Writing a Synthesis Paper on Biofeedback Interventions for Stroke Patients: Effectiveness and Benefits

 Biofeedback Interventions for Stroke Patients: Effectiveness and Benefits

 Research Question  

In stroke patients, how does the use of biofeedback interventions affect the improvement of motor function compared with patients not receiving biofeedback? 

Statement of the problem  

Stroke is the second greatest cause of death in the world, as well as a primary cause of serious long-term impairment. Nearly 800,000 strokes occur in the United States each year, making stroke the fifth-greatest cause of death overall and the fourth major cause of death among women. Stroke can be largely reduced through Biofeedback interventions, but less so through effective acute stroke treatment. As such, the purpose of this research is to create awareness about the implication of Biofeedback interventions to the patient suffering from acute cerebrovascular accident rehabilitation.

Rationale  

Acute cerebrovascular accident or rather stroke is the fourth greatest cause of death in the United States, affecting almost 800,000 individuals each year; around 140,000 of these patients die, accounting for one in every twenty fatalities in the country (CDC). Stroke is a primary cause of long-term disability for survivors, with sequelae including speech and memory loss, paralysis, pneumonia, incontinence, pressure ulcers, difficulties with everyday activities, depression, unemployment. Furthermore, the yearly economic impact of stroke in the United States is $34 billion (CDC), which includes costs for healthcare, drugs, rehabilitation, and lost employment. 

Many acute cerebrovascular accident survivors have long-term disabilities, however, breakthroughs in stroke care have allowed for the recovery of some physical and cognitive function. Biofeedback has been demonstrated to help with motor function recovery after a stroke (Brewer, Horgan, Hickey, & Williams, 2012). This issue is relevant to patients suffering from stroke and clinical practitioners especially nursing students pursuing medical-surgical jobs and caring for stroke victims. Knowing about interventions like biofeedback can help stroke survivors heal more holistically, which will have a favourable impact on stroke patients, their families, and the economy. 

The following will be investigated: 

• What is Biofeedback intervention?
• How effective is Biofeedback Intervention?
• How does biofeedback affects stroke patients' motor–muscular status in terms of balance and walking abilities, muscle stiffness (spasticity), and hand muscle strength
• What are the advantages of using Biofeedback intervention in acute cerebrovascular accident rehabilitation?
• What are complications associated with Biofeedback intervention to stroke patients receiving it?
• What are future recommendations to help reduce complications associated with Biofeedback interventions?

 Review and synthesis of sources  

A cerebrovascular event or stroke, occurs every forty seconds in the United States (CDC). Stroke patients frequently regain some motor function, although the majority require therapy. Biofeedback is a non-pharmaceutical method of assisting stroke patients in regaining lost movement while also enhancing morale and commitment to a treatment plan. People can learn to relax their minds and bodies and cope better with stress symptoms by employing biofeedback to regulate the physical and psychological impacts of stress. Biofeedback's purpose is to make little changes in the body that have the desired effect. This could involve relaxing certain muscles, lowering the heart rate, or lessening pain. Biofeedback stimulates the brain to conduct motor activities using electronic instruments and monitoring systems. Information on the functions of the body is presented to the user using accurate measurement equipment. The presentation of this information, which is frequently combined with changes in thinking, emotions, and behaviour, promotes the physiological changes that are wanted. Without the use of an instrument, these alterations can persist over time. Because biofeedback may aid in the rehabilitation of motor impairments in stroke patients, we owe it to our patients as nurses to learn more about this technique.  

Electromyography (EMG) is the best intervention for the recovery of gross motor function in stroke patients, according to a literature review. Ravegani et al. observed that when EMG biofeedback was compared to traditional occupational therapy (OT), EMG biofeedback resulted in improved hand function on par with conventional OT (137-151). While this study found no significant benefits of biofeedback over traditional OT, it did suggest that EMG therapies can be just as beneficial as OT and that more research into this area is needed. During the study, thirty stroke patients were enrolled in the trial. The Jebsen Hand Function Test was used to assess hand function before and after the intervention. Patients were randomly assigned to one of three intervention groups: OT, OT plus EMG-biofeedback therapy, or OT plus neurofeedback therapy. All of the patients had ten sessions of traditional OT. EMG-biofeedback and neurofeedback therapy were also given to patients in cohorts 2 and 3. The abductor pollicis brevis (APB) muscle was strengthened via EMG-biofeedback therapy. After mental motor imagery, neurofeedback training was used to improve sensorimotor rhythm. It was discovered by the authors that in all three groups, hand function improved dramatically. After mental motor imagery, the spectral power density of the sensorimotor rhythm band increased in the neurofeedback group. After EMG-biofeedback training, the maximum and mean contraction values of the electrical activity of the APB muscle during voluntary contraction rose dramatically. It was concluded that both neurofeedback and EMG-biofeedback improved hand function similarly to conventional therapy. Najafi, Manzari, Rezaeitalab, and Azhari published a randomized control trial in 2017 that demonstrated that stroke patients who underwent 20 minutes of EMG biofeedback exercises twice a week for 15 weeks improved their balance and strength but not their muscular stiffness (spasticity) (35). This study shows that biofeedback may help with some elements of stroke rehabilitation, but not all, and that combining EMG biofeedback with other therapy modalities may help stroke patients attain optimal outcomes. 

The effectiveness of two biofeedback techniques on the Volitional Laryngeal Vestibule Closure (vLVC) manoeuvre was examined in a recent study at the Johns Hopkins Kennedy Krieger Institute (Azola et al. 115–122). The voluntary laryngeal vestibule closure (vLVC) is a swallowing method that requires swallowing and keeping the laryngeal vestibule closed for at least 2 seconds. Participants with dysphagia would be at risk for aspiration, hence thirty healthy persons with no history of dysphagia were chosen. Participants were divided into two groups, one of which received videofluoroscopy (VF) and the other of which received submental surface electromyography (SSEM) (ssEMG). While VF displays a real-time X-ray image of the structures and motions of the throat while swallowing, ssEMG graphs the electrical activity of throat muscles. Patients in the VF group did significantly better on the vLVC and followed clinician cues more precisely than those in the ssEMG group. These findings suggest that not all biofeedback therapies are created equal when it comes to teaching new volitional motor patterns. Participants were better at learning from a visual cue (an X-ray image) of themselves making a motion than from representational data (a graph) of themselves performing the same motion in this study. 

A study by Nasafi et al. was carried out to investigate how biofeedback affected stroke patients' motor–muscular status in terms of balance and walking abilities, muscle stiffness (spasticity), and hand muscle strength (Nasafi et al. 89-93). In the study, the participants were randomized into two groups at random (case and control group). Biofeedback was used in the intervention group. A physician performed a checklist of important criteria, including balance and capacity to walk, muscle stiffness (spasticity), and hand muscle strength, before and after the intervention (16th session). SPSS version 13 was used to conduct the statistical analysis. From the study’s results, there were significant differences in the mean balance score between the intervention and control groups. The findings revealed that by removing the impacts of muscular strength before the intervention, this measure improved significantly in both the intervention and control groups after the intervention. The average spasticity evaluation score before and after the intervention demonstrated no significant difference between the two groups when compared. From the results, it was concluded by Nasafi et al. that patients after stroke can improve their motor-muscular function by using biofeedback therapy. 

According to Weerdmeester et al., biofeedback intervention has proven to be a promising method for treating stroke; yet, various theoretical and practical constraints have hampered its adoption until now. Given the current technological advancements and growing interest in using self-monitoring technology to promote mental health, biofeedback is currently an excellent time to launch a new wave of biofeedback training. The authors considered the current state of biofeedback training, as well as more traditional techniques and mechanisms that have been proposed to explain biofeedback's effectiveness, such as the integration of operant learning and meditation techniques, as well as changes in interoceptive awareness and physiology. The authors then presented an integrated model that comprises a set of cognitive appraisals such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals as potential determinants of adaptive trajectories during biofeedback training. 

Finally, based on the integration of the model with the mechanics and mechanisms afforded by modern interactive technology, the researchers presented a series of specific instructions to stimulate a new phase of biofeedback research and implementation. As such, there are future hopes of developing biofeedback interventions that use wearables and video games in combination with a user-centred approach to help people regulate their stroke in a way that feels engaging, personal, and meaningful have a lot of promise. 

Work Cited

 Azola, Alba M., et al. “Kinematic Visual Biofeedback Improves Accuracy of Learning a Swallowing Maneuver and Accuracy of Clinician Cues during Training.” Dysphagia, vol. 32, no. 1, 2016, pp. 115–122., https://doi.org/10.1007/s00455-016-9749-z. 

Najafi, Zohre, et al. “The Effect of Biofeedback on the Motor– Muscular Situation in Rehabilitation of Stroke Patients.” Journal of Caring Sciences, vol. 7, no. 2, 2018, pp. 89–93., https://doi.org/10.15171/jcs.2018.014. 

Najafi, Zohre, et al. “The Effect of Biofeedback on the Motor– Muscular Situation in Rehabilitation of Stroke Patients.” Advances in Bioscience and Clinical Medicine, 2017, p. 35., https://doi.org/10.7575/aiac.abcmed.ca1.35. 

Rayegani, S. M., et al. “Effect of Neurofeedback and Electromyographic-Biofeedback Therapy on Improving Hand Function in Stroke Patients.” Topics in Stroke Rehabilitation, vol. 21, no. 2, 2014, pp. 137–151., https://doi.org/10.1310/tsr2102-137. 

“Stroke Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 May 2021, https://www.cdc.gov/stroke/facts.htm. 

Weerdmeester, Joanneke, et al. “An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint.” Journal of Medical Internet Research, vol. 22, no. 7, 2020, https://doi.org/10.2196/14958.