Workshops: Strokes - Modalities + Training Weak Muscles

Question 1

Understand the types of patients that are more suitable for EMG biofeedback over electrical stimulation

Answer 1

o EMG - translating muscle activity to a visual or auditory feedback to be shown concurrently to the patient
o EMG - you would use this for strong patients - Grade 2+
o ES - weaker patients because they cant stimulate the muscle themselves - Grade 0-1 MMT

Question 2

Describe the aims of EMG biofeedback and electrical stimulation and the types of patients/conditions/impairments that these can be used for.

Answer 2

EMG biofeedback is a useful technique for strengthening Grade 2+ muscles. It can be set up as semi-supervised or independent practice, thus allowing the patients to engage in intensive practice. It also provides visual and auditory feedback in the absence of a therapist.

Question 3

Understand/apply the national Stroke foundation Guidelines for EMG biofeedback and electrical stimulation

Answer 3

NSFG says that at least one of the following should be used in those with reduced strength
- resistance exercise
- ESTIM
- EMG biofeedback with conventional therapy

Question 4

Explain the evidence for/against EMG biofeedback and electrical stimulation using the manuscripts Langhorne et al (2009) and de Souza et al (2018)

Question 5

Define the MMT grade based on a statement and provide an appropriate training strategy for the MMT grade.

Answer 5

0 - No contraction
1 -Flicker or trace of contraction
2- Partial ROM with gravity eliminated, not full ROM
2- Full ROM with gravity eliminated
2+ <50% of ROM available against gravity
3- >50% of ROM available against gravity, but not full ROM
3 Full ROM against gravity
3+ Resist minimal force applied at <50% of the available ROM
4- Resist minimal force for >50%, but not full ROM
4 Full ROM against gravity and against resistance
4+ Resist maximum resistance for some of the available ROM, but not full ROM
5 Normal strength

Question 6

Describe the different strategies to train weak muscles.

Answer 6

If someone is at a 2-, we are trying to train them at a 2. If they are a 2+ or 3-, we would train them at a 3. They may need interventions and strategies to make sure they can train up to that level.

Question 7

Discuss the skill vs compensation balance

Answer 7

Being able to perform a skill correctly using the correct technique, vs using incorrect, compensatory techniques to execute the skill

Question 8

Outline factors that can increase/decrease the difficulty of training, generally.

Answer 8

Degrees of Freedom
Load
Gravity vs non gravity position
Friction
Lever length
Manual guidance
Intensity/Volume
Variability
Specificity