Rehabilitation is more than functional recovery

Summary

The purpose of this study was to quantitatively and objectively evaluate and monitor regenerative processes in peripheral nerve lesions using a new electrophysiological method, and to develop and evaluate an electromyographic (EMG) biofeedback training programme for the rehabilitation of patients with such injuries. Five patients with traumatic unilateral brachial plexus injuries participated in the study longitudinally on a twice-weekly basis. The electrophysiological method was based on quantitative on-line analyses of the myoelectric signal from affected muscles of the upper limb. The biofeedback programme was developed and used to: (1) increase maximum voluntary centrally mediated neuromuscular activity; (2) dissociate desired and interfering neuromuscular activity; and (3) improve patient control over the neuromuscular activity. The electrophysiological results have differentiated clearly between muscles where regeneration can be assumed to be in progress and muscles where it is not in progress. This differentiation can be made prior to the occurrence of any observable contraction in muscle under study. The biofeedback training resulted in improved neuromuscular function in all patients.

Résumé

Le but de cette étude était d'évaluer quantitativement et objectivement le processus régénératif de lésions situées dans la région d'un nerf à l'aide d'une nouvelle méthode électrophysiologique, de développer et d'évaluer un programme de biofeedback électromyographie (EMG) pour la rééducation de patients ayant des lésions de ce genre. Cinq patients souffrant de blessures traumatiques unilatérales du plexus brachial ont participé à cette étude deux fois par semaine pendant une certaine période de temps. La méthode électrophysiologique était basée sur des analyses quantitatives du signal myoélectrique provenant des muscles affectés du membre supérieur. Le programme de biofeedback a été mis au point et utilisé afin de: (1) augmenter l'activité neuromusculaire volontaire maximum transmise centralement; (2) dissocier l'activité neuromusculaire désirée de celle non-voulue; (3) améliorer le contrôle du patient sur l'activité neuromusculaire. Les résultats électrophysiologiques ont differencié clairement les muscles pour lesquels le processus de régénération est en progrés et les muscles pour lesquels aucun progrès n'est réalisé. Cette différenciation peut s'établir avant qu'il y ait une contraction observable du muscle faisant l'objet de cet examen. Le programme de biofeedback a permis l'amélioration de la fonction neuromusculaire chez tous les patients.

Zusammenfassung

Der Zweck dieser Forschung war quantitative und objektive Auswertung sowie Überwachung der regenerativen Prozesse in peripheren Nervenläsionen unter Anwendung einer neuen elektrophysiologischen Methode, ferner die Entwicklung und Auswertung eines elektromyographischen Biofeedback Trainingprogramms zur Rehabilitation von Patienten mit derartigen Verletzungen. Fünf Patienten mit traumatischen einseitigen Brachialplexusverletzungen nahmen an der Forschung zweimal wöchentlich teil. Die elektrophysiologische Methode basierte auf quantitativen on-line-Analysen des myoelektrischen Signals von angegriffenen Muskeln der oberen Gliedmassen. Das Biofeedbackprogramm wurde entwickelt und angewendet um:

(1) die maximale spontane zentral vermittelte neuromuskuläre Aktivität zu erhöhen;

(2) gewünschte und störende neuromuskuläre Aktivität voneinander zu trennen

(3) die Kontrolle des Patienten über seine neuromuskuläre Tätigkeit zu verbessern.

Die elektrophysiologischen Resultate haben klar unterschieden zwischen Muskeln, bei denen fortschreitende Regeneration angenommen werden konnte, und Muskeln, bei denen dies nicht der Fall war. Diese Differenzierung kann man noch vor einer sichtbaren Kontraktion des untersuchten Muskels vorgenommen werden. Das Biofeedback Training brachte in verbesserter neuromuskularer Funktion bei allen Patienten Erfolg.     

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