Investigating the effect of biofeedback therapy on the range of motion of hand joints in stroke patients

Master's Thesis

Occupational Therapy Group

Persian Abstract

Introduction: The increasing prevalence of stroke requires the use of more effective tools and techniques in this disease in order to reduce the duration of treatment and accelerate and facilitate the recovery and return of function of affected organs. Therefore, the present study was conducted with the aim of investigating the impact of biofeedback on the range of motion and daily life performance of stroke patients. Method: 24 stroke patients with an average age of 54.75 participated in this study, who were randomly divided into two test and control groups. Considering the key role of the hand in performing daily tasks, its performance before and after the intervention was evaluated by spasticity test with Ashworth test, evaluation of range of motion of elbow, wrist and fingers with goniometer and daily life performance with Barthel test. Two groups were treated and examined with common occupational therapy exercises (control group) and these exercises together with biofeedback (experimental group) for 3 months.

Findings: By providing biofeedback, the severity of spasticity in the hands of 4 people from the experimental group was reduced from 1 to zero, while in the control group only one person had slight spasticity. The use of biofeedback led to a significant increase in the range of motion of the elbow (p<0.001), wrist (p<0.003) and finger (p<0.001) compared to the control group. Also, after the intervention, the Bartel score in the experimental group increased significantly compared to the control group (p<0.001).

Conclusion: The use of biofeedback therapy in combination with treatments Occupational therapy routine has a significant and decisive effect on improving the range of motion of upper limb joints and daily life function.

Key words: stroke, wrist extension movement, biofeedback electromyography

Chapter One

(1-1) Introduction

Brain vascular injuries are the most common debilitating diseases of the nervous system. A stroke is a cerebrovascular accident, which by definition means a sudden decrease in blood flow that occurs due to a disruption in the blood vessels entering the brain. As a result, lack of oxygen causes the brain tissue to be damaged or even destroyed. Stroke also occurs due to hematoma in the brain. This disease is a cerebro-vascular accident that occurs suddenly and is related to regional (or general) brain function that continues for more than 24 hours and has no clear cause other than vascular origin. This disease causes the death of about half of the patients, and the other half who survive are mostly permanently disabled [1]. Stroke is one of the most common debilitating neurological diseases in adults, which is actually the cause of hospitalization of half of neurological patients [2]. 

Stroke can cause physical disorders such as: weakness, numbness of facial muscles, arms and legs, especially on one side of the body, imbalance, loss of consciousness, inability to speak, headache and confusion, visual disturbances, incontinence of urine and feces, difficulty in swallowing, numbness and burning in body parts, problems in understanding the position and position, double nose and blurred vision, or loss of vision, especially in one eye, and the inability to perform fine movements [1].

The occurrence of motor and psychological disorders leads to non-use of limbs, more weakness and paralysis, disruption in performing daily life activities, more dependence and ultimately a decrease in the quality of life. Therefore, due to the occurrence of such disorders, timely treatment is necessary. Treatment methods also include surgery (if necessary) to remove the clot from the cerebral artery, the use of blood-thinning drugs and finally a rehabilitation program such as physiotherapy, occupational therapy and speech therapy [1]. Adequately, the disability and problems caused by the disease will be reduced and the patient can regain his lost ability and independence [3].In this chapter, we will discuss the problem, the importance and necessity of research, the theoretical and operational definition of research keywords. rtl;">(2-1) Statement of the problem

Since all physical and mental activities are under the control of the brain, damage to brain cells due to a stroke causes disturbances in a person's physical and mental activities. These physical and mental disorders have severe effects on the quality of life. Research has shown that the main cause of functional impairment in daily life activities after a stroke is paralysis of the upper limb, despite the important effects that the upper limb has on the daily activities of a person's life, such as dressing, eating, etc. Yes, damage in this area reduces the quality of life and will result in consequences such as depression and reduced self-confidence [1]. 

Occupational therapy as part of rehabilitation can make an important contribution to the recovery and management of stroke patients. Occupational therapist due to the breadth of treatment aspects that include: treatment in the range of movement, cognition and understanding of the patient; He usually spends the most treatment time with the patient compared to other members of the treatment team, and also by using effective treatment techniques in which the patient is actively involved, he improves the upper limb. Through these therapeutic techniques, the patient's functional skills are strengthened, functional skills training makes progress in the all-round recovery of daily life activities and the improvement of daily activities using tools [4]. In this regard, the goal of occupational therapy is to restore patients to their maximum physical, mental and social ability. The philosophical basis of occupational therapy is the active treatment of the patient; So that he can use his existing physical and mental abilities to improve day by day. Carrying out purposeful activities that enable mental health and social and physical environment. To achieve this goal, the occupational therapist considers the patient's all-round progress and accordingly uses the effective treatment plan using the appropriate modality, which is the best quality treatment and at the same time the shortest and the least expensive [2]. 

Since the disabilities caused by stroke lead to a decrease in the daily performance and social participation of affected people, therefore, occupational therapy is an important part of rehabilitation to help a person achieve maximum independence. To achieve these long-term goals, short-term goals are considered, including: increasing awareness of natural movement patterns and the development of voluntary and involuntary responses, reducing extensor or flexion synergies, reducing annoying reflexes, reducing spasticity, increasing strength and tolerance of natural movement patterns, increasing coordination, reducing or removing the limitation of the range of motion of the joints, supporting the painful limb in cases of shoulder pain and increasing the range of motion of the joints, active participation of the patient in activities and obtaining maximum independence in daily life performance. is [1]. Different treatments are used in this process. One of the methods that can be included in the therapeutic interventions of stroke rehabilitation is biofeedback therapy.

For years, different uses of biofeedback have been made in the clinical medicine of musculoskeletal diseases and brain-spinal cord patients, which have been studied in each gender and age group. In working with biofeedback, the most emphasis is on receiving a relatively quick response from the patient, creating active participation of the patient, teaching this technique to the patient for use at home, increasing the patient's independence and reducing health costs. Biofeedback is a relatively simple and effective treatment for neuromuscular diseases, which can even be taught to the patient's family to expand the scope of treatment [5].

In the process of creating a stroke, the main central motor pathways that regulate normal tone are damaged and their function is disturbed, but some motor pathways that were previously unused may not be damaged by the stroke, patients can learn to use these inactive motor pathways. activate, this operation is possible by teaching biofeedback to the patient [6, 7].