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

Sperimentale: 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

Dispositivo: 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.

Altro: 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).

Sperimentale: 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.

Altro: 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).

Altro: 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.

muscle activity of deltoid, elbow extensor, and wrist extensor muscles

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

ROM of shoulder, elbow, and wrist joints

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

quality of upper limb movement

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