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Electromyography Biofeedback Training Versus Mirror Therapy on Muscle Activity, Range of Motion and Function of Upper Limb in Children With Hemiplegia

14 septembre 2026 mis à jour par: Andrew Gameel Mourice, Cairo University
One of the main motor control issues in hemiplegic CP is spasticity, which affects the flexor muscles of the upper limb. This spasticity causes the limb to adopt a flexed posture, limiting the range of motion and contributing to a decreased ability to perform tasks that require precise movement and controlled muscle activation. Several studies have demonstrated that EMG biofeedback can significantly improve upper limb function in children with hemiplegic CP. Also, mirror therapy has gained recognition as an innovative and effective rehabilitation method for children with hemiplegic CP

Aperçu de l'étude

Statut

Pas encore de recrutement

Les conditions

Intervention / Traitement

Description détaillée

Ethics statement:

The current study was approved by the local Ethical Committee at the Faculty of Physical Therapy Cairo University (No: P.T.REC/012/005590).

Study Design:

Comparative randomized study.

Sample size estimation Sample size calculation was done using the comparison of QUEST scale as a marker for upper limb functional performance between children with hemiplegic cerebral palsy treated with electromyography biofeedback training and those treated with mirror therapy. As reported in a previous publication, the mean ± SD of length of QUEST scale in Smart Glove group was 328 ± 52, while in conventional group it was 265.4 ± 45.5. Accordingly, we calculated that the minimum proper sample size was 18 participants in each group to be able to reject the null hypothesis with 80% power at α = 0.05 level using Student's t test for independent samples. Sample size calculation was done using PS Power and Sample Size Calculations Software, version 3.1.2 for MS Windows (William D. Dupont and Walton D., Vanderbilt University, Nashville, Tennessee, USA).

Randomization Forty hemiplegic children will be randomly assigned into two equal groups; group A and group B. The way of randomization will be using sealed envelopes; each envelope contains a sheet of paper that will show where the child will be assigned; either into group A or group B. The process of randomization will be performed by an independent person who will be blinded to the purpose or protocol of the study.

Type d'étude

Interventionnel

Inscription (Estimé)

40

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

Lieux d'étude

  • Egypte
    • Giza Governorate
      • Giza, Giza Governorate, Egypte, 12662
        • Faculty of Physical Therapy, Cairo University
        • Contact:

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Enfant

Accepte les volontaires sains

Non

La description

Inclusion Criteria:

  • Age ranging from 8 to 12 years
  • Spasticity grade 1+ and 2 on the Modified Ashworth Scale
  • Gross Motor Function Classification System (GMFCS) level I or II
  • Ability to follow verbal instructions

Exclusion Criteria:

  • Visual or hearing defects
  • Neurological conditions other than cerebral palsy
  • Previous surgical intervention of the upper limb
  • Botulinum toxin injection into the upper limb within the last 6 months prior to the study
  • Fractures of the upper limb
  • Uncontrolled convulsions

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Tripler

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: EMG Biofeedback Training
Children in group A will receive 30 minutes of EMG biofeedback training. The EMG biofeedback device will be placed on the muscles of the upper extremities. First, surface electrodes will be applied at the deltoid muscle for 10 minutes; then electrodes will be applied at the triceps for 10 minutes, and then electrodes will be applied at the wrist extensors for 10 minutes to pick up the activity of the muscles and convert it to visual and auditory impulses produced from the device. In addition to the designed physical therapy program for 30 minutes
Dispositif: Neurotrac Simplex electromyography biofeedback device
This intervention has been assigned to 'Group A.'. The Neurotrac Simplex device has been developed to enhance the understanding of muscle activity and to improve muscle conditioning. It stands upright on a flat surface, enabling the user to carry out specific exercises and at the same time view the biofeedback by way of bright LED lights on the front of the unit; the LCD screen will automatically display the average muscle readings for the session. Then using training programs in the NeuroTrac software for facilitation of the desired muscle. This software will be used in training the program for group A.
Autre: a designed physical therapy program

This intervention has been assigned to both groups. A designed physical therapy program for 30 minutes three times per week for three successive months

  1. Active resisted exercises:

    A. Shoulder flexion and abduction. B. Elbow extension. C. Wrist extension.

  2. Hand weight-bearing exercises:

    A. Quadriped position B. Side-sitting position C. Hand support standing

  3. Reaching exercise with shoulder flexion, elbow and wrist extended.
  4. Throwing the ball overhead by the affected hand and by both hands.
  5. Protective extensor thrust from sitting on the roll and from the standing position.
  6. Wheelbarrow walking (walking on hands).
Expérimental: Mirror Therapy Training
Children in group B will receive 30 minutes of mirror therapy training. Children will be seated on a chair, with the mirror positioned between the upper limbs perpendicular to the child's midline, and the reflecting side of the mirror will be adjusted to face the non-affected arm. Isolated movements of shoulder, elbow, and wrist joints by the unaffected limb will be performed in all degrees of freedom. In each direction up to 30 repetitions per session. In addition to the same designed physical therapy program for 30 minutes as group A.
Autre: a designed physical therapy program

This intervention has been assigned to both groups. A designed physical therapy program for 30 minutes three times per week for three successive months

  1. Active resisted exercises:

    A. Shoulder flexion and abduction. B. Elbow extension. C. Wrist extension.

  2. Hand weight-bearing exercises:

    A. Quadriped position B. Side-sitting position C. Hand support standing

  3. Reaching exercise with shoulder flexion, elbow and wrist extended.
  4. Throwing the ball overhead by the affected hand and by both hands.
  5. Protective extensor thrust from sitting on the roll and from the standing position.
  6. Wheelbarrow walking (walking on hands).
Autre: Mirror

This intervention has been assigned to 'Group B.'A mirror (20 cm × 70 cm) on a movable stand will be used to provide a mirror therapy training program for group B. It stands on mobile wheels surrounded by a frame made of wood, with the main reflective surface likely being a standard glass mirror. The affected limb will be situated in a safe and preferably comfortable position behind the mirror. The non-affected limb will be positioned in a similar position as the affected limb, which would result in facilitating the intensity of the mirror illusion. The therapist will repeatedly remind the child to focus on the movement of the unaffected limb in front of the mirror, which helped to increase the mirror illusion.

Under the supervision of the physiotherapist, children observed the reflection of their unaffected limb while performing the following movement: flexion of the shoulder, elbow extension, and wrist extension.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
muscle activity of deltoid, elbow extensor, and wrist extensor muscles
Délai: The treatment period will be 3 times per week for 3 successive months
The Neurotrac Simplex EMG biofeedback device (model ESS102, manufactured by Verity Medical Ltd., UK) is a single-channel EMG device that has been designed to be used with a variety of applications. It acts as a diagnostic tool to measure the muscle activity, which is measured in microvolts (μV). The Neurotrac Simplex is an accurate and sensitive device that measures muscle activity down to as low as 0.2 μV and up to 2000 μV. The diverse range enables the device to measure very weak muscle activity
The treatment period will be 3 times per week for 3 successive months
ROM of shoulder, elbow, and wrist joints
Délai: The treatment period will be 3 times per week for 3 successive months
A goniometer is an instrument that either measures an angle or allows an object to be rotated to a precise angular position. The baseline digital goniometer is used to measure a patient's ROM and incorporates integral absolute vertical and horizontal levels in one arm for ease of use. The device weighs 0.45 kg. The device displays 0 to 180 degrees on an LCD screen for viewing readings and has the ability to freeze angle measurements for reference. The goniometer has a durable powder-coated steel exterior with inch/cm marks screened onto its arms and is powered by one 9V battery (included). (L is length, the horizontal distance from left to right; W is width, the horizontal distance from front to back; H is height, the vertical distance from the lowest to highest point.) These ROM measurements can be taken at any joint, and they typically involve some knowledge about the anatomy of the body, particularly bony landmarks
The treatment period will be 3 times per week for 3 successive months
quality of upper limb movement
Délai: The treatment period will be 3 times per week for 3 successive months
The Quality of Upper Extremity Skills Test is a descriptive, impairment-based, and evaluative measure designed to evaluate movement patterns and hand function in CP children separately for each arm. It has been validated for children who exhibit neuromotor dysfunction with spasticity. Quality of movement is assessed in four domains: dissociated movements (19 items), grasp (6 items), weight bearing (5 items), and protective extension (3 items), including 33 items. The total testing time, including administration and scoring, is approximately 45 minutes
The treatment period will be 3 times per week for 3 successive months

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Cairo University

Les enquêteurs

  • Chaise d'étude: Hebatallah M Kamal, Cairo University, Egypt
  • Directeur d'études: Hala R Mahmoud, Cairo University, Egypt
  • Directeur d'études: Walaa A Abd El-Nabie, Cairo University, Egypt
  • Chercheur principal: Andrew G Mourice, Cairo University, Egypt

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Estimé)

10 septembre 2026

Achèvement primaire (Estimé)

15 décembre 2026

Achèvement de l'étude (Estimé)

31 décembre 2026

Dates d'inscription aux études

Première soumission

8 septembre 2026

Première soumission répondant aux critères de contrôle qualité

8 septembre 2026

Première publication (Réel)

14 septembre 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

16 septembre 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

14 septembre 2026

Dernière vérification

1 septembre 2026

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • Hemiplegic Cerebral Palsy

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

NON

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

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