Journal of Neurology & Stroke EMG - Supported Biofeedback Training in a Person with Multiple Sclerosis - A Case Study Submit Manuscript | http://medcraveonline.com Introduction 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 non- pharmacological 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 bio- and 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 EMG- supported 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 1 Hochschule Fresenius, Faculty of Health & Social Sciences, Germany 2 Carl Remigius Medical School, Germany 3 University Duisburg-Essen, General Psychology: Cognition, Germany *Corresponding author: Stephanie Kersten, Hochschule Fresenius, Faculty of Health & Social Sciences, Germany, Limburgerstr. 2, 65510 Idstein, Germany, Tel: +49 (0)6126 - 9532 - 932; Email: Received: November 29, 2017 | Published: December 21, 2017 Clinical Paper J Neurol Stroke 2017, 7(7): 00268 Abstract Background: Until now, the etiology of Multiple Sclerosis (MS) has not been clarified. The symptoms vary from person to person and can affect motor, sensory, and cognitive body functions. Objectives: Next to pharmacological treatments, non-pharmacological therapy approaches become more and more important for maintaining physical, sensory, psychological and social functions in people with MS (pwMS). Furthermore, Biofeedback (BF) seems to be an interesting treatment option in order to improve motor functions such as postural stability, walking safety and walking speed in pwMS. Methods: In the present case study, an Electromyography-Biofeedback (EMG-BF) has been examined over 6 weeks in a 74-year old female with MS. Functional Gait Assessment (FGA) and 10-Meter-Walking- Test (10MWT) has been tested pre (t0), after three weeks, (t1) and after six weeks (t2) of treatment (2x/week). Results: The results showed an increase in walking speed after 3 and 6 weeks in 10MWT and a decrease of postural stability after 3 weeks. In contrast, postural stability increased after 6 weeks. The participant tolerated the EMG-BF training very well and she felt more secure in everyday life in relating to a better perception of her feet in the moment of foot contact while walking. Conclusions: EMG-BF training has been examined especially in order to improve the control of pelvic floor muscles in pwMS. Additionally, pwMS might benefit from BF training in regard to improve gait and postural control. More research is necessary to examine BF therapy options in order to support pwMS in their current motor impairments.