EMG BIOFEEDBACK

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 Feedback
• Feedback is a response to a particular process or activity

• According to Weiner, 1948, ‘feedback is a method of controlling a

system by reinserting into it the results of its past performance’

• Physiological feedback is a self-regulatory biological system in

which the output or response affects the input either positively or
negatively

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 Positive Feedback
• Change in one direction
causes further change in Uterine Pressure on
contraction cervix
the same direction

Oxytocin
release

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 Negative Feedback
• Change in one direction Body
Temperature
causes further change in drops
the opposite direction
Body
Temperature
Rises

Body Sweats
more

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 Feedback
• Physiological feedback refers to intrinsic information inherent to
movement including kinesthetic, visual, cutaneous, vestibular, and
auditory signals collectively termed as response produced
feedback
• Feedback from some measuring instrument which provides
information about a biologic function is referred to as biofeedback
• Also refers to extrinsic information or some knowledge of results
presented verbally, mechanically, or electronically to indicate the
outcome of some movement performance

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 Definition of Biofeedback
• Three professional biofeedback organizations, the Association for Applied Psychophysiology
and Biofeedback (AAPB), Biofeedback Certification International Alliance (BCIA), and the
International Society for Neurofeedback and Research (ISNR), arrived at a consensus
definition of biofeedback in 2008:
• “is a process that enables an individual to learn how to change physiological
activity for the purposes of improving health and performance. Precise
instruments measure physiological activity such as brainwaves, heart
function, breathing, muscle activity, and skin temperature. These instruments
rapidly and accurately 'feed back' information to the user. The presentation of
this information — often in conjunction with changes in thinking, emotions,
and behavior — supports desired physiological changes. Over time, these
changes can endure without continued use of an instrument.

http://en.wikipedia.org/wiki/Biofeedback Sreeraj S R
 In Biofeedback…
1. The information is detected,
2. provided in an understandable way to the patient
who can then, at their own initiation,
3. use the information to achieve a measure of control over the
same process.
i.e. engaging the patient in a ”closed loop” learning, using
feedback until sufficient development of his motor skills occurs,
so that an “open loop“ movements can be achieved.

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 Detection
Physiologic Response by
Closed Loop signal patient
and
feedback

Physiologic Response by
Open Loop signal patient

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 Requirements
• To be realistic and successful, three main elements are needed in
order to enhance motor learning:
1. Relevant
2. Accurate
3. Speed of information
• Most EMG biofeedback devices nowadays introduce 50 to 100
milli sec. delays before the signal can reach the ears or eyes of
the patient

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every day forms of biofeedback

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 you have to have
accurate feedback, of course

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 EMG Biofeedback
• EMG does not measure muscle contraction directly

• EMG measures electrical activity associated with muscle

contraction

• Electrical activity of muscle measured in micro volts (1 volt =

1,000,000 µV)

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 EMG Biofeedback

Advantages:
• Can be integrated with other therapeutic interventions
• an enhancer of the therapy
• reduce patient’s reliance on the therapist
• gain control without reliance on the therapist,
and once gained,
• to maintain control without either the therapist or the
machine.
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Working
A biofeedback loop.

Here the forearm

muscles are monitored to
provide a visual readout
to the user.

The feedback loop is

completed when the user
alters her muscle tension
to adjust the readout.

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Working

Two active electrodes

One reference electrode

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 Working - CMRR
• Two signals are fed to a differential amplifier which subtracts the
signal from one active electrode from the other active electrode
• Differential amplifier uses reference electrode to compare the
signals of the two active electrodes
• This in effect cancels out or rejects any components that the two
signals coming from the active electrodes have in common thus
amplifying the difference between the signals
• Ability of the differential amplifier to eliminate the common noise
between active electrodes is called the common mode rejection
ratio (CMRR)
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 Working - filtering
• EMG signals are in the range of 0 – 500 Hz
• Frequencies above 500 Hz is filtered out
• The dominant energy of the EMG signal is in the range of
50 – 150 Hz
• Motion artifacts in the range of 0 – 20 Hz
• Frequencies below 20 Hz are filtered by using a high
pass filter

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Working – Rectification & Integration

Raw EMG activity in muscle is an alternating voltage -

direction or polarity is constantly reversing

Rectification is the summation of electrical activity. To

determine the overall increase and decrease in electrical
activity, deflection toward the negative pole must be flipped
upward toward the positive pole

EMG signal is then smoothed to eliminate the peaks and

valleys or high frequency fluctuations

The signal may then be integrated by measuring the area

under the curve for a specified period of time. Integration
forms the basis for quantification of EMG activity. Sreeraj S R
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Visual cues Auditory cues
1. Meter read outs 1. Changing tones
2. Flashing lights 2. Clicks
3. Oscilloscope
4. Computer screens

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 Features of the BF Devices
• Gain settings, low & high
• Sound
• Threshold

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 Gain settings
• On low gain settings the machine will require a greater
signal before the output changes - in other words, it is
less sensitive.
• On higher gain settings, a small amount of EMG activity
will be easily seen by the patient.

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 Sound

• Most EMG biofeedback devices offer an audible feedback

in addition to the visual information

• the change in sound is such that the frequency of the

‘beeps’ increases with increased EMG activity.

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 Threshold

• Incorporation of a threshold system enables the patient

targets to be set.
• The audible signal can be adjusted so that it will only be
heard if the patient achieves a preset activity level.
• To achieve an increase in muscle activity, the threshold
can be set so that the audible feedback only comes on
when 50% of the scale has been achieved.

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Equipment

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 Electrode Placement

• Silver/Silver Chloride
construction
• judicious electrode placement
• electrode spacing
• Noise/ movement artefact
• active electrodes should be
placed in parallel with the
dominant muscle fibres

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 Uses
• Facilitate muscle contractions
• Promote increased motor recruitment
• Regain neuromuscular control
• Decrease muscle spasm
• Promote relaxation

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 Indications
• Stroke • Balance and mobility
• Spinal cord injury • Trunk muscle re education
• Improving muscle action • Respiratory muscle control
• Posture control • Incontinence

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 Contraindications
• If the patient is prohibited from moving the joint or
isometric contractions, then BF should NOT be used
• Unhealed tendon grafts
• Avulsed tendons
• Third degree tears of muscle fibers
• Unstable fracture
• Injury to joint structure, ligaments, capsule, or articulating
surface

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 Technique for Motor Recruitment
• Position pt., Explain to pt., Work in quiet area.
• Apply sensors to an area to demonstrate the desired A-V signal and activity.
• Adjust to the most sensitive level that picks up any MUAP that pt. can
produce
• Instruct pt. to try to produce an A-V signal
• As voluntary muscle activity improves, the A-V signal will increase. Adjust
the gain to decrease the sensitivity, so pt. has to work harder to recruit more
muscle units.
• As pt. masters in one position, change positions
• Document all parameters. Tx duration 30-60 min
• Clean up
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 Inhibition of Spasticity
• Goal: decrease undesirable muscle activity that may be interfering with
functional movement.
• Eval. spasticity, Explain to pt., Apply sensors and demonstrate desired
activity.
• Find the least sensitive setting that produces minimal A-V feedback
• Have pt relax, use techniques and have pt. lower the A-V signal.
• As the signal decreases, lower the shaping controls (gain), to a more
sensitive level. As pt. relaxes better, continue to increase sensitivity
• Change positions

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 Pressure Biofeedback
• A simple device to provide feedback
to ensure quality, and precision in
exercise performance and testing.

• Monitors position of the low back

and provides feedback when the
abdominal muscles are not actively
or effectively protecting the spine.

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 References

1. http://en.wikipedia.org/wiki/Biofeedback
2. http://bme2.aut.ac.ir/~towhidkhah/MotorControl/Resources/EMG.pdf
3. http://www.electrotherapy.org/modalities/biofeed.htm
4. Low & Reed, Electrotherapy Explained, principle and Practice, 4th edition, 2009, Elsevier,
5. Jagmohan Singh, Textbook of Electrotherapy,1st Edition, 2005, Jaypee Publications.

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