Biofeedback thus improves accuracy and muscle learning with every rep. ![]() Alternatively, a biofeedback interface like that in the mTrigger system provides real-time audiovisual feedback of a patient’s volitional contraction, encouraging maximum volitional contraction (MVC) and allowing for a temporal and spatial understanding of activation. This does not allow for the natural order of motor unit recruitment to take place, and thereby misses the opportunity to rebuild the neuromuscular pathway in a manner reflective of activity in a healthy muscle. When using EMS (electronic muscle stimulation), all nerve fibers are stimulated simultaneously. Since muscle atrophy predominantly affects Type I fibers ( Mechanisms for fiber-type specificity of skeletal muscle atrophy Muscle type and fiber type specificity in muscle wasting), recruitment thereof is critical to reverse the effects of muscle inhibition and atrophy. In practice, this means that Type I muscle fibers (slow-twitch, low-force, fatigue-resistant, small diameter) are naturally activated before Type II muscle fibers (fast-twitch, high-force, less fatigue-resistant, excitable, large diameter). The concept known as order of recruitment is based on Heinemann’s Size Principle, which states that under load, motor units are naturally recruited from smallest to largest. Reversing inhibition via voluntary contraction helps to “wake up” the neuromuscular pathway and attack neuromuscular deficits that follow surgery or injury head-on. Compensation (activity in a co-contracting muscle that is not the target muscle but can assist in the performance of particular exercises) and inability to control resting tone/tension also impacts rehabilitation goals. Combating inhibition and atrophy is critical to making the strength and neuromuscular control gains that get patients back to functionality. As a result of inhibition, atrophy can occur, which has numerous negative effects, including weakness, asymmetry, avoidance patterns, and increased re-injury risk. Inhibition is a lack of volitional contraction caused by post-injury or post-surgery effusion, pain, swelling, etc. However it presents clinically, most people in physical therapy for musculoskeletal or orthopedic concerns are there due to inhibition. By communicating muscle activity in real time, biofeedback enables the reacquisition of pre-injury performance. When patients begin to use their own electrical system early on through volitional contraction, they gain both motor control and strength, as well as re-educate the neuromuscular pathway. The primary rationale for the use of biofeedback in physical therapy is that monitoring voluntary muscle activation improves accuracy and quality of performance and helps patients make faster progress. ![]() Decreased EMG activity and neuromuscular control inhibit patients’ ability to regain pre-injury functionality. The mTrigger ® Biofeedback System uses surface electromyography ( sEMG) instrumentation to measure the electrical activity produced by targeted muscle groups during therapeutic exercise.
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