Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature.

    Publication Date
    Source Authors
    Source Title
    Source Issue
    Publication Date

    Dicembre 2018

    Source Authors

    Duarte-Moreira, R.J., Castro, K.V., Luz-Santos, C., Martins, J.V.P., Sá, K.N., & Baptista, A.F.

    Source Title

    Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature.

    Source Issue

    Applied Psychophysiology and Biofeedback

    43

    Page Range: 247-257

    La diminuzione o l’assenza delle capacità sensoriali e della percezione del movimento sono tra le principali difficoltà riscontrate nella riabilitazione delle paralisi nervose periferiche. In effetti, queste diventano vere e proprie barriere per l’esercizio terapeutico, per le attività funzionali e tendono a far abbandonare la regione colpita durante le attività di vita quotidiana.
    Facilitazioni esterne però, possono aiutare l’individuo a sviluppare le abilità funzionali che non sono completamente perse, ma restano impercettibili.
    Tra queste, ritroviamo il biofeedback elettromiografico (EMG-BF), che consiste nell’uso di un dispositivo che permette di far visualizzare al soggetto che lo sta utilizzando, la sua attività muscolare elettrica, attraverso dei segnali audio-visivi che permettono di raggiungere degli obiettivi funzionali altrimenti impossibili.  Questo metodo ha il vantaggio di avere elevata sensibilità nell’identificare la contrazione muscolare e fornisce un feedback immediato e in tempo reale. Tutto ciò permette di acquisire nuovi compiti e contribuisce al rinforzo e al reclutamento muscolare mentre avviene la reinnervazione.
    L’EMG-BF è stato usato per la riabilitazione di diverse paralisi nervose periferiche ma ci sono evidenze conflittuali sui suoi effetti. Per tale motivo gli autori hanno impostato una revisione sistematica della letteratura per sintetizzare le evidenze disponibili per il trattamento delle paralisi nervose periferiche con EMG-BF, investigare su efficacia ed efficienza di questo strumento nel facilitare il recupero funzionale dopo la paralisi, identificare la struttura concettuale e le strategie degli interventi con EMG-BF e infine analizzare la qualità della descrizione tecnica delle procedure basate su EMG-BF.

    Il lavoro in questione è dunque, una revisione sistematica della letteratura eseguita tra l’ottobre del 2013 e il luglio del 2018. Secondo dei precisi criteri di inclusione, rispettando le strategie di ricerca del modello PICO e utilizzando delle specifiche parole chiave, sono stati ricercati su Pubmed, ISI e Cochrane gli articoli da includere nella revisione. In base a questi sono stati dunque selezionati 9 articoli per un totale di 374 soggetti reclutati di cui 173 sottoposti ad intervento con EMG-BF. Da questi articoli sono stati poi estratti dati riguardanti la data di pubblicazione, il disegno dello studio, le dimensioni del campione, il tipo, la severità e lo stadio della patologia, le caratteristiche del trattamento e le misure di outcome della funzione motoria utilizzate. Successivamente, ognuno di essi è stato valutato per la qualità metodologica mediante la scala PEDro.
    Di questi 9 studi inclusi, 7 valutavano l’effetto del trattamento con EMG-BF su soggetti affetti da paralisi del nervo faciale, 1 valutava l’effetto del trattamento su soggetti affetti da sindrome del tunnel carpale e l’altro su soggetti affetti da sciatalgia.

    In base ai risultati della revisione, in generale, gli studi analizzati, dimostrano che gli interventi con biofeedback determinano un miglioramento delle misure di outcome motorio dopo paralisi nervosa periferica, ma questi risultati devono essere presi in considerazione con cautela.
    In primis perché viene rilevato che il punteggio medio della scala PEDro degli RCT inclusi è 5, che corrisponde ad una bassa qualità metodologica. Poi, bisogna prendere in considerazione degli importanti limiti della revisione stessa, riguardo l’omogeneità delle misure di outcome e degli interventi utilizzati negli studi che, non permettono di sintetizzare i risultati e trarre conclusioni più coerenti. In aggiunta, alcuni studi non sono stati trovati anche dopo che sono stati contattati personalmente gli autori degli studi stessi e le riviste su cui sono stati pubblicati e questo, ha impedito di offrire tramite questa revisione, una visione più comprensiva in questo campo.

    Concludendo, i dati che supportano l’efficacia dell’intervento con EMG-BF per il recupero della funzione motoria per i pazienti con paralisi nervosa periferica, sono includenti. Questo è in parte dovuto alla scarsezza di studi e alla bassa qualità metodologica degli stessi.

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