It is a well-known fact that games make everything more fun. Physical therapy and rehabilitation are no exception. The gamification of rehabilitation has really taken off and gained popularity recently. From the Wii Fit, to balance trainers and wearable devices, science has recognized the importance of taking the competitive, engaging, and fun aspect of games and incorporating them into the sometimes boring, monotonous, and repetitive process of rehab.
EMG biofeedback provides a way to look at muscle activation in real time while exercise games provide motivation and engagement for patients. The “Play” component of the mTrigger app offers four different games to help patients achieve their goals. mTrigger has gamified rehabilitation for patients trying to improve their muscle activation and movement patterns across the spectrum of rehab.
Where is EMG gamification being used?
Lets take a look at several studies investigating the effects of sEMG biofeedback on a variety of physical therapy diagnosis and how the use of EMG gamification can impact patients’ results.
Gripping Strength Improvements
During a hand gripping exercise, EMG biofeedback was used in this study with the intention of helping to promote a higher grip force. Not only did participates performing gamified exercise exhibit higher grip force but they also demonstrated a more accurate performance and reported higher levels of motivation and an overall better experience.(1)
Similarly, when biofeedback games were used following a distal radius fracture, 40% greater handgrip strength improvements were seen in the group that trained with games for four weeks.(2) This same group self-reported feeling less frustration, higher motivation, and decreased mental demands when performing their rehabilitation exercises through gamification.(2)
Nervous System Injury
After a major central or peripheral nervous system injury such as a stroke, spinal cord injury, brachial plexus injury, or trauma, it can be especially challenging for patients to re-establish muscle activity.(3) With good reason, there is often a lot of frustration that comes along with such a challenging injury. Often times the amount of achievable muscle activation is low and progress is extremely slow. This is where the visual conformation that sEMG biofeedback provides can be essential. On top of helping to improve muscle activation EMG gaming also helps to facilitate the re-learning of motor patterns.(3) By making rehab more fun, exercising with games helped to improve adherence and motivation during a long recovery process in these patients.(3)
*while this example is not using the game function of the mTrigger app specifically, it is an excellent reminder of how biofeedback in general can prove immensely helpful in the re-learning movements for this population.
Cerebral Palsy
For children, games are a great way to make less desirable tasks more fun. A study in children with cerebral palsy utilized a game implemented with biofeedback to help engage and promote quality of movement during hand gestures. Since children with cerebral palsy often struggle with dexterity, improving dexterity through active wrist extension and grip strength can really help with their function and willingness to participate in activities.(4) Electrodes placed on the forearm muscles targeting certain hand gestures/movements were used during a gesture-controlled biofeedback game.(4) The authors found that individuals who utilized gamified biofeedback had less compensatory arm motions, higher quality of movement, and reported feeling more engaged.(5) Ultimately, the use of EMG gamification made therapy in this population more fun and motor learning more effective.(5)
Prosthetics
In prosthetics, researchers have found a way to incorporate biofeedback into prosthetic limbs to help patients use EMG gaming to better learn limb training and movement.(6) Patients who used EMG incorporated gaming spent a greater amount of time on training with their prothesis and doing exercises compared to patients who didn’t.(6) The use of EMG gamification greatly facilitated the learning of proper movement for these patients.(6)
Older Adults and Knee Osteoarthritis
In older adults, exercise and staying active is of vital importance. In this population, the use of interactive video games with EMG biofeedback helped to increase physical activity levels and promote strength and movement in sedentary adults with knee OA.(7) Additionally, knee extension torque production in older adults who used biofeedback gamification was 25% greater than in their non-gaming counterparts.(7) Not only did gamification provided a motivational element that encourage patients to put forth greater effort, but it also kept them willing to exercise longer.(7) Some patients reported that the interactive nature of performing exercises with gamification helped to take way some of the knee discomfort normally experienced during exercise.(7)
Clinical Examples
This is far from an exhaustive list of the different ways gamification is currently being used to enhance rehabilitation outcomes. From sports injuries, to pediatrics, to general orthopaedics, there are no limits to the use of mTrigger biofeedback gamification. Here are just a few more examples.
To improve engagement after rotator cuff injury/surgery try using mTrigger gamification for basic rotator cuff exercises.
Get creative with balance and ankle work by gamifying it.
Finally, EMG gamification with athletes can make a huge impact when it comes to keeping them motivated and having fun.
Summary
Together, these studies allude to the widespread benefit the incorporation of gaming has in healthcare.(5) Biofeedback games have the capacity to help patients train muscle activity and movement patterns in real time by seeing how their physical movements correlate to in-game performance.(5) Furthermore, this allows them to appropriately adjust those movements to achieve a more optimal result.(5) By utilizing gamification to teach movement and education, EMG biofeedback gamification can supplement the learning of transferable skills and movement patterns.(5) As a whole, mTrriger EMG biofeedback gamification is a novel way to engage patients during their physical therapy rehab programs to help improve motivation and optimize outcomes.
References
1. Garcia-Hernandez N, Garza-Martinez K, Parra-Vega V, Alvarez-Sanchez A, Conchas-Arteaga L. Development of an EMG-based exergaming system for isometric muscle training and its effectiveness to enhance motivation, performance and muscle strength. Int J Hum Comput Stud. 2019;124:44-55. doi:10.1016/J.IJHCS.2018.11.010
2. Garcia-Hernandez N, Garza-Martinez K, Parra-Vega V. Electromyography Biofeedback Exergames to Enhance Grip Strength and Motivation. Games Health J. 2018;7(1):75-82. doi:10.1089/G4H.2017.0054
3. Liu Y, Silva RML, Friedrich JB, Kao DS, Mourad PD, Bunnell AE. “Surface Electromyography-Driven Therapeutic Gaming for Rehabilitation of Upper Extremity Weakness: A Pilot Study.” Plast Reconstr Surg. 2022;150(1):125. doi:10.1097/PRS.0000000000009208
4. MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study. PLoS One. 2020;15(6). doi:10.1371/JOURNAL.PONE.0234767
5. MacIntosh A, Vignais N, Vigneron V, et al. The design and evaluation of electromyography and inertial biofeedback in hand motor therapy gaming. https://doi.org/101080/1040043520201744770. 2020;34(2):213-221. doi:10.1080/10400435.2020.1744770
6. McLinden S, Smith P, Dombrowski M, et al. Utilizing Electromyographic Video Games Controllers to Improve Outcomes for Prosthesis Users. Applied Psychophysiology Biofeedback. 2023;1:1-7. doi:10.1007/S10484-023-09598-Y/FIGURES/6
7. Krepkovich E, Kaur M, Mangum LC, et al. Feasibility of a Novel Video Game-Based Electromyography Biofeedback System in Patients With Knee Osteoarthritis. J Sport Rehabil. 2022;31(7):937. doi:10.1123/JSR.2021-0397
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