Dissertation/Thesis Abstract

Biofeedback Cotreatment with Stroke Survivors in Rehabilitation
by Downum, Jana, Ph.D., Saybrook University, 2019, 162; 13899034
Abstract (Summary)

Rehabilitation clinics turn to integrative healthcare to provide patients alternative recovery strategies (Benore et al., 2014). Integrative care practices service the mind and body, holistically. Biofeedback, an integrated medicine skill set, often supplements physical rehabilitation of survivors of stroke (Bolek, 2016). Due to stroke, ambulation is often impaired. Surface electromyography biofeedback (SEMG-BFB) supplemented four stroke survivors’ traditional physical therapy.

The research documented the process of biofeedback cotreatment at a rehabilitation clinic. This mixed methods case study collected quantitative and qualitative data of the four patient participants (PPs) including SEMG amplitude, rehabilitation outcomes, patient questionnaires, and Researcher Observation Notes. During biofeedback cotreatment, the anterior tibialis amplitude was recorded. Questionnaires recorded PPs’ experience with the training, before, during, and six weeks after biofeedback cotreatment. Qualitative data were analyzed using thematic analysis, and descriptive statistics used for the quantitative data.

The findings demonstrated PPs practiced the biofeedback skill set during and up to six weeks after completion of the cotreatment. SEMG-BFB techniques aided the PPs’ ability to identify the anterior tibialis muscle weakened as a result of a stroke. PPs exhibited positive gains on rehabilitation measures, including distance walked, the angle of dorsiflexion, and level of supervision as expected. PPs also reported less foot drag. Results of the motor activity were mixed and case dependent. Three of the four PPs demonstrated increased anterior tibialis amplitude during the lift toes training. Furthermore, as biofeedback cotreatments continued, PPs refined the lift toes motor activity. The qualitative data revealed themes from a rehabilitation clinic and the PPs experience including: (a) practice and repetition; (b) use of reinforcement; (c) increasing body awareness; (d) distractions; and (e) flexibility. PPs reported being able to recognize, isolate, and intentionally contract the anterior tibialis involved in dorsiflexion.

At a time when healthcare is seeking non-invasive alternatives, SEMG-BFB cotreatment effectively supplemented the PPs’ traditional physical therapy for foot drop. The researcher captured the experience of the PPs as well as the process used at a rehabilitation clinic, which has not been previously well documented, filling a gap in the current literature. Future investigation of integrating biofeedback with other treatments as well as with different kinds of brain injury would be valuable. Longitudinal studies are also needed. Integrating biofeedback cotreatment into traditional rehabilitation may be of assistance to future practitioners and providers in rehabilitation clinics.

Indexing (document details)
Advisor: Fortune, Luann
Commitee: Moss, Donald, Willmarth, Eric
School: Saybrook University
Department: Mind Body Medicine
School Location: United States -- California
Source: DAI-B 81/2(E), Dissertation Abstracts International
Subjects: Health sciences, Behavioral psychology, Behavioral Sciences
Keywords: Biofeedback, Co-treatment, Foot drop, Integrative medicine, Rehabilitation, Stroke
Publication Number: 13899034
ISBN: 9781085610827
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