master Edition 1.08 XP software. All participants underwent both interventions consisting of the EMG-VR biofeedback combination and EMG biofeedback alone. EMG analysis resulted in improved muscle activation in the underactive triceps while decreasing overactive or hypertonic biceps in the EMG-VR biofeedback compared with EMG biofeedback. The muscle imbalance ratio between the triceps and biceps was consistently improved. The present study is the first clinical trial to provide evidence for the additive benefits of VR intervention for enhancing the upper limb function of children with spastic CP.
authors.affiliation: Department of Physical Therapy, Yonsei University, Wonju City, Kangwon-do, Republic of South Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoo
authors.affiliation: Department of Physical Therapy, Honam University, Gwangju, Republic of South Korea.
authors.forename: Dong Ryul
authors.initials: DR
authors.lastname: Lee
authors.affiliation: Department of Physical Therapy, Yonsei University, Wonju City, Kangwon-do, Republic of South Korea.
authors.forename: Yon Ju
authors.initials: YJ
authors.lastname: Sim
authors.affiliation: Department of Physical Therapy, Yonsei University, Wonju City, Kangwon-do, Republic of South Korea.
authors.forename: Joshua H
authors.initials: JH
authors.lastname: You
authors.affiliation: NeuroMedi Inc, Daejeon, Republic of South Korea.
authors.forename: Cheol J
authors.initials: CJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology / Q000379:methods*; D002547:Cerebral Palsy / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D020820:Dyskinesias / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009068:Movement; D009119:Muscle Contraction; D004856:Postural Balance; D016896:Treatment Outcome; D014584:User-Computer Interface; D018910:Video Games
keywords: EMG visual feedback; Virtual reality; cerebral palsy; muscle imbalance; neuromotor control