EMG - Supported Biofeedback Training in a Person with Multiple Sclerosis - A Case Study

Abstract

Multiple Sclerosis (MS) is defined as a “chronic, inflammatory, demyelinating disease of the central nervous system (CNS) with additionally differently pronounced loss of axons and reactive gliosis” [1]. Although etiological and pathogenetic processes are still unclear, it is assumed that MS can be assigned to autoimmune diseases, in which body tissue is attacked by the immune system [1,2]. Due to their different inflammatory origin, persons with MS still differ in the manifestation of individual symptoms. The most common symptoms comprise sensory disturbances (approx. 40% of the patients), motor impairments (ca. 39% of the patients), pain syndrome (ca. 15% of the patients), and cognitive impairments (ca. 10% of the patients) [3]. Therefore, MS must be seen as a complex and inter-individually strong varying neurodegenerative disease. On a symptomatic level, limitations can occur in neuropsychological functions (e.g. cognition, fatigue, depression), vegetative functions (e.g. bladder, dysentery, and sexuality disorders), as well as in deficits associated with the cerebral nerves (e.g. eye movement disorders, dysarthria, dysphagia) and pain phenomena [1,4]. Sustained motor impairments are caused by spasticity, muscle weakness, gait and balance disorders [1,4]. Significant differences in people with MS (pwMS) base on the fact that the course of the disease pattern is unpredictable. Until this day and age, pharmacological treatments are considered as gold standard in MS therapy. Thereby, pharmacological as well as nonpharmacological interventions must be seen as symptom-based treatment. Until now, the etiology of MS has not been clarified; in consequence it is absolutely necessary to further develop existing rehabilitation programs in order to maintain physical, sensory, psychological and social functions. In this context, first investigations pointed out the possibilities of using bioand neurofeedback as a therapeutical intervention in this group of patients. In biofeedback (BF) therapy, body signals are reported to the patients in real-time, so that the person can learn to influence these body functions [5]. The aim of biofeedback treatment is the perception and influence of physical processes, which are important in the maintenance of mental, psychosomatic and physical diseases. Biofeedback can be used as a specific intervention, without already known side effects [5]. For example, Jensen et al. [6] used Neurofeedback (EEG-Biofeedback) to treat chronic pain in people with MS (pwMS). The authors reported a positive influence of the additional use of neurofeedback on self-hypnosis in chronic pain of pwMS. Choobforousshazadeh et al. [7] investigated the effects of neurofeed back training on depressive symptoms and fatigue in pwMS. Furthermore, Lucio & colleagues [8] found an improved control of pelvic floor muscles in pwMS who suffer from sexual dysfunctions, after EMGsupported biofeedback training and additional neuromuscular electrostimulation. Prosperini et al. [9] focused on the effects of visual-sensomotor biofeedback training (BFT) on postural control and the risk of falling in pwMS. Patients were asked to Volume 7 Issue 7 2017