Stroke Structured Abstract - S #12
Kinethetic biofeedback is as beneficial as Brunstrom's movement therapy in improving elbow range of motion in stroke clients
CITATION: Greenberg, S. & Fowler, R. S., Jr. (1980). Kinesthetic biofeedback: A treatment modality for elbow range of motion in hemiplegia. American Journal of Occupational Therapy, 34, 738-743.
LEVEL OF EVIDENCE: IC2c
What is the effectiveness of kinesthetic biofeedback vs tradional OT intervention on elbow range of motion (ROM) in stroke patients?
Randomized Controlled Trial (RCT)
Subjects were randomly assigned to one of two treatment groups: A Kinesthetic Biofeedback Treatment Group or a Control OT Treatment Group.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Inclusion criteria were: (1) minimum age of 30 years, (2) hemiplegia secondary to a cerebral vascular accident (CVA), (3) minimum of 1 year post-CVA, and (4) minimum discrepancy of 20 degrees between active and passive elbow extension.
N = 20
Male = 13
Female = 7
Mean age = 64.9
LCVA = 7
RCVA = 13
Attrition = NR
NR = Not Reported
Elbow ROM, using a traditional goniometer
Experimental Group: Kinesthetic Biofeedback Treatment - Using audiovisual feedback associated with active elbow extension as monitored by an electrogoniometer.
Control Group: Brunnstrom's Therapeutic Approach - Including eliciting postural reflexes and body positioning, sensory stimulation to increase awareness of the impaired upper extremity, manual resistance, and functional activities to facilitate movements out of synergy patterns.
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
30-minute session, twice a week for 4 weeks.
There was no significant difference between the two groups (p = .58, r = .05).
The majority of the subjects in each group achieved a significant increase in active elbow extension following therapy.
Mean increase = 11 degrees ROM.
Experimental group(t = 2.256, p = .025, r = .60
Control Group(t = 3.535, p = .003, r = .76).
The within-group effect sizes were confounded with maturation effect. However, all subjects were in chronic stage so the maturation effect was exclusive of spontaneous recovery.
THREATS TO VALIDITY
The results indicate that kinesthetic biofeedback was as beneficial as (Brunnstrom's) movement therapy for improving elbow ROM in stroke patients. A majority of subjects in both groups improved in ways not directly related to treatment, which suggests the need for long-term follow up of patients with hemiplegia.
The study suggests the similar effects of kinesthetic biofeedback and "conventional" (Brunnstrom) OT treatment in improving active elbow ROM. The carry over of the increased ROM to functional activities was not studied.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
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