FV 776. sEMG Biofeedback Therapy in Children with Cerebral Palsy

Background: Surface electromyography (sEMG) biofeedback (BFB) has been an established therapy to improve motor function in patients with lesions of the central nervous system for many years. Interventions training own activity and perception based on the model of neuronal plasticity seem to be of particular interest in children with cerebral palsy (CP), consequently leading to an increased importance of BFB in these patients. This therapy takes advantage of the mechanisms underlying the principle of operant conditioning aiming to achieve control in recruitment of certain muscles. Patients learn to voluntarily control and coordinate their muscles by a direct feedback, finally achieving a better functional control and force of the affected muscles, as well as a better body function. Despite the fact that BFB appears to be a promising approach in children with CP, the literature is inconsistent with respect to the methods used, indications or clinical evidence.

Aim: Here, we elaborate on the clinical evidence of BFB in children with CP based on relevant literature and compare it with our own clinical experience.

Question: Can the sEMG-BFB be considered an intervention with sufficient evidence in the therapy of children with CP? What is the current recommendation and the consensus on a standardized implementation of the therapy?

Methods: Clinical results and methodical details were evaluated on the basis of a systematic literature review/search (PubMed/National Center for Biotechnology Information) and compared with the clinical experiences and findings of the BFB therapy in the kbo-Kinderzentrum Munich.

Results: Only a few studies exist focusing on a target-oriented sEMG-BFB therapy in children with CP. Studies differ considerably with respect to the used methods and their quality. Most studies point out the effect of BFB in combination with other therapies (e.g., physical therapy) with regard to motor abilities of the upper and lower extremities in patients with CP. No consensus exists in detailed procedures such as duration of the intervention, intensity, and evaluation, while the evidence level is classified as moderate (class IIb, level Ib). The positive rating of the therapy in patients with CP is in line with our own clinical experiences.

Conclusion: The sEMG-BFB therapy in children with CP has been evaluated only in a few studies so far. The relevant literature and own clinical experience point toward an effective treatment to improve motor abilities in these patients. However, more randomized and controlled studies with large sample sizes and homogenous participant fields as well as standardized study protocols are needed to ensure the evidence for the therapy in use.