**1. Introduction**

#### **1.1. Musculoskeletal disorders today**

Musculoskeletal disorders, known as MSDs, are injuries or pain in the body joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck, and back. MSD pain is a

global challenge, since it affects up to three-quarters of the overall population [1]. It is the most common cause of severe long-term pain and disability in Europe with a tremendous social and economic impact, as evidenced by the following:

Within the later approach, exercises are often tailored to a specific anatomic region, and in many cases to patients even, aiming to prevent a specific injury or to treat localized symptoms by improving movement and strength. In addition, exercises usually need to be performed with specific objectives and repeated regularly for a certain period of time. The need to automate these processes and provide extra input to guide the patient while performing the exercises, allowing an accurate and correct performance, motivated the introduction of

Bridging the Clinic-Home Divide in Muscular Rehabilitation

http://dx.doi.org/10.5772/intechopen.76790

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A common type of biofeedback rehabilitation is surface electromyography (sEMG), in which one or more muscles are assessed to show (e.g.) graphics and/or play sounds in real time, providing information to both patient and physiotherapist as to whether the correct muscle groups are active or relaxed and the precise levels of activation. This approach accelerates the learning process for a new mobility task, helping also to avoid re-occurrence by making sure the patient effectively learned the new pattern [5–7]. While re-education by means of biofeedback has been mostly adopted at the clinical level, novel paradigms are enabling its extension

Biofeedback is a general concept that involves every external input given to the patient in order to enable him/her to learn how to change physiological activity, to facilitate his/her performance, and improve health and performance, where sEMG is also included [8]. For the case of MSDs, this technique is particularly useful to give the correct perception about the dynamics of the muscle groups that are being exercised. As a result of the conditionings introduced by the disorders, very often patients perform a specific task or movement

converge to a full recovery scenario with mobility patterns that can be considered clini-

It is common to see patients alone in the physiotherapy gym, performing the exercises in a highly distorted way (e.g. as fast as they can), which often contributes to worsen their condition. Using sEMG biofeedback equipment helps to prevent this kind of situations, ensuring that patients have specific indications to follow and get motivated by visual and acoustic aids, while knowing that in the end the physiotherapist will have access to all that was done when the patient is alone. This puts the patient in charge and also increases his/her responsibility

At a clinical level, sEMG biofeedback is first used as an assessment tool, allowing an objective analysis of movement patterns (e.g. activation sequences and timings), levels of electrical

Compensation occurs when the muscles responsible for a specific movement are not working (due to pain, neurologic reasons, or simply by altered movement patterns related with specific sport gestures or daily activities), and other sur-

with a low participation of the muscle groups needed to correctly

to patients' homes, as described throughout the next chapters.

**2. Re-education via biofeedback**

regarding the recovery process (**Figure 1**).

rounding muscles replace their activity, in order to allow functionality.

biofeedback techniques.

**2.1. At the clinic**

full of compensations,1

cally normal.

1


For these reasons, MSDs are recognized as a priority by the EU Member States and European Social partners, according to European Agency for Safety and Health at Work [4]. Physiotherapy is the main non-pharmacological clinical MSD treatment. However, a host of common problems plague physiotherapy treatment today, namely.


For these reasons, the majority of patients abandon or must repeat treatment within a year. The low success rate and inconsistency of treatments for MSD pain lead to increased financial costs, both for the patient and for health reimbursement systems.

#### **1.2. Treatment methodologies**

According to the National Health Service (NHS) in England, physiotherapy practice to address MSDs can include a variety of different treatment and preventive approaches, depending on the specific condition. On a first session, the physiotherapist will assess and determine together with the diagnostic provided by the doctor (if the patients visited a doctor before) as to what kind of intervention the patient may need.

The main approaches generally used by physiotherapists are (1) education and advise (i.e. providing general and specific guidance on ways to improve well-being, by taking regular exercise or to reduce risk of pain or injury during daily life activities); (2) manual therapy (e.g. mobilization, massage, and manipulation of body tissues and structures to relieve pain and stiffness, improve blood circulation and promote relaxation, and improve movement); (3) electrotherapy (e.g. transcutaneous electrical nerve stimulation—TENS, ultrasound, iontophoresis, and treatments alike); (4) movement and exercise (e.g. specific training activities to help improve mobility, function, and decrease pain levels).

Within the later approach, exercises are often tailored to a specific anatomic region, and in many cases to patients even, aiming to prevent a specific injury or to treat localized symptoms by improving movement and strength. In addition, exercises usually need to be performed with specific objectives and repeated regularly for a certain period of time. The need to automate these processes and provide extra input to guide the patient while performing the exercises, allowing an accurate and correct performance, motivated the introduction of biofeedback techniques.

A common type of biofeedback rehabilitation is surface electromyography (sEMG), in which one or more muscles are assessed to show (e.g.) graphics and/or play sounds in real time, providing information to both patient and physiotherapist as to whether the correct muscle groups are active or relaxed and the precise levels of activation. This approach accelerates the learning process for a new mobility task, helping also to avoid re-occurrence by making sure the patient effectively learned the new pattern [5–7]. While re-education by means of biofeedback has been mostly adopted at the clinical level, novel paradigms are enabling its extension to patients' homes, as described throughout the next chapters.
