Research Article
Volume 13 Issue 2 - 2021
Effects of a Therapy Based on a Functional Electrical Stimulation of Bimanual Activation Combined with the Training of Electromyographic Biofeedback on the Motor Function of the Upper Limb in Subjects with Stroke
Sebastián Eduardo Alarcón Arancibia1*, Barbara Sánchez O1, Hachi Manzur V2 and Julio Torres E1
1Kinesiologist, Service of Physical Medicine and Rehabilitation, Clínica Dávila, Recoleta, Chile
2Hospital Clínico Universidad Católica, Santiago, Chile
*Corresponding Author: Sebastián Eduardo Alarcón Arancibia, Kinesiologist, Master degree in Neurorehabilitation, Service of Physical Medicine and Rehabilitation, Clínica Dávila, Recoleta, Chile.
Received: December 14, 2020;Published: January 30, 2021


Introduction: Stroke is the leading cause of death and disability in Chile. More than 85% of patients suffer from hemiplegia and more than 69% functional motor disability of the upper extremities. This alteration generates an impact on the use of the upper limb, affecting the various activities of people's daily lives. There are no studies that combine electromyographic biofeedback therapy and bimanual activation with functional electrical stimulation in subjects with stroke. Therefore, there is interest in determining the effect of a training protocol based on Functional Electrical Stimulation (FES) with bimanual activation and biofeedback therapy on the function of the upper limb.

Methodology: 15 subjects with stroke between 40 and 85 years recruited in the outpatients neurorehabilitation program of Clínica Dávila, randomized in an experimental group and in two control groups of 5 subjects. In each session the experimental group will train fifteen minutes of bimanual activation with functional electrostimulation and then a ten-minute biofeedback training program, while the control 1 and control 2 group trained under the same conditions but with placebo FES and placebo BF-EMG respectively.

Results: There were significant changes in the experimental group after the intervention.

Conclusion: This study suggests the electrical stimulation works and biofeedback as a tool for the rehabilitation of the upper limb in subjects with stroke.

Keywords: Stroke; Neurofeedback; Rehabilitation


  1. Guía Clínica AUGE. “Accidente cerebrovascular isquémico en personas de 15 años y más”. Serie Guías Clínicas MINSAL (2013).
  2. Ju-Hong Kim. “The effects of training using EMG biofeedback on stroke patients upper extremity functions”. The Journal of Physical Therapy Science 29 (2017): 1085-1088.
  3. Hyun Seok MD., et al. “Can Short-Term Constraint-Induced Movement Therapy Combined With Visual Biofeedback Training Improve Hemiplegic Upper Limb Function of Subacute Stroke Patients?”. Annals of Rehabilitation Medicine 6 (2016): 998-1009.
  4. Kim HH., et al. “Intervenciones para promover la recuperación de la extremidad superior en pacientes con accidente cerebrovascular: una revisión sistemática”. Journal of Korean Society of Occupational Therapy (2012): 129-145.
  5. Pietrosimone Brian., et al. “Clinical Strategies for Addressing Muscle Weakness Following Knee Injury”. Clinics in Sports Medicine 2 (2015): 285-300.
  6. Urra O., et al. “The impact of visual feedback on the motor control of the upper-limb”. IEEE Engineering in Medicine and Biology Society (2015): 3945-3948.
  7. Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application.
  8. Nelson Lonnie a. “The Role of Biofeedback in Stroke Rehabilitation: Past and Future Directions”. Topics in Stroke Rehabilitation4 (2007): 59-66.
  9. Giggins Oonagh M., et al. “Biofeedback in Rehabilitation”. Journal of Neuro Engineering and Rehabilitation1 (2013): 60.
  10. Jonsdottir J., et al. “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”. Neurorehabilitation and Neural Repair 21 (2007): 190-194.
  11. Johanna Jonsdottir., et al. “Task-Oriented Biofeedback to Improve Gait in Individuals With Chronic Stroke: Motor Learning Approach”. Neurorehabilitation and Neural Repair5 (2010): 478-485.
  12. Rosalyn Stanton., et al. “Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review”. Journal of Physiotherapy1 (2017): 11-16.
  13. Oonagh M., et al. “Persson and Brian Caulfield Biofeedback in rehabilitation”. Journal of Neuro Engineering and Rehabilitation (2013).
  14. Akkaya N., et al. “Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial”. Clinical Rehabilitation 3 (2012): 224-236.
  15. Vanessa Draper. “Electromyographic Biofeedback and Recovery of Quadriceps Femoris Muscle Function Following Anterior Cruciate Ligament Reconstruction”. Physical Therapy 1 (1990): 11-17.
  16. Nelson LA. “The Role of Biofeedback in Stroke Rehabilitation: Past and Future Directions”. Topics in Stroke Rehabilitation 4 (2007): 59-66.
  17. Taub R., et al. “A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke”. Stroke 4 (2006): 1045-1049.
  18. Axel Forman. “Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training (2017).
  19. Howlett O. “Using functional electrical stimulation with stroke survivors: A survey of Victorian occupational therapists and physiotherapists”. Australian Occupational Therapy Journal 4 (2018): 306-313.
  20. Jonsdottir J., et al. “Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach”. PLoS One12 (2017): e0188642.
  21. Cuesta-Gómez., et al. “The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study”. Frontiers in Neurology 8 (2017): 186.
  22. Nakipoğlu Yuzer GF., et al. “A Randomized Controlled Study: Effectiveness of Functional Electrical Stimulation on Wrist and Finger Flexor Spasticity in Hemiplegia”. Journal of Stroke and Cerebrovascular Diseases 7 (2017): 1467-1471.
  23. Eraifej J., et al. “Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis”. Systematic Reviews 1 (2017): 40.
  24. Schuster-Amft C., et al. “Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial”. PLoS ONE10 (2018): e0204455.
  25. Amano S., et al. “Reliability of remote evaluation for the Fugl-Meyer assessment and the action research arm test in hemiparetic patients after stroke”. List of issues Topics in Stroke Rehabilitation 6 (2018): 432-437.
  26. Bernhardt Julie., et al. “Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce”. International Journal of Stroke5 (2017): 444-450.
Citation: Sebastián Eduardo Alarcón Arancibia., et al. “Effects of a Therapy Based on a Functional Electrical Stimulation of Bimanual Activation Combined with the Training of Electromyographic Biofeedback on the Motor Function of the Upper Limb in Subjects with Stroke”.EC Neurology 13.2 (2021): 77-86.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 08, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to