Concepts of motor learning applied to a rehabilitation protocol using biofeedback to improve gait in a chronic stroke patient : an A-B system study with multiple gait analyses

Objective: The impact of electromyographic biofeedback (EMG BFB) applied during functional gait activities and employed in accord with theories on motor learning was investigated in a chronic hemiplegic patient. Methods: A single-subject A-B design was used. EMG BFB was applied to the triceps surae during gait. A rehabilitation program with a fading frequency of BFB application and an increasing variability in the task training was implemented. Responses to the rehabilitation program were documented via multiple quantitative gait analyses, performed during a baseline, treatment, and at follow-up 6 weeks after the end of treatment. Results: From baseline to end of treatment, there were significant changes in ankle power at push-off, both in amplitude and timing, as well as onset of ankle power at push-off relative to heel strike of the healthy leg. There was a significant increase in gait velocity, step length of the healthy side, stride length, and stride frequency. At follow-up, changes were still significantly different from baseline and the patient had reduced the use of the cane in activities of daily living. Conclusions: BFB appears to have been effective in promoting positive changes in gait in this pilot study. The rehabilitation protocol also appeared to be effective in promoting learning and the incorporation of trained activities into daily activities.