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The purpose of this study was to evaluate the effects of adding biofeedback training to active exercise training on quadriceps torque, voluntary activation and functional activity after total knee arthroplasty (TKA). A total of 45 patients with unilateral TKA participated in this study; their ages ranged from 58 to 67 years. They were assigned randomly to two groups. Group I comprised 21 patients who practiced an active exercise training program for 30 to 45 min/session, two sessions/week, for 4 months. Group II contained 24 patients who practiced biofeedback training in addition to the active exercise training program for 30 to 45 min/session, two sessions/week, for 4 months. Isometric peak torque of the quadriceps, voluntary activation and knee functional activity were measured. The results revealed significant improvements in quadriceps torque, voluntary activation and knee functional activity for both groups, with more improvement in knee functional activities in group II. There were nonsignificant differences between the two groups in both quadriceps peak torque and voluntary activation after training (p > 0.05). Conclusion: An active exercise program can enhance quadriceps peak torque, voluntary activation and knee functional activity after unilateral TKA. The addition of biofeedback training increases the benefits for the knee functional activity of a patient.

Postural control is an important aspect of human locomotion and stance. When inputs to the Central Nervous System (CNS), consisting of the vestibular, somatosensory, and visual senses, degrade or become dysfunctional, the postural control is affected. Biofeedback has been established as a potential intervention method to assist individuals improve postural control, by augmenting or complementing signals to the CNS. This paper presents an approach to help achieve better postural control using vibrotactile biofeedback. Tests to monitor postural control, in eyes open and eyes closed states, on a wobble board were introduced to assess the viability of the designed system in providing accurate real-time biofeedback responses. Postural control was gauged by measuring the angular displacement of perturbations experienced. Perturbations along the anterior and posterior direction are used to determine the level of provided vibrotactile biofeedback. The feedback informs subjects the severity of perturbation and direction of imbalance. Significant improvement (p-value < 0.05) in postural control while on perturbed surface was detected when the designed biofeedback system was used. The wearable system was found to be effective in improving postural control of the subjects and can be expanded for rehabilitation, conditioning, and strengthening applications dealing with human postural control.

Plantar pressure refers to the interfacial contact pressure between the foot and the supporting surface during daily locomotor activities. Information derived from plantar pressure measures is essential in gait and posture research for diagnosing patho-mechanics associated with the musculoskeletal diseases. In particular, it is compulsory to reduce the abnormally high plantar pressure in people with diabetes for the prevention and treatment of foot ulcerations in this population. In this study, a portable biofeedback-based gait training device is developed to advocate able-bodied subjects to adopt different movement patterns in walking to manipulate the plantar pressure distribution under the foot. Through the simultaneous detection of the plantar pressure pattern and the kinematics of the lower extremity joints, it was revealed that the unloading effects for the plantar site in particular to the lateral forefoot subareas were more abundant through biofeedback-assisted gait alterations than the self-awareness control for gait adjustment. In addition, the corresponding relationship between joint coordination and pressure redistribution pattern was obtained, which could potentially be used in gait retraining interventions to correct abnormal plantar pressure patterns in people with diabetes.

Spectral power (SP) of EEG alpha and beta-2 frequencies in different cortical areas has been used for neurofeedback training to control a graphic interface in different scenarios. The results show that frequency range and brain cortical areas are associated with high or low efficiency of voluntary control. Overall, EEG phenomena observed in the course of training are largely general changes involving extensive brain areas and frequency bands. Finally, we have demonstrated EEG patterns that dynamically switch with a specific feature in different tasks within one training, after a relatively short period of training.

Pain and anxiety are common accompaniments of surgery, and opioids have been the mainstay of pain management for decades, with about 80% of the surgical population leaving the hospital with an opioid prescription. Moreover, patients receiving an opioid prescription after short-stay surgeries have a 44% increased risk of long-term opioid use, and about one in 16 surgical patients becomes a long-term user. Current opioid abuse and addiction now place the US in an “opioid epidemic,” and calls for alternative pain management mechanisms. To mitigate the preoperative anxiety and postoperative pain, we developed a virtual reality (VR) experience based on Attention Restoration Theory (ART) and integrated the user’s heart rate variability (HRV) biofeedback to create an adaptive environment. A randomized control trial among 16 Total Knee Arthroplasty (TKA) patients undergoing surgery at Patewood Memorial Hospital, Greenville, SC demonstrated that patients experiencing the adaptive VR environment reported a significant decrease in preoperative anxiety ($p<0.01$) and postoperative pain ($p<0.01$) after the VR intervention. These results were also supported by the physiological measures where there was a significant increase in RR Interval (RRI) ($p<0.01$) and a significant decrease in the low frequency (LF)/high frequency (HF) ratio ($p<0.01$) and respiration rate (RR) ($p=0.01$).

Objective: To investigate the effect of pelvic floor electromyography Biofeedback and “four sacral needles” on pelvic floor muscle strength and quality of life in mild to moderate female stress Urinary incontinence (UI) patients.

Methods: A total of 96 patients with mild to moderate female stress UI who were treated in Qingpu District Hospital of Traditional Chinese Medicine from June 2021 to May 2023 were randomly divided into a control group and a test group, with 48 cases in each group. The control group was given pelvic floor myoelectric stimulation combined with Biofeedback, and the treatment group was given “four sacral needles” on the basis of the control group. Record the Glazer electromyography assessment and 1-hour urine pad test leakage at weeks 0, 4, and 8 of treatment, and compare the therapeutic differences between the two groups.

Result: Compared with before treatment, after 4 and 8 weeks of treatment, the Glazer evaluation and 1 h urine pad test leakage in both groups were significantly reduced ($P<0.01$), and the experimental group had better indicators than the control group at 4 and 8 weeks of treatment ($P<0.01$). The total effective rate of the experimental group was 97.7%, significantly higher than the control group’s 90.9% ($P<0.05$).

Conclusion: Pelvic floor electromyography Biofeedback combined with “four sacral needles” and simple pelvic floor electromyography Biofeedback is effective for women with mild to moderate stress UI. Pelvic floor electromyography Biofeedback combined with “four sacral needles” is superior to simple pelvic floor Biofeedback in the treatment of mild to moderate stress UI.

Proprioceptive neuromuscular facilitation and foot sensory compensation are critical to balance control and ambulatory performance in below-knee amputees. Sub-sensory stimulation has been shown to be effective in enhancing the sensitivity of the human somatosensory system. In addition, visual-auditory biofeedback to improve foot sensory compensation for amputees was suggested in recent articles. The purpose of this study is to develop a new biofeedback proprioceptive neuromuscular facilitation system for improving balance control and foot sensory compensation in below-knee amputees. The proposed system functioned with sub-threshold electrical stimulation and visual-auditory biofeedback was developed for clinical study. Two unilateral trans-tibial amputees who consecutively wore prosthetics over 10 years were participated in this study. Subjects performed multiple single leg quite standing trails with sub-sensory electrical stimulation applied at the quadriceps muscle during half of the trails. Four static balance performance indices (i.e. Holding Time Index, HTI; Sway Length Index, SLI; Max Sway Distance Index, MSDI; Average Sway Distance Index, ASDI) were characterized using Zebris motion analysis system. The improvement ratio of these static balance performance indices across subjects for single leg quiet standing tests were resulted in a 209.7% in HTI, 39.1% in SLI, 24.3% in MSDI, and 65.4% in ASDI respectively. In addition, multiple treadmill ambulatory trails with or without visual-auditory biofeedback were evaluated. Four dynamic gait performance indices (i.e. Double Support Time Index, DSTI; Constant Time Cadence Index, CTCI; Single Support Time Index, SSTI; Stance/Swing Phase Index, SSPI) were characterized with Zebris instrumented insole and associated FMS analysis software. With visual-auditory biofeedback, the improvement of all four dynamic gait performance indices in below-knee amputees was verified. The improvement ratio of four gait performance indices across subjects resulted in a 14.81% in DSTI (sound side), 14.29% in DSTI (affected side), 14% in CTCI, 13.00% in SSTI (sound side), 6.02% in SSTI (affected side), 45.17% in SSPI (sound side), and 27.49% in SSPI (affected side) respectively. These findings suggest that sub-threshold electrical stimulation and visual-auditory biofeedback proprioceptive neuromuscular facilitation strategies may be effective in compensating foot sensory loss and improving balance control for below-knee amputees.