The assumption that EMG biofeedback cultivates an antistress response was tested under stress conditions while investigating the comparative efficacy of low versus high arousal treatment strategies. Biofeedback-assisted, cue-controlled relaxation training was used as the low arousal treatment strategy for half of the 20 normal subjects used in the study. The other half received a high arousal treatment strategy which used the same training in combination with an avoidance conditioning procedure. In this procedure mild electric shock was used as contingent aversive stimulation designed to reinforce relaxation responses. Both groups received four in-lab training sessions with a 4-day interim of home practice of cuecontrolled relaxation prior to the last in-lab training session. Pretraining assessment consisted of four 10-minute periods of alternating no-stress and stress conditions. Mild electric shock and loud tones were used as stressors. Posttraining assessment was identical to pre training except subjects employed self-directed, cue-controlled relaxation rather than self-directed relaxation based on instructions without training. Frontal EMG, subjective mental and muscle tension ratings, and behavioral observations of relaxation behavior served as dependent measures during pre- and posttraining assessment. EMG readings were used during in-lab training and the two subjective rating scales were used during home practice.

This master’s thesis focuses on real-time detection of activity in electromyographic signal for reaction time measurement. For patients motivation there was designed and implemented therapeutic car game controlled throught the muscle activity. In this thesis were used three different algorithms for muscles activity detection in EMG signal. The best accuracy of this three methods has designed artificial network with U-Net hierarchy, which is used to segment samples into two categories - samples of signal with activity and samples representing calm. Accuracy of this method is 97 %. Later there were examined differences between groups of probands, different stimulus and the changes of reaction time over time.

Purpose: The upper trapezius to serratus anterior muscle activation ratio is essential for optimal shoulder function. An alteration of this ratio, specifically a decrease in upper trapezius and increase in serratus anterior activation, is a main area of focus in shoulder rehabilitation (Kibler, 1998; Paine & Voight, 1993). Electromyography (EMG) biofeedback has been shown to be an effective rehabilitation technique to address many musculoskeletal disorders but there is limited research on the retention of improvements seen with EMG biofeedback (Ma et al., 2011; Lim et al., 2014; Weon, et al., 2011). The purpose of this study was to determine if EMG biofeedback can be used to improve scapular control by decreasing the upper trapezius to serratus anterior activation ratio. A secondary purpose was to determine if these predicted improvements in the ratio can be retained beyond the timeframe in which the treatment is provided. Methods: Twenty college aged (age=21.75±1.77) subjects (10 males, 10 females) volunteered to participate in this study. Subjects were randomized to the exercise only group or EMG biofeedback group. The exercise only group performed three exercises twice a week for four weeks with supervision. The EMG biofeedback group performed the same exercises twice a week for four weeks with the addition of watching EMG biofeedback on a computer monitor with the instructions to decrease the upper trapezius activation and increase the serratus anterior activation by adjusting the corresponding lines on the monitor. The percent maximal voluntary contraction (MVC) for each muscle during each exercise was measured on visit one, visit nine (after the four weeks of practice) and visit ten (after a two-week retention period). The ratio and the individual muscle changes were analyzed using multi-factor ANOVAs against group, exercise, and group by exercise interaction. Results: There was no significant effect of any of the variables on the ratios visit one to visit nine, nor when comparing visit nine to visit ten. The was a significant effect of group on the upper trapezius when comparing visit one to visit nine (p=0.007) with no effect seen comparing visit nine to visit ten. There was also a significant effect of group on the serratus anterior activation for both visit one to visit nine (p=0.000) and visit nine to visit ten (p=0.001). Conclusion: EMG biofeedback did not decrease the upper trapezius to serratus anterior activation ratio, but the individual muscle activation changes indicate that EMG biofeedback is effective at altering muscle activation rates in individual muscles and that those changes can be retained beyond the timeframe of the intervention. Additional research is needed with more subjects and in populations with shoulder pathologies to further investigate the effectiveness of this concept.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico / A espasticidade é observada na maioria dos pacientes após Acidente Vascular Encefálico (AVE), e exercem influência na presença de deficiências e incapacidades, comprometendo a função motora. As estratégias de neuroreabilitação, o biofeedback eletromiográfico (EMG), têm sido utilizado com aceitação na comunidade médica para reajustes nas habilidades sensório-motoras como retreinamento motor, redução da espasticidade e/ou treinamento de relaxamento. A intervenção ainda apresenta evidências delimitadas quanto a sua efetividade na reabilitação, principalmente, quanto a interferência sobre a atividade cortical e na redução dos sinais espásticos que oferece características negativas na execução do movimento. O objetivo dessa pesquisa foi analisar a possível interferência do treino com biofeedback eletromiográfico sobre a conscientização do controle motor no membro espástico e a caracterização da atividade das bandas de baixa frequência em diferentes regiões corticais orientada pela técnica de treinamento. Dezesseis voluntários acometidos por AVE isquêmicos foram selecionados e divididos em dois grupos (n=8). Grupo experimental (GE) submetidos ao treino com biofeedback associado a fisioterapia, e o grupo controle (GC) submetido apenas à fisioterapia convencional. Foi realizada a avaliação do grau de espasticidade pelo limiar de reflexo do estiramento tônico (LRET) e pela Escala Modificada de Ashworth (EMA) antes e três semanas após o término do treinamento com a técnica. Os sujeitos foram submetidos ao biofeedback durante 6 semanas, com 2 sessões semanalmente. O mesmo tempo para o tratamento fisioterápico foi padronizado para o GC. Os resultados mostram variação do percentual médio de melhora do grau de espasticidade, mensuradas pelo LRET, de 38,59% (dp=13,03%) no GE comparado com 18,58% (dp=11,90%) do GC. Essa variação apresentou diferença significativa (p=0,020; t=2,776; p<5%) entre os grupos (controle e experimental), e a diferença significativa do LRET antes e após do treinamento no GE (p=0,003; t=5,338; p<5%) quando comparado ao GC (p=0,015; t=3,657; p<5%). A medida semi-quantitativa da EMA antes e após o término das sessões mostraram variações apenas no GE. Com relação a atividade cortical, houve diferença de atividade das bandas (delta, teta, alfa e beta) quando a 3ª e 12ª sessão foram comparadas para cada sujeito do GE. Essa diferença foi encontrada, principalmente, em regiões frontal, central (vértex), parietal e occipital em ambos hemisférios (ipsilateral e contralateral a lesão) tanto na fase de planejamento cognitivo motor quanto na execução do movimento. Houve predominância da diferença de atividade para a banda delta, alfa e beta em diferentes sujeitos distribuída difusamente ao longo dos canais de registro de viii EEG. A atividade diferenciada das bandas foi devido ao aumento e/ou diminuição da energia espectral entre as sessões, notado apenas em alguns voluntários do GE. Observou ainda diferença de atividade em áreas motoras secundárias. As avaliações, principalmente do LRET mostram que o treino com biofeedback EMG foi efetivo na redução do grau de espasticidade. A diferença de atividade cortical das bandas de frequência entre as sessões sugere que o biofeedback modula a cognição por meio do esforço e atenção imposta pela tarefa na tentativa do movimento no membro acometido. Além de que a diferença de energia espectral entre as sessões é dependente do ajuste e complexidade da tarefa direcionado pelos sinais do biofeedback, auxiliando na aprendizagem motora. / Spasticity is observed in most patients after cerebrovascular accident (CVA), and exerts influence in the presence of disabilities, affecting motor function. For neurorehabilitation strategies, electromyographic biofeedback (EMG) has been used with acceptance in the medical community for adjustments in the sensory-motor skills as a motor retraining, reducing spasticity and/or relaxation training. The intervention still presents limited evidence regarding their effectiveness in rehabilitation, especially as the interference of cortical activity and the reduction of spastic signs that provides negative characteristics in movement execution. The aim of this study was to analyze the workout possible interference with EMG biofeedback on the motor control awareness in spastic member in the characterization of the activity of low-frequency bands in different cortical regions targeted by the training technique. Sixteen volunteers affected by ischemic stroke were selected and divided into two groups (n = 8). Experimental group (EG) underwent biofeedback training associated with physical therapy and control group (CG) only conventional physiotherapy. The assessment of the degree of spasticity by reflex threshold of the tonic stretch (TSRT) and Modified Ashworth Scale (MAS) was performed before and three weeks after the end of treatment with the technique. The subjects underwent biofeedback for 6 weeks, with two sessions weekly. The same time for physiotherapy treatment was standardized to the GC. The results show variation of the average percent improvement in the degree of spasticity measured at TRST, 38,59% (sd=13,03%) in GE compared to 18,58% (sd=11,90%) of GC. This variation showed a significant difference (p=0.020; t=2,776; p<5%) between groups (control and experimental), and the significant difference of TRST before and after training in EG (p = 0.003; t=5,338; p <5%) when compared to the CG (p=0.015; t=0,015; p<5%). The semi-quantitative measure of the MAS before and after the end of the sessions presented variations only in GE. Regarding the cortical activity, there were band activities differences when 3rd and 12th sessions were compared for each subject of GE. This difference was found primarily in the frontal, central (vertex), parietal and occipital lobe in both hemispheres (contralateral and ipsilateral to the lesion) in both the cognitive motor planning phase and in the movement execution. It was observed the predominance of activity difference for the delta band, alpha and beta in different subjects distributed diffusely over the EEG recording channels. The different activity of the bands was due to the increase and/or decrease the spectral energy between sessions, x noticed only in some GE volunteers. It was also pointed out distinct activity in secondary motor areas. Evaluations mainly from TSRT show that training with EMG biofeedback was effective in reducing the degree of spasticity. The difference in cortical activity of the frequency bands between sessions suggested that biofeedback modulates cognition through the effort and attention required by the task of movement attempt in the affected limb. Besides that, the spectral energy difference between the sessions depends on the tuning and task complexity driven by biofeedback signals, helping motor learning. / Tese (Doutorado)