All forms of physical therapy have a common goal: return to function. But OTs and CHTs have a special perspective on function. Patients undergoing occupational or hand therapy are there to get their daily lives back, to regain skills that most take for granted. For this group of professional problem-solvers, tools that help actively engage patients are critical. By engaging at the cognitive level as well as the motor level, we reinforce the control patients have over their bodies, and support their journey to independence. Biofeedback for occupational therapy can make a huge difference in the transition from basic motor control through functional strength and endurance.
Here, we talk with OTR/L and CHT, Jim Wagner, about the benefits and how-to’s of incorporating sEMG biofeedback into his occupational and upper extremity practice.
mTrigger Biofeedback System:
Applications for Occupational & Hand Therapy
For Wagner, it’s all about engaging patients on a cortical level. Biofeedback helps combat abnormal movement and recruitment patterns by teaching the body – at both the motor and neural level – what it’s doing in real time.
When patients wake up target muscles with voluntary recruitment, it activates neural pathways much more efficiently than with passive treatment (like e-stim/NMES). In other words, the body inherently recruits endurance muscle fibers first; with biofeedback, we’re producing the same natural order of recruitment. “I’ve found this has been a much more effective treatment than just stim alone,” Wagner says. By activating muscles in this way, we encourage cortical control, functional strength and endurance, and combine the power of the body’s motor and neural systems to heal.
“[Biofeedback] fills a gap in our treatment regime to not just have a passive modality, but an active modality that engages cognition. The goal is to get patients back to function, back to living again. This [mTrigger] is an integral part of our plan of care, where we can engage and encourage overall independence with daily living skills.”
Wagner notes that seeing activation in real time helps him to connect with and encourage his patients, motivating them to improve.
Above, Wagner discusses several cases in which he has utilized mTrigger to improve outcomes:
CASE 1: Scapholunate ligament reconstruction | Musculoskeletal
- Target lateral extensor wad: ECRB, ECRL
- Radial deviation, wrist extension
- Set target to attainable goal based on contraction level, patient responds to audiovisual cues to actively engage/contract on each rep
- Use as preparatory modality OR during function
CASE 2: 5th metacarpal fracture | Musculoskeletal
- Hypothenars aren’t functioning well (no neural damage, but problematic scar tissue)
- Target specific, small muscles that have huge impact on hand function
- Engage in meaningful activities that are important to the patient
- Games help sustain contraction, work on muscle endurance
- Active modalities encourage controlled, sustained contractions in the target muscle, leading to greater functional outcomes
CASE 3: Stroke rehab | Neurological
- First, activate the motor unit: Active assisted range of motion with visual feedback to activate biceps; cognitive link to functional activity: self feeding
- Second, use in functional activity: Transition to function, move into mobile arm support setup
- Layer with other modalities, like kinesiology tape for proprioceptive input
- Biofeedback is a very effective piece of the puzzle to engage cognitively and physically
- “We can get them involved and get that cognitive component at the same time while getting motor function, so it’s really a game changer.”
- Incorporate biofeedback into musculoskeletal practice, from isolated movement all the way up through functional activity, as it really helps to motivate and increase patient compliance. Neurological patients can become orthopedic problems.
- Patients see therapists for maybe an hour or two a week – but armed with the knowledge and experience that biofeedback provides, they can take their learnings and continue that long term rehab in the home setting.
with OTD, OTR/L, CHT, Jim Wagner and mTrigger Product Manager, Amy Lalime
How do I tell when biofeedback would be a helpful tool?
- Evaluation & Assessment
- After immobilization, does the patient have deficits in motor control?
- Joint assessment – is it a stability and motor control issue? Are they hypomobile, or do we need to mobilize the joint first? Do they not know how to move/fire the target muscle?
- Exercises & Functional Activities
- Look at how the uninvolved side moves, and get them to start reproducing that (mirror box therapy, for example) while monitoring activation on the target side with mTrigger
- Multiple levels of cortical engagement
How do I set up mTrigger? (“I’m not a techy! This is a very easy setup.”)
- Down and dirty – put the pads on the muscle belly, activate that motor unit, see microvolts on the display. Set the goal a little higher or lower, based on what you’re trying to achieve. This creates an objective measure each time.
- Set time cues for specific contraction and relaxation periods
- Some conditions (like stroke) require more time to let the soft tissue and neural system calm down between reps, quiet the noise
- Setting up electrodes
- 2 pads per muscle belly
- Look at activity between those two points
- Dual channel
- Neuromuscular deficit test to check against contralateral side activation
- Antagonist / agonist movement pattern
- Functional inhibition, focused relaxation
What does success look like when using mTrigger in an OT setting?
- OTs are trained to see the person as a whole instead of cutting them into body parts – because mTrigger isn’t an isolated piece of equipment, it fits in very naturally. It’s something we use to engage the patient in a different way than traditional passive modalities.
- Success means I’m able to engage not just the motor units, but cognitively and emotionally within that treatment session. To give them a goal they can carry into the home. So they can say “now I know what it’s like to feel that again, I can actively control that muscle, and now I can link that to function at home.”
- It will always take time, but it’s much more effective to do something with somebody than to somebody. mTrigger is a very active intervention, requiring efferent output through cognitive function and multiple body systems. That leads to long term results.
What is the patient response to biofeedback?
- It’s not boring for patients – they can enjoy their therapy and understand the link to function, understand the purpose of their exercises so that they have much greater buy-in to their program. That’s a game changer.
- Both biomechanical + psychosocial – engage the patient where they are
- How can we modify a treatment session to help them meet their goals? mTrigger offers that versatility.
From Jim’s perspective, using biofeedback for occupational therapy is a game changer. Recognizing the importance of cognitive link to function and its impact on motor skills is one of the things that makes great therapists great. Another part of the equation is having the right tools.