MARCH 1979 P H Y S I O T H E R A P Y 11 in s p o rt sh o u ld lead to a se n se o f d u ty , a sh o w o f in i­ tia tiv e a n d d riv e , as well as p e rs e v e ra n c e , w illp o w e r, e n d u ra n c e , r e lia b i lity a n d re s p o n s ib ility . A s p o rt p ro g ra m m e sh o u ld b e p la n n e d so t h a t e ach child c a n p a r tic i p a te w ith in h is lim ita tio n s w h ilst it is still a c c e p ta b le to te a c h e rs a n d th e ra p is ts . T h is is a co m p le x p ro b le m , c o n s id e rin g th a t th e ra p is ts , p sy c h o ­ logists a n d te a c h e rs h a v e b e e n m e e tin g a n n u a lly f o r the p a s t five y e a rs to d e c id e w h e th e r c h ild re n w ith le a rn in g d is a b ility s h o u ld p a r ti c ip a te in s p o rt, w h ic h item s sh o u ld b e in c lu d e d a n d w h a t effect it w o u ld h a v e on th e c h ild re n . T h u s f a r n o c le a r a n sw e r h a s e m e rg e d , as d iv e rs e o p in io n s r e n d e r a s o lu tio n im p o s sib le . T h e a u th o r does n o t d o u b t th e e d u c a tio n a l v a lu e o f s p o rt. I n th e n e a r fu tu re a d e c isio n w ill h a v e to b e ta k e n a b o u t w h ic h item s a re to b e offered, w h o sh o u ld p a r ti c ip a te a n d how a c h ie v e m e n ts s h o u ld b e c a lc u la te d a n d re c o g n iz e d , a lb e it b y m ea n s o f re se a rc h , d isc u ssio n o r tr ia l a n d erro r. Sources 1. G u n te r , C. F . G . (1967): A s p e k te v a n d ie te o re tie s e o p v o e d k u n d e , S te lle n b o sc h . U n iv e r s ite its U itg e w e rs. 2. H a m ilto n , J. H . (1971): D ie v e rs ta n d e lik g e s tre m d e le e rlin g . S te lle n o sc h , U n iv e rs ite its U itg e w e rs. 3. L a n d m a n , W . A ., R o o s , S. G . en L ie b e n b e rg , C. R . ( ........): O p v o e d k u n d e en o p v o e d in g s le e r v ir b e g in ­ n e rs. S te le n b o sc h , U n iv e r s ite its U itg e w e rs. 4. S o n n e k u s, M . C. H . (1978): D i e p sig iese lew e v a n die k in d m e t sp esifiek e le e rg e s tre m d h e d e (In : L e e rlin g e m et spesifieke le e rg e s tre m d h e d e in sk o le v a n die D e p a rte m e n t van N a s io n a le O p v o e d in g . S im p o siu m 11 - 13 O k to b e r 1978). 5. V a n d e r S to e p , F . en van d e r S to e p , O . A . (1968): D id a k tie s e o rie n ta s ie . P r e to r ia . A c ad e m ic a . 6. V a n N ie k e rk , P. A . (1978): W ie is d ie k in d m et spesifieke le e rg e s tre m d h e d e ? (In : L e e rlin g e m et sp e si­ fiek e le e rg e s tre m d h e d e in sk o le v a n d ie D e p a rte m e n t v a n N a s io n a le O p v o e d in g . S im p o s iu m 1 1 - 1 3 O k ­ t o b e r 1978). REPORT ON THE USE OF BIOFEEDBACK J e a n e tte M itc h e ll B.Sc. (P h y s io th e ra p y ), M .Sc. ’n O orsig van d ie jo n g ste U 'eratuur o o r bio te ru g rig tin g en veral lera p eu liese a a n w e n d in g , w o rd gegee. T o e sta n d e w at g e s k ik is vir b e h a n d elin g , m e t o d e s van a a n w e n d in g en seine w o rd g e n o e m . V e r sk e ie stu d ie s w o rd aangehaal m aar geen g e k o n tro lle e rd e stu d ie b e w y s tot d u sv e r sta tis­ tics d ie w aarde van b i o ’.eru g rig tin g nie. B io fe e d b a c k , o r m o re a c c u ra te ly , e le c tro m y o g ra p h ic b io fe e d b a c k , a p p e a r s fro m th e c u rre n t l ite r a tu r e to be a p ro m is in g a n d re la tiv e ly n ew e le c tro th e ra p e u tic m o d a lity . It is u s e d m a in ly f o r th e tre a tm e n t o f n e u r o ­ m u s c u la r d is o rd e rs . I t is a n a d ju n c t to th e m o re c o n ­ v e n tio n a l m e th o d s o f tr e a tm e n t a n d p h y s io th e ra p is ts , w ith th e c o - o p e ra tio n o f b io e n g in e e rs , m a y u se it in ­ c re a sin g ly in th e r e h a b i li ta t io n o f p a tie n ts . H o w e v e r, as îts u s e as su c h in c re a se s, n e w te c h n iq u e s as re g a rd s its A p p lic a tio n w ill n e ed to b e d e v e lo p e d to s u it th e in d i- •Vidual p a tie n t ’s needs. R e c e n t stu d ie s a n d re p o rts o f th e r a p e u t ic successes h a v e sh o w n th a t e le c tro m y o g ra p h ic b io fe e d b a c k , u sed w ith c a re fu lly d ire c te d in s tru c tio n a n d m o tiv a tio n , e n ­ a b les a p a tie n t to o b ta in “ . . . a n e x tr a o r d in a r y d e g ree o f v o lu n ta r y c o n tro l o v e r p h y sio lo g ic a l a c tiv itie s p r e ­ v io u sly c o n sid e re d (to be) in v o lu n ta ry , re fle x iv e o r s u b c o n sc io u s.” (N a fp lio tis , 1976), a n d th is d e g re e o f c o n tro l is o b ta in e d in a re la tiv e ly s h o rt p e r io d o f tim e. E le c tro m y o g ra p h ic b io fe e d b a c k in v o lv e s so m e a u d ito r y o r v isu a l r e p re s e n ta tio n o f a p a tie n t’s m u s c u la r a c tiv ity , w h ic h th e p a tie n t is ta u g h t to m o n ito r in a n a tte m p t to a lte r m u s c u la r a c tiv ity v o lu n ta r ily to a c h ie v e a d e sire d re sp o n se . T h is p ro c e d u re seem s to w o rk e q u a lly well in cases o f fla c c id ity a n d s p a s tic ity (Tnglis e t al., 1976). A p a r t f r o m u se in n e u ro m u s c u la r d is o rd e rs , it has b e e n e x te n d e d to r e tr a in in g c o rre c t m u s c u la r a c tiv ity in c h ro n ic r e s p ir a t o r y c o n d itio n s (J o h n s to n & L ee, 1976), g a it r e tr a in in g in o rth o p a e d ic p ro b le m s (Z im n ic k i & F e m ie , 1976), a n d in r e la x a tio n o f m u sc le sp a sm in te n s io n h e a d a c h e s (B u d z y n sk i et al., 1970) a n d to rtic o llis (B rudny, G ry n b a u m & K o r e in , 1974). I n a p p ly in g th e m e th o d o f e le c tro m y o g ra p h ic b io fe e d - b a c k , a fu ll f u n c tio n a l a sse ssm e n t is m a d e o f th e p a tie n t, w h o is th e n in tro d u c e d to th e a p p a ra tu s . S u rfa c e e le c ­ tro d e s , w h ic h a r e m o s t o fte n u se d , a re a p p lie d to th e sk in a f te r c le a n in g th e a r e a w ith a lc o h o l a n d a c o n d u c ­ tiv e p a s te is u se d to e n s u re p r o p e r e le c tric a l c o n ta ct. T h e ty p e s o f v is u a l a n d /o r a u d ito r y s tim u li to b e e x p e c te d , a n d w h ic h a r e d e sire d to e lic it a v o lu n ta ry re sp o n se , a re e x p la in e d to th e p a tie n t b e f o re a few “ tr ia l r u n s ” a r e c o n d u c te d . T r e a tm e n t se ssio n s la s tin g 30 to 60 m in u te s a r e u su a lly c a r r ie d o u t tw o to th re e tim e s a w eek, a n d c o n tin u e d u n til th e p a tie n t show s so m e g a in in v o lu n ta r y c o n tro l a n d /o r fu n c tio n a l im ­ p ro v e m e n t. R eview o f Current Literature T h e u se o f e le c tro m y o g ra p h ic b io fe e d b a c k w as first r e p o rte d in 1960 as a m e th o d o f n e u ro m u s c u la r r e ­ e d u c a tio n in cases o f h e m ip le g ia (M a rin a c c i & H o r a n d e , 1960). N e e d le e le c tro d e s a n d a u d ito r y fe e d ­ b a c k w e re u se d , firstly on th e u n a ffe c te d lim b in th e in itia l tra in in g . T h e a u th o r s c la im e d a 20% im p ro v e ­ m e n t in th e fu n c tio n o f th e a ffe c te d lim b w ith in o n e h o u r o f tre a tm e n t. I n 1964 A n d re w s r e p o rte d a n o tic e a b le im p ro v e m e n t in th e m o to r u n it a c tiv ity in n o n - f u n c tio n ­ ing m u sc le s in cases o f h e m ip le g ia w ith p a re s is o f f r o m o n e to f o u rte e n y e a rs d u r a tio n . N e e d le e le c tro d e s a n d v isu a l f e e d b a c k w e re u se d . In s im ila r cases o f o n e y e a r d u r a tio n w ith tib ia lis a n te r io r p a resis, n e e d le e le c tro d e s a n d b o th a u d ito r y a n d v isu a l fe e d b a c k w e re used a n d g o o d re s u lts r e p o rte d in 1973 b y Jo h n s o n & G a rto n . S o m e o f th e s e p a tie n ts w e re re p o rte d to im p ro v e to th e e x te n t o f no lo n g e r n e e d in g sh o rt-le g b ra c e s f o r fo o t- d r o p c o n tro l a f te r o n e m o n th ’s tre a tm e n t. S u rfa c e e le c tro d e s a n d v isu a l fe e d b a c k w e re u se d at th e sa m e tim e b y A m a to e t al. (1973), to tr e a t s p a s tic ity o f th e g a s tro c n e m iu s m u sc le g ro u p o f a b o u t n in e y e a rs d u r a tio n . T h e y re p o rte d im p ro v e m e n t a f te r f o u r m o n th s ’ tra in in g , w h ic h w a s m a n ife s te d in som e cases as a h e e l-s trik e to m id -s ta n c e p a tte rn w ith th e fo o t b e in g h e ld flat. S w aa n e t al. (1974) e x te n d e d th e u se o f su rfa c e e le c tro d e s a n d a u d it o r y fe e d b a c k to re d u c e m u sc le sp a stic ity in cases o f h e m ip le g ia a n d , in th e w o rd s of R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 12 F I S I O T E R A P I E MAART 1979 ln glis e t al. (1976), (fo u n d th e p ro c e d u re to b e g e n e ­ ra lly ) . . m o re effective th a n c o n v e n tio n a l re h a b ili­ ta tio n m e th o d s .” B ru d n y e t al. (1974) fo u n d th a t th e im p ro v e m e n t in th e fu n c tio n o f th e h e m ip le g ic h a n d e v en 12 m o n th s o r lo n g e r a f te r o n se t o f th e h e m ip le g ia la s te d f r o m tw o to tw e lv e w eek s a f te r tre a tm e n t w ith su rfa c e e le c tro d e s a n d a u d ito r y a n d v isu a l fe e d b a c k . T h e y u s e d f o u r a r b i t r a r y g ra d e s o f im p ro v e m e n t in th e ir stu d y a n d r e p o rte d th a t p re h e n s io n b e c a m e p o ss ib le in a b o u t o n e - t h ir d o f th e ir cases. B ru d n y et al. (1976) c a rrie d o u t a fo llo w -u p th r e e m o n th s to th re e y e a rs a f te r tre a tm e n t o f p a tie n ts w ith a h e m ip a re s is w h o h a d re c e iv e d e le c tro ­ m y o g ra p h ic b io fe e d b a c k tra in in g . T h e y fo u n d th a t a p p r o x im a te ly h a lf h a d m a d e a n d r e ta in e d a sig n ific a n t f u n c tio n a l im p ro v e m e n t. It w as n o t u n til 1975, h o w e v er, t h a t th e firs t a tte m p t a t a sc ie n tific a lly c o n tro lle d stu d y w as re p o rte d by B a sm ajian e t al. A g a in s u rfa c e e le c tro d e s a n d a u d ito r y a n d v isu a l f e e d b a c k w e re u se d o n p a tie n ts w ith fo o t- d r o p fo llo w in g C V A . I n th is stu d y , th e effects o f e le c tro m y o g ra p h ic fe e d b a c k u s e d w ith c o n v e n tio n a l p h y s io th e r a p y w e re c o m p a re d w ith th o se o f s ta n d a r d r e h a b ilita tio n m e th o d s a lo n e (c o n tro l g ro u p ), a sse ssin g c h an g e s in m u sc le s tre n g th , ra n g e o f m o tio n in in v o lv e d jo in ts, a n d g a it p a tte rn s . T h e y fo u n d th a t a p p ro x im a te ly tw ice as m u c h im p ro v e m e n t in m u sc le stre n g th a n d ra n g e o f m o tio n w as sh o w n in th e g r o u p re c e iv in g e le c tro m y o g ra p h ic b io f e e d b a c k a n d p h y s io th e r a p y t r e a tm e n t as in th e c o n tro l g ro u p . I n 1976, T a k e b e & B a s m a jia n a lso c o m p a re d th e g a it o f s im ila r p a tie n ts d iv id e d in to th r e e g ro u p s — th o se re c e iv in g b io fe e d b a c k tra in in g , th o s e re c e iv in g tre a tm e n t w ith a p e ro n e a l n e rv e s tim u la to r, a n d th o se re c e iv in g o n ly in te n s iv e p h y s io th e r a p e u tic ex erc ise. G e n e ra lly sp e a k in g , th e y fo u n d th e le a st im p ro v e m e n t in th e la s t g ro u p . O n e o f th e la te st re p o rts o n th e u s e o f e le c tro m y o ­ g ra p h ic b io fe e d b a c k is b y B a k e r e t al. in A p r i l 1977. T h e y h a v e a p p lie d th is te c h n iq u e to p a tie n ts w ith in ­ c o m p le te sp in a l c o rd lesio n s, p a ra ly s is f r o m p o lio ­ m y elitis, sp a sm o d ic to rtic o llis a n d h e m ip leg ia o f 10 y e a rs d u r a tio n , all o f w h o m sh o w “ . . . p ro m is in g re su lts in te rm s o f m u sc le re -e d u c a tio n a n d f u n c tio n a l im ­ p ro v e m e n t . . .” (B a k e r e t al., 1977). A p a r t f r o m its u se in th e a b o v e ty p e s o f cases, e le c tro ­ m y o g r a p h ic b io fe e d b a c k h a s b e e n re p o rte d to b e u se d w ith success in te a c h in g d ia p h ra g m a tic b re a th in g e x e r­ cises (B lack e t a!., 1969), a n d in r e tr a in i n g c o rre c t b r e a th in g p a tte rn s in e m p h y s e m a to u s p a tie n ts (J o h n s to n & L ee, 1976). A g a in s u rfa c e e le c tro d e s a n d a u d ito r y a n d v is u a l f e e d b a c k w e re used. B io fe e d b a c k h a s a lso b e e n u s e d w ith success as a n a id in h e a d - p o s itio n tr a in in g in th e c e re b ra l p a ls ie d c h ild (W o o ld rid g e & R u ss e l, 1976). W o o ld rid g e e t al., 1976, a lso r e p o r t th e su c c essfu l u se o f a n e x te n s io n o f th is p r o c e d u r e in g a it- tr a in in g in c e re b ra l p a ls ie d c h ild ­ re n , w h e re th e o b je c tiv e w a s e ith e r im p ro v e d k n e e fle x io n o r e x te n sio n . I n th is case, w h e re b io fe e d b a c k is u se d to r e tr a in a m o re fu n c tio n a l g a it p a tte rn , th e te c h n iq u e h a s b e e n sim p lified . I n s te a d o f u sin g th e e le c tro m y o g ra p h w ith n e e d le o r s u rfa c e e le c tro d e s to e n ab le f e e d b a c k via a u d ito ry o r v isu a l stim u li, a n e le c tro ­ g o n io m e te r a n d a u d ito ry fe e d b a c k u n it a re used. I n o th e r cases o f g a it re tr a in in g , as f o r e x a m p le in p ro s th e tic tr a in in g in g e r ia tr i c a b o v e -k n e e a m p u te e s (Z im n ic k i & F e r n ie , 1976), a n e v en s im p le r m e c h a n is m e n a b lin g b io fe e d b a c k h a s b e e n de sig n ed . T h is c o n sists o f a n e le c tric a l sw itc h fitte d to th e k n e e jo in t o f th e p r o s ­ th esis, w h ic h is a c tiv a te d b y th e jo in t p o s itio n , th e re b y trig g e rin g a b u z z e r — th e a u d ito r y fe e d b a c k m e c h a n ism . H o w e v e r, th e p r in c ip le o f th e p r o c e d u r e r e m a in s th e sam e. ' T h is re v ie w o f th e c u r re n t lite r a tu r e in d ic a te s th a t a lth o u g h m a n y d iffe re n t stu d ie s in v o lv in g v a r io u s c on­ d itio n s h a v e b e e n c o n d u c te d , th e r e a re n o n e re p o rte d to d a te w h ic h sh o w a c o n tro lle d sc ien tific a p p r o a c h w ith s ta tis tic s to give v a lid ity to th e c la im s o f im p ro v e m e n t o r th e r a p e u tic success m a d e . T h e r e f o r e , m o re c o n tro lle d stu d ies a re o b v io u sly n e c e ssa ry in th is field , a n d good e x p e rim e n ta l d e sig n a n d a n a ly sis a re e sse n tia l f o r an o b je c tiv e a sse ssm e n t o f b io fe e d b a c k , as a te c h n iq u e of v a lu e in r e h a b ilita tio n , to b e p o ssib le . References 1. A m a to , A ., H e rm s m e y e r, C., K le in m a n , K . (1973): U s e o f e le c tro m y o g ra p h ic fe e d b a c k to in c re a s e in ­ h ib ito ry c o n tro l o f sp a stic m uscles. P h y s. T h e r 53, 1063 - 1066. 2. A n d re w s, J. (1964): N e u ro m u s c u la r re -e d u c a tio n of th e h e m ip leg ic w ith th e a id o f th e e le c tro m y o g ra p h . A r c h . P hys. M e d . R e h a b il., 45, 5 3 0 - 532. 3. B a k e r, M ., R e g en o s, E ., W o lf, S. L ., B a sm a jia n , J. Wa (1977): D e v e lo p in g stra te g ies f o r b io fe e d b a c k . A p p lilj c a tio n s in n e u ro lo g ic a lly h a n d ic a p p e d p a tie n ts. P h ys. T h e r., 57, 4 0 2 - 4 0 8 . 4. B a rb e r, T . (ed.) (1971): B io fe e d b a c k a n d se lf-co n tro l. C h ica g o , A ld in e -A th e rto n . 5. B a s m a jia n , J., K u k u lk a , C., N a r a y a n , M . G ., T a k e b e , K . (1975): B io fe e d b a c k tre a tm e n t o f f o o t-d ro p a fte r s tro k e c o m p a re d w ith s ta n d a r d r e h a b ilita tio n te c h ­ n iq u e , A r c h . P hys. M e d . R e h a b il., 56, 231 -2 3 3 . 6. B lack, J., L a g e rso n , J., Z o h m a n , L. (1969): A fe e d ­ b a c k device f o r te a c h in g d ia p h ra g m a tic b re a th in g . A m . R e v . R e s p ir . D is., J00, 335 - 348. 7. B o o k e r, H ., R u b ro w , R ., C o le m a n , P . (1969): S im p lified fe e d b a c k in n e u ro m u s c u la r re tra in in g : A n a u to m a te d - a p p r o a c h u sin g e le c tro m y o g ra p h ic signals. A r c h . P h ys. M e d . R e h a b il., 50, 621 - 625. 8. B ru d n y , J., G ry n b a u m , B., K o re in , J. (1974): S p a s­ m o d ic to rtic o llis: T r e a tm e n t b y fe e d b a c k d isp la y o f E M G . A r c h . P h ys. M e d . R e h a b il., 55, 403 -4 0 8 . 9. B ru d n y . J., K o re in , J., G ry n b a u m . B., F rie d m a n , L . W ., W ein stein , S., S a c h s -F ra n k e l, G ., B e la n d res, P. V . (1976): E M G f e e d b a c k th e r a p y ; re v ie w o f tre a tm e n t o f 114 p a tie n ts . A r c h . P h y s . M e d . R e h a b il., 57, 5 5 - 6 1 . 10. B ru d n y , J. K o re in , J., L ev id o w , L ., G ry n b a u m , B., L ie b e rm a n . M ., F rie d m a n , L. W . (1974): S e n so ry fe e d b a c k th e ra p y as a m o d a lity o f tre a tm e n t in , C N S d iso rd e rs o f v o lu n ta ry c o n tro l. N e u r o lo g y , lfiS 9 2 5 - 9 3 2 . \ 11. B ud z y n sk i, T ., S to y v a , J., A d le r, C. (1970): F e e d ­ b a c k -in d u c e d m u sc le re la x a tio n : A p p lic a tio n to te n ­ sio n h e a d a c h e . J. B e h a v . T h e r. E x p . P sy ch ia tr., 1 2 0 5 - 2 1 1 . 12. G ry n b a u m , B., B ru d n y , J., K o re in , J., B e la n d res, P . V . (1976): S e n so ry fe e d b a c k th e r a p y f o r stro k e p a tie n ts . G e riatrics, 31, 43 - 47. 13. H a r r is , F . A ., S p e lm a n , F . A ., H y m e r, J. W . (1974): E le c tro n ic se n so ry aid s f o r c e re b ra l p a ls ie d c h ild re n . P h y s T h e r., 54, 3 5 4 - 3 6 5 . 14. In g lis, J., C a m p b e ll, D ., D o n a ld , M . W . (1976): E le c tro m y o g ra p h ic b io fe e d b a c k a n d n e u ro m u s c u la r r e h a b ilita tio n . C anad. J. B eh a v . Sci.. 8 , 299 - 323. 15. Inglis, J., S p ro u le , M ., L e ic h t, M ., D o n a ld , M . W ., C a m p b e ll, D . (1976): E le c tro m y o g ra p h ic b io fe e d b a c k tre a tm e n t o f re sid u a l n e u ro m u s c u la r d isa b ilitie s a fte r c e re b ro v a s c u la r acc id e n t. P h ysio . C an. 28, 260 - 264. 16. J o h n s o n , H ., G a rto n . W . (1973): M u scle re -e d u c a ­ tio n in h e m ip le g ia b y u se o f e le c tro m y o g ra p h ic device. A rc h . P h ys. M e d . R e h a b il., 54, 3 2 0 - 3 2 2 . 17. Jo h n s to n , R ., L ee, K y u -H a (1976): M y o fe e d b a c k . A n e w m e th o d o f te a c h in g b r e a th in g exercises in e m p h y s e m a to u s p a tie n ts . P hys. T h e r., 56, 826 - 829. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) MARCH 1979 P H Y S I O T H E R A P Y 13 18. K a rlin s , M ., A n d re w s , L. (1972): B io fe e d b a c k . T u r n ­ ing o n th e p o w e r o f y o u r m in d . P h ila d e lp h ia , J. B. L ip p in c o tt C o. 19. K u lk u lk a , C . G ., B a sm a jia n , J. V . (1975): A sse ssm e n t o f a n a u d io v isu a l fe e d b a c k device u se d in m o to r tra in in g . A m e r . J. P hys. M e d ., 54, 1 9 4 -2 0 8 . 20. L ee, K y u -H a ., H ill, E ., J o h n s to n , R ., S m ieh o ro w sk i, T h . (1976): M y o fe e d b a c k f o r m u sc le r e tra in in g in h e m ip leg ic p a tie n ts . A rc h . P h ys. M e d . R e h a b il., 57, 588 - 591. 21. M a h e r, K . R . (1972): A u d ito r y fe e d b a c k o f m u sc le a c tio n p o te n tia ls : p o te n tia ls to sp a stic ity a n d a th e ­ tosis. P ro c e e d in g s o f P ro d u c tiv ity a n d th e C e re b ra l P a lsied . S ydney, A u s t. S p a stic C e n tre o f N S W . 22. M a rin a c c i, A . A ., H o r a n d e , M . (1960): E le c tro m y o ­ g ra m in n e u ro m u s c u la r re -e d u c a tio n . B u ll. L o s A n g e le s N e u ro l. Soc., 25, 5 7 - 7 1 . 23. N a fp lio tis , H . (1976): E le c tro m y o g ra p h ic fe e d b a c k to im p ro v e a n k le d o rsifle x io n , w rist e x te n sio n , a n d h a n d g ra sp . P h y s . T h e r., 56, 821 - 825. .24. R u ssel, G ., W o o ld rid g e , C. P. (1975): C a se stu d y : \ c o rre c tio n o f a n h a b itu a l h e a d tilt u sin g b io fee d - ' b a c k te c h n iq u e s. P h ysio . C an., 21, 181 - 184. 25. Segal, J. (1975): B io fe e d b a c k as a m e d ic a l tre a tm e n t. J A M A 232, 1 7 9 - 180. 26. S w aa n , D ., V a n W ie rin g e n , P. C. W ., F o k k e m a , S. D . (1974): A u d ito r y e le c tro m y o g ra p h ic fe e d b a c k th e ra p y to in h ib it m o to r a ctiv ity . A r c h P hys. M e d . R e h a b il., 55, 251 - 254. 27. T a k e b e , K ., B a sm a jia n , J. V . (1976): G a it a n aly sis in s tro k e p a tie n ts to assess tre a tm e n ts o f fo o t-d ro p . A r c h . P h ys. M e d . R e h a b il., 57, 3 0 5 - 310. 28. T a k e b e , K ., K u k u lk a , C. G ., N a r a y a n , M . G ., M iln e r, M ., B a sm ajian , J. V . (1975): P e ro n e a l n e rv e s tim u la to r in r e h a b ilita tio n o f h e m ip leg ic p a tie n ts . A r c h . P h ys. M e d . R e h a b il., 56, 237 - 240. 29. W o lf, S. L. (1976): C o m m e n ts. P hys. T h e r., 56, 8 3 0 - 831. 30. W o lp e rt, R ., W o o ld rid g e , C. P . (1975): T h e u se of e le c tro th e ra p y as b io fe e d b a c k th e ra p y in th e m a n a g e ­ m e n t o f c e re b ra l p a lsy : a review a n d case stu d y . P h y s io . Can., 27, 5 - 9 . 31. W o o ld rid g e , C. P ., L e ip e r, C ., O g sto n , D . G . (1976): B io fe e d b a c k tra in in g o f k n e e jo in t p o s itio n o f the c e re b ra l p a ls ie d child. P h y s io . C an., 28, 138 - 143. 32. W o o ld rid g e , C . P ., R ussel, G . (1976): H e a d p o s itio n tra in in g w ith th e c e re b ra l p a ls ie d c h ild : a n a p p lic a ­ tio n o f b io fe e d b a c k tec h n iq u es. A r c h . P h ys. M e d . R e h a b il., 57, 407 - 414. 33. Z im n ic k i, B., F e rn ie , G . R . (1976): B io fe e d b a c k a n d th e lo w e r e x tre m ity a m p u te e : a n e w tra in in g aid. P hysio. C an., 28, 79 - 82. THE NEED FOR CO-ORDINATED RESEARCH J. C. B E E N H A K K E R B.Sc. (P h y s io th e ra p y ) (W itw a te rs ra n d ) D .P .E . (W itw a te rsra n d )* R e s e a rc h in a ll fields o f p h y s io th e ra p y , w h ic h is lo n g o v e rd u e , c a n o n ly re s u lt in im p ro v e d p a tie n t care. W e m u s t b e s u re th a t o u r tre a tm e n t p ro g ra m m e s do h a v e th e effects th a t w e a re h o p in g to a c h ie v e , w h ic h w ill o n ly o c c u r w h e n th e s e effects a re in v e s tig a te d a n d th e re su lts o f th e fin d in g s a n aly se d . T o o lo n g h a v e m o d a litie s b e e n u s e d ‘b e c a u s e th e y w o r k ’! I f w e do n o t k n o w w h y th e y w o rk , h o w can w e b e su re th a t s o m e th in g else w ill n o t b e m o re su c c essfu l? I o f te n h a v e th e fe e lin g th a t o u r p a tie n ts im p ro v e in sp ite o f p h y sio th e ra p y ! \ E v a lu a tio n o f th e d e liv e ry o f h e a lth se rv ice s to th e p a ti e n t as w ell as th e c o m m u n ity is re q u ire d . A re w e m a k in g th e b e st u se o f a v a ila b le re s o u rc e s ? W e n e ed to in v e s tig a te th e effects o f o u r v a r io u s m o d a litie s on n o rm a l tis su e a n d e n d e a v o u r to d e te rm in e w h e th e r th e s e effects a re a lte re d b y in ju r y o r dise ase. W e w ill h a v e to d e sig n a n d c o n s tru c t m e a s u rin g d e v ic es w h ic h w ill g iv e a n o b je c tiv e m e th o d o f a sse ssin g a p a tie n t ’s re sp o n se to tre a tm e n t, a n d re s e a rc h in to th e m o s t e ffective a n d re lia b le to o l is re q u ire d . R e s e a rc h is th e n a tu r a l re s u lt o f a tte m p tin g to find a n sw e rs to q u e stio n s . E v e ry p h y s io th e r a p is t m u s t h a v e c o m e u p a g a in s t so m e p r o b le m in h e r w o rk , y e t v e ry fe w h a v e set o u t to so lv e th is o n a sc ien tific b a sis. E a c h o n e o f u s is in a p o s itio n to test a th e o ry , w h e th e r th is is in th e c lin ic a l field o r o f a m o r e a c a d e m ic n a tu r e , y e t h o w o fte n is th is d o n e ? I f re s e a rc h is b e in g d o n e , w h y do n o t m o re p h y s io ­ th e ra p is ts k n o w a b o u t it? I t w o u ld se e m t h a t th e r e is a p re ssin g n e e d f o r c o -o rd in a tio n o f re s e a rc h p ro je c ts b o th a t a n u n d e r g ra d u a te a n d a p o s tg ra d u a te level. * A c tin g H e a d , D e p a r tm e n t o f P h y s io th e r a p y , U n iv e rs ity o f W itw a te rs ra n d . P h y s io th e ra p is ts w h o a r e in v o lv e d in re s e a rc h p ro je c ts o r c lin ic a l tria ls , o r th o se w h o w o u ld lik e to b e c o m e in v o lv e d , h a v e v e ry little id e a o f w h a t is b e in g d o n e in S o u th A fric a . E v e n th e w o rth w h ile tr ia ls a n d su rv e y s w h ic h h a v e b e e n w r itte n u p , o fte n lie f o r g o tte n in c u p b o a rd s o r o n lib r a r y shelves, I n o r d e r, th e r e f o r e , to p r o m o te i n te re s t i n re s e a rc h , a g ro u p w as f o r m e d b y th e P h y s io th e r a p y D e p a r tm e n t a t th e U n iv e rs ity o f th e W itw a te rs ra n d . T h e a im s o f th is g r o u p a re to d isc u ss p ro b le m s in, a n d m e th o d s o f re s e a rc h , to c o -o rd in a te re s e a rc h efforts, to p ro v id e a p la tf o r m to d is s e m in a te k n o w le d g e a n d p ro v id e a s tim u lu s f o r f u r th e r re se a rc h . T h is g ro u p o f a c a d e m ic sta ff a n d p ra c tis in g c lin i­ c ia n s m e e ts e v e ry tw o m o n th s . T o p ic s d isc u sse d h a v e c o v e re d a w id e field, in c lu d in g p ro b le m s e n c o u n te re d b y v a rio u s w o rk e rs a n d h o w th e s e w e re re so lv e d , the a v a ila b ility o f re s e a rc h f a c ilitie s , o rg a n is a tio n o f m a te ria l a n d th e m e th o d o f w r itin g u p a d is s e rta tio n . A ta p e o n “ R e s e a rc h in S p in a l T h e r a p y ” stre sse d th e im p o r ta n c e o f th e in v o lv e m e n t o f th e c lin ic ia n in th e d e sig n o f th e e x p e rim e n t a n d th e stu d y o f its c lin ic a l 6 ff£ C t lV 6 I 1 6 S S W o rk s h o p s a re p la n n e d f o r 1979 a n d sp e a k e rs w ill b e in v ite d to le a d d isc u ssio n s in sp e c ia lis e d a re a s. T h e re s u lts o f tria ls a n d e x p e rim e n ts u n d e r ta k e n b y u n d e r ­ g ra d u a te s tu d e n ts w ill b e c o rre la te d in o r d e r to e s ta ­ b lis h a r e a s f o r f u r t h e r re se a rc h . I t is fe lt t h a t a g ro u p , su c h as th is , c o u ld offer a c o -o rd in a tin g se rv ic e f o r re se a rc h . A lth o u g h th e g ro u p is c o n fin e d to th e J o h a n n e s b u rg a re a , its a c tiv itie s c o u ld b e e x p a n d e d to a n a tio n a l level, if th e re w a s a sufficient n e ed . # . . . . I f a n y p h y s io th e r a p is t is in te re s te d in jo in in g th is g ro u p , th e y sh o u ld c o n ta c t th e w r ite r a t th e P h y s io ­ th e r a p y D e p a r tm e n t o f th e U n iv e rs ity o f th e W it­ w a te rs ra n d . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )