Visual and Auditory Electromyography Biofeedback Among Stroke Patients

Comparative Effects of Visual and Auditory Electromyography Biofeedback Combined With Conventional Physiotherapy on Balance, Functional Mobility, Motor Function, and Functional Independence Among Patients With Stroke: A Randomized Controlled Trial

Stroke commonly results in impairments of balance, mobility, and lower extremity motor function that limit independence in daily activities. Electromyography (EMG) biofeedback enhances motor relearning by providing real-time feedback regarding muscle activation. Although both visual and auditory EMG biofeedback have demonstrated benefits in stroke rehabilitation, evidence directly comparing these feedback modalities remains limited. This randomized controlled trial aims to compare the effects of visual and auditory EMG biofeedback, each combined with conventional physiotherapy, on balance, functional mobility, motor function, and functional independence in individuals with stroke.

This randomized controlled trial will compare two modes of electromyography biofeedback in individuals with stroke undergoing lower extremity rehabilitation. Eighty-four eligible participants will be randomly allocated into two parallel groups using sealed-envelope randomization. Both groups will receive conventional physiotherapy consisting of lower extremity strengthening, balance, gait, and task-oriented exercises for 10 minutes per session. The experimental intervention will consist of either visual or auditory EMG biofeedback applied to the tibialis anterior muscle for 20 minutes. Treatment will be provided five sessions per week over three weeks (15 sessions). Outcomes including balance (Berg Balance Scale), functional mobility (Timed Up and Go Test), motor recovery (Fugl-Meyer Assessment-Lower Extremity), and functional independence (Barthel Index) will be assessed at baseline and immediately after completion of the intervention by a blinded assessor.

Inclusion Criteria:

• Age between 20 and 30 years
• Male or female participants
• Clinically diagnosed hemiplegic stroke.
• Medically stable and able to participate in rehabilitation.
• No visual impairment that would interfere with visual biofeedback.
• No hearing impairment that would interfere with auditory biofeedback.
• No sensory aphasia affecting the ability to understand study instructions.

Exclusion Criteria:

• Traumatic injury or lesion affecting the lower extremities
• Lower-limb amputation
• Severe systemic disease that could interfere with participation
• Peripheral vascular disease affecting the lower extremities
• Fixed ankle contracture
• Motion sickness or intolerance to rehabilitation technology