title: Augmented effects of EMG biofeedback interfaced with virtual reality on neuromuscular control and movement coordination during reaching in children with cerebral palsy.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physical Therapy, The Graduate School Yonsei University, Wonju, Republic of Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoo
authors.affiliation: Department of Physical Therapy, Honam University, Gwangju, Republic of Korea.
authors.forename: Dong Ryul
authors.initials: DR
authors.lastname: Lee
authors.affiliation: The Sports·Movement Institute & Technology (S·MIT), Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Cha
authors.affiliation: The Sports·Movement Institute & Technology (S·MIT), Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: You
mesh_terms: D001676:Biofeedback, Psychology / Q000379:methods*; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D011597:Psychomotor Performance / Q000502:physiology*; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods*
keywords: Arm swing movement; central pattern generator; cerebral palsy; gait training; muscle activity