July 2023, Volume 17, Number 3
Research Article
The Evaluation of Electromyography Biofeedback on
Proprioception and Balance in Healthy Young Athletes
Aliyeh Daryabor1
, Javad Naghizad2
, Aliasghar Jamehbozorgi2*
, Khosro Khademi Kalantari3
, Mehdi Rezaei3
1. Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2. Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3. Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran. Iran.
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Citation: Daryabor A, Naghizad J, Jamehbozorgi A, Khademi Kalantari K, Rezaei M. The Evaluation of Electromyography
Biofeedback on Proprioception and Balance in Healthy Young Athletes. Journal of Modern Rehabilitation. 2023; 17(3):334-342.
:
https://doi.org/10.18502/jmr.v17i3.13074
Article info:
Received: 10 Sep 2022
ABSTRACT
Accepted: 20 Nov 2022
Available Online: 01 Jul 2023
Introduction: We evaluated the effect of electromyography biofeedback on proprioception
and functional balance in healthy young athletes.
Materials and Methods: In this clinical trial, 24 athletes were randomly divided into two
study (n=12) and control (n=12) groups. The study group received rehabilitation exercises,
including one-foot standing, squatted standing, and isometric contraction of quadriceps
muscle at different knee angles, including 30, 45, and 90 degrees of knee flexion along with
electromyography biofeedback. The control group received only rehabilitation exercises
without electromyography biofeedback. Exercises were performed by both groups for a
4-week period in three sessions per week. Functional balance and proprioception before and
after exercises were measured using the star excursion balance test and a system consisting of
digital photography non-reflective markers, respectively. The data of the center of pressure and
time of vertical ground reaction force using a force plate was also collected to evaluate static
balance and dynamic balance, respectively.
Keywords:
Results: The absolute error in knee joint reconstruction for 30° (P=0.005), 45° (P=0.001),
and 90° (P=0.033) angles significantly decreased after the intervention in the study group
compared to the control group. Star excursion balance test scores in all directions did not show
any significant differences between the two groups (P>0.05), except for the anterior-lateral
direction (P=0.03). Moreover, all variables related to static and dynamic balance did not show
a significant difference between two the groups after the interventions (P>0.05).
Balance; Electromyography
biofeedback; Proprioception;
Athletes; Rehabilitation
Conclusion: The electromyography biofeedback intervention can probably be used as a
rehabilitation protocol in recovering and healing proprioception injuries resulting from
sports injuries.
* Corresponding Author:
Aliasghar Jamehbozorgi, PhD.
Address: Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tel: +98 (912) 2081106
E-mail: ass.bozorgi@yahoo.com
Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license(https://creativecommons.org/licenses/by-nc/4.0/).
Noncommercial uses of the work are permitted, provided the original work is properly cited.
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July 2023, Volume 17, Number 3
1. Introduction
alance is defined as the integration of
sensory information with respect to the
body’s position in relation to the environment as well as the ability to provide appropriate muscle responses to maintain
postural adaptation so that the body’s center of gravity is
maintained on the base of support. Balance is one of the
indicators of functional and fundamental independence
for daily activities to enable activities from maintaining
static condition to complex dynamic movements. The
posture control system adjusts the body position in space
for the purpose of positioning and balance [1]. To initiate
a movement or maintain the body’s posture and balance
control, different systems, such as the musculoskeletal
or neuromuscular system should be coordinated. The
nervous system consists of visual, vestibular, and proprioception parts, which provide information about the
body’s position in space [2].
B
Proprioception is defined as a person’s ability to feel
or perceive the position and movement of body parts,
strength, and timing of muscle contraction. Many
proprioception receptors transmit useful information
through the neuromuscular pathways to control centers
of the central nervous system [3, 4]. Proprioception plays
an active role in optimizing exercise skills and preventing injuries [5]. The information provided by the sensors
of proprioception can contribute to delicate and precise
movements [6]. Proprioception also plays a prominent
role in individuals’ balance. Therefore, the effect of proprioception, in the absence of other balance systems, has
been examined in different age groups, which depended
on proprioception to maintain balance [7, 8]. It has been
suggested that weakness and disturbance in proprioception can significantly increase the risk of injury in athletes [9] and others [10]. Some interventions, including
exercises currently used for balance problems, could
improve an individual’s physical capability [11, 12]. Exercises usually consist of group exercise programs [13],
home-based sports programs [14], and recently biofeedback types [15, 16].
Biofeedback is considered a technique utilized to facilitate normal movement patterns after injuries [17]. This
can refer to external or completed feedback; thus it provides additional information to the user. This information is available to people online and harmonized with
internal sensory feedback, which helps an individual to
use different sensory receptors for obtaining information [18]. Research has suggested that using therapeutic
biofeedback is feasible and effective in improving func-
tional balance and postural control [19, 20]. Given the
importance of balance as a critical factor in individuals’
improvement in rehabilitation after injury, numerous
techniques have been employed to improve individuals’
balance. However, it is necessary to find newer and more
effective techniques. Therefore, as most studies have neglected the impact of biofeedback on proprioception,
which is one of the important aspects of balance control,
this study attempted to consider this issue. Moreover, the
impact of biofeedback has been investigated mostly in
people with musculoskeletal injuries [21, 22]. We aimed
to evaluate the effect of using biofeedback on proprioception and balance performance in healthy young athletes so that in the case of positive results, it can be used
by the relevant experts.
2. Materials and Methods
Participants
In this clinical trial, 24 healthy athletes (men: 12, women: 8) aged 18-30 years participated. Regarding the 95%
confidence level and 80% power and considering the
Mean±SD of the star excursion balance test (SEBT) for
the anterior-lateral direction in a previous study [23],
the number of subjects was calculated as 11 per group
(Equation 1):
1. n=
(Zα+Zβ)2(δ21+δ22)
(μ1-μ2)
2
=
(1.96+1.28)2(4.8+5.86)2
=11
(88.86-85.80)2
Inclusion criteria were as follows: 1) regular activity
in the gym and being a member of the student Sports
Olympiads in sports focused on the lower limbs, such as
football, volleyball, and basketball, 2) the lack of cognitive, visual, and hearing impairments (using glasses and
hearing aid was permitted), 3) the lack of any systemic
or neuromuscular diseases (such as diabetes and rheumatism), 4) the lack of limb length discrepancy (more
than one centimeter), and 5) the absence of neurological diseases or uncontrolled seizures. Exclusion criteria
were as follows: 1) undergoing surgery, 2) being absent
for more than three sessions in the training, 3) existence
of musculoskeletal injury during the study, and 4) using
drug or alcoholism and any disorder that disturb balance
(vestibular disorders, stroke, etc.). At the beginning of the
study, the aim and process of the study were explained
to all individuals and they filled out the informed written
consent. Then, individuals were randomly divided into
the two study (n=12) and control (n=12) groups. Also,
the participants were blind to the assignment of groups.
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
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July 2023, Volume 17, Number 3
Outcome measures
Outcome measures were the knee reconstruction error
for 30, 45, and 90 degrees, the displacement and velocity of the center of pressure using force plate data,
and functional balance using SEBT in eight different
directions, including anterior, anterior-lateral, lateral,
posterior-lateral, lateral, posterior-medial, medial, and
posterior-medial.
Proprioception
In both groups, the knee angle reconstruction method
in the standing posture was used to evaluate joint proprioception. A system consisting of skin marking and
digital photography was utilized to measure the target
angle and reconstruction angles. For marking, individuals wore sport short. Each person was placed on a treatment bed in a supine and relaxed position, while three
passive colored and circle-shaped markers with a diameter of 2 cm were attached to the lateral part of the individuals’ lower extremity as follows: The first marker
was located at the upper 1/4 of the line between the large
trochanter and the middle part of the lateral articular
line of the knee, and the second marker was attached to
the upper part of the lateral malleolus. The person was
then seated on the bed edge with the flexion position of
knees at about 90 °, and the third marker was attached
to the upper section of the popliteal line along with the
upper edge of the patella. A Samsung model ES95 camera, with a resolution of 20 megapixels, was positioned
on a tripod and perpendicular to the knee joint motion
plane at 185 cm from the individual and 65 cm from the
ground so that the lens was fully aligned with the knee
joint. Then, when the person was in the standing position (full extension of the knee joint (0°)), he/she was
asked to touch his/her non-dominant leg with the ground
(a ball-hit test was used to determine the dominant leg)
so that the person could easily maintain his/her balance.
The person was also asked to keep his/her head straight
(to avoid stimulation of the vestibular system) and not
to lean the trunk back. Then, while the individual’s eyes
were closed, he/she was asked to flex the knee joint.
When the knee reached 30, 45, and 90 degrees of flexion, the patient was asked to hold his/her knee at those
angles for 5 seconds while remembering those positions. After 10 seconds of rest, the person was asked to
reconstruct the angle and announce it. For further measurement accuracy, the angular reconstruction test was
repeated three times, and a rest time of ten seconds was
considered between each repetition. By an announcement from the participant, the examiner photographed
the restored status, and the data were extracted using a
336
system consisting of digital photography, non-reflective
markers, and Digitizer software, version 5.3.4. The difference between the test and reconstruction angles considered as the absolute error was recorded.
Static and dynamic balance
For the evaluation of static and dynamic balance, a
force plate (Bertec Corporation, Columbus, USA) with
dimensions of 60×40 cm was used to collect the data
of the center of pressure and ground reaction force. For
static balance, participants were assessed on the force
plate in four conditions: double-leg standing with eyes
open, double-leg standing with eyes closed, single-leg
standing with eyes open, and single-leg standing with
eyes closed. The order of these conditions was chosen
randomly for each subject. To evaluate this type of balance, the displacement and velocity of the center of
pressure in the anterior-posterior and medial-lateral directions were measured.
To evaluate the dynamic balance, first individuals were
asked to jump the maximum distance on the ground with
both feet and the examiner measured this distance. Then,
half of this distance was determined, from which individuals jumped on the force plate with both feet. Thus,
for the dynamic balance, the time to reach the maximum
of the peak vertical ground reaction force was measured.
The shorter the time to reach the maximum value, the
better the balance.
Functional balance
For evaluation of the functional balance, we used the
star excursion balance test (SEBT) with reliable and
valid outcomes [24], in which the individual should
maintain his/her balance on one leg (dominant) without
disrupting the base of support while achieving maximum functional reach in eight directions with another
leg (Figure 1).
Procedure
All tests were conducted by another trained examiner
(someone other than the researcher). The study group
received the rehabilitation exercises, including one-foot
standing, squatted standing, and isometric contraction
of the quadriceps muscle along with the electromyography biofeedback. The control group received only the
rehabilitation exercises without electromyography biofeedback. Both groups were subjected to interventions
for a 4-week period and three half-hour sessions per
week. Electromyography biofeedback means measur-
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
July 2023, Volume 17, Number 3
Figure 1. Star excursion balance test
ing electrical signals associated with muscle activity and
displaying these signals for individuals to control muscle
activity. The signals were presented as visual feedback.
In this study, a 5-channel ProComp5 biofeedback device made by Canada’s ThoughtTechnology Company,
model SA7525 with serial number CB1825, as well as
BioGraph Infiniti Software and EMG MyoScan-Pro™
sensors -T9401M-60 were utilized. The electrodes used
were the silver chloride T3402M-Triode electrode with
a standard distance of 20 mm. To reduce the impedance,
individuals’ skin was cleaned with cotton and medical
alcohol after thorough shaving of hair. The electrode
was obliquely mounted on the vastus medialis obliques
(VMO) muscles at a 20 mm distance from each other,
at an angle of 55 degrees above the muscle bulk and 4
cm above the patella edge with a distance of 3 cm from
the inner part of the upper patella edge. The reference
electrode was also placed on the tibia prominence. At
first, the maximum isometric contraction was recorded
in the knee extension position in a way that the individual performed the contraction four times, each lasting
four seconds, and then ten seconds of rest. In the end,
the mean of the contraction was calculated by the software. During the intervention, 20% of the mean of these
contractions was deducted to prevent muscle fatigue,
which was considered as the threshold point. Individuals
received feedback only when the immediate contraction
of muscle was more than the threshold value. The exercises were performed in three positions, including squat
(Figure 2 A), one-leg extension (Figure 2 B), and knee
extension (Figure 2 C) each for 10 minutes.
Statistical analysis
The data were analyzed using SPSS software, version
22. In this study, the independent t-test was used for the
data with normal distribution and the Mann-Whitney U
test for their non-normal data to compare the absolute
error of angle reconstruction and balance function between the study and control groups. P<0.05 was considered significant.
3. Results
During the study period, all 24 participants were evaluated and followed up with regular and continuous attendance at intervention sessions. Demographic data of
the individuals, including age, sex, height, and weight
are shown in Table 1. All outcomes are presented as the
average of three repetitions for each condition. Data distribution was not normal for some variables, including
absolute error at 30, 45, and 90 degrees; therefore, the
Mann-Whitney U test was utilized to compare the two
groups. There was no statistically significant difference
between the two groups in terms of demographic data.
Moreover, no significant difference was observed between the two groups before the interventions for knee
reconstruction error and SEBT scores (Table 2).
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
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July 2023, Volume 17, Number 3
Table 1. Mean±SD of individuals’ demographic characteristics
Mean±SD
Group (n=12)
Age (y)
Height (cm)
Weight (kg)
BMI (kg/m2)
Study
22.91±2.57
173.75±8.67
65.83±4.54
21.74±2.41
Control
20.91±1.88
173.58±5.63
66.50±6.03
22.02±0.92
BMI: Body mass index.
Table 2. Mean±SD, and P for knee reconstruction error
Mean±SD
Variables
(Angle)
P Between Two Groups
Study (n=12)
Control (n=12)
Before
Intervention
After
Intervention
Before
Intervention
After
Intervention
Before
Intervention
After
Intervention
30 degreesa
10.79±6.61
2.36±0.93
4.95±2.18
6.78±4.79
0.170
0.005*
45 degreesa
11.87±8.17
2.17±0.91
8.13±5.94
6.01±3.52
0.213
0.001*
90 degreesa
7.68±2.89
2.29±0.82
11.40±6.76
5.08±3.88
0.143
0.033*
P<0.05, aNon-parametric data analyzed by Mann-Whitney U test.
*
Table 2 shows that the absolute error rate in knee joint
reconstruction at 30° (P=0.005), 45° (P=0.001), and 90°
(P=0.033) angles significantly decreased after the interventions in the study group compared to the control
group. Table 3 shows that SEBT scores in all directions
did not show any significant differences between the two
groups after the interventions (P>0.05), except for the
anterior-lateral direction (P=0.03), in which there was a
significant increase in the study group compared to the
control group. Finally, Table 4 indicates that all variables of static balance, including the center of pressure
displacement and velocity in four different conditions of
the test as well as the variable of dynamic balance did not
Table 3. Mean±SD and P for balance performance
Mean±SD
P Between Two Groups
Variables
Study Group (n=12)
Control Group (n=12)
Before
Intervention
After
Intervention
Before
Intervention
After
Intervention
Before
Intervention
After
Intervention
Anterior (cm)
101.33±4.96
111.19±6.43
110.67±7.29
107.78±5.99
0.478
0.713
Anteriorlateral (cm)
103.58±6.43
113.72±7.31
93.90±6.96
92.55±6.62
0.198
0.033*
Lateral (cm)
99.35±6.16
110.87±7.24
103.52±6.30
98.11±5.29
0.347
0.319
Posteriorlateral (cm)
93.56±4.29
104.33±5.42
102.56±7.15
96.89±4.98
0.242
0551
Posterior (cm)
93.35±3.84
96.56±4.75
102.28±7.97
97.52±6.00
0.478
0.977
Posteriormedial (cm)
89.61±4.35
91.91±4.07
104.35±9.84
98.34±7.07
0551
0.478
Medial (cm)
76.00±3.93
81.50±4.93
95.15±11.13
94.36±8.86
0.347
0.443
Posteriormedial (cm)
63.66±4.02
66.23±5.50
88.52±13.57
85.10±11.78
0.378
0.219
*
P<0.05
338
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
July 2023, Volume 17, Number 3
Table 4. Mean±SD, and P for static and dynamic balance, before and after intervention
Mean±SD
P Between Two Groups
Test
Balance
Conditions
Double-leg
standing
with eyes
open
Double-leg
standing
with eyes
closed
Static balance
Single-leg
standing
with eyes
open
Single-leg
standing
with eyes
closed
Dynamic
balance
Jumping
Variables
Study (n=12)
Control (n=12)
Before
After
Before
After
Before
After
Anterior/posterior
displacement of
CoP (cm)
6.24±2.25
5.86±2.14
5.20±1.25
5.54±1.68
0.221
0.690
Medial/lateral
displacement of
CoP (cm)a
3.27±1.2
4.61±3.54
3.34±1.59
3.27±1.27
0.843
0.410
Anterior/posterior velocity of CoP 30.67±12.42
(m/s)
29.79±1.30
41.71±16.25
36.27±17.71
0.76
0.348
Medial/lateral velocity of CoP (m/s)
13.87±6.78
14.27±5.02
14.17±1.43
11.47±3.47
0.977
0.128
Anterior/posterior
displacement of
CoP(cm)
6.57±2.53
6.69±1.92
55.44±1.66
5.80±2.34
0.319
0.324
Medial/lateral
displacement of
CoP(cm)a
3.61±1.49
4.28±1.57
4.07±2.09
3.72±1.87
0.478
0.242
Anterior/posterior velocity of CoP 30.85±10.77
(m/s)
13.92±6.87
33.81±19.26
32.71±1.87
0.843
0.837
Medial/lateral ve33.80±10.90
locity of CoP (m/s)a
14.12±7.84
13.30±5.39
14.90±4.84
1.000
0.410
Anterior/posterior
displacement of
CoP(cm)
8.63±1.69
8.23±1.90
8.2±1.59
8.03±1.41
0.373
0.777
Medial/lateral
displacement of
CoP(cm)
8.97±1.71
8.10±1.71
8.63±1.65
8.62±2.09
0.635
0.381
Anterior/posterior velocity of CoP
(m/s)a
38.63±8.37
38.28±12.18
45.95±10.96
36.49±8.69
0.079
0.932
Medial/lateral ve74.08±21.67
locity of CoP (m/s s)
70.72±20.34
72.54±20.10
69.16±24.76
0.859
0.868
Anterior/posterior
displacement of
CoP( cm)a
14.45±6.33
15.56±5.82
17.96±9.94
16.83±11.83
0.590
0.799
Medial/lateral
displacement of
CoP (cm)a
20.45±16.47
13.22±3.37
20.37±16.98
13.68±6.72
0.977
0.713
Anterior/posterior velocity of CoP 99.92±81.46 103.15±97.58 139.75±129.60 112.96±92.71
(m/s)a
0.347
0.977
Medial/lateral ve101.00±25.58 104.10±26.65 109.23±35.62
locity of CoP (m/s)
99.36±31.95
0.523
0.697
1.61±0.61
0.819
0.939
Time of vertical
ground reaction
force (s)
1.75±0.48
1.59±0.53
1.81±0.79
a
Non-parametric data analyzed by Mann-Whitney test, Cop: Center of pressure.
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
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July 2023, Volume 17, Number 3
Figure 2. Performing balance exercises including A) Squats, B) One-leg extension, C) knee extension
show any significant differences between the two groups
after the interventions (P>0.05).
proprioception in sports activities may reduce the risk of
injuries, such as ankle sprain [27].
4. Discussion
Concerning the functional balance, there was no significant difference between the two groups in all directions of SEBT, except for the anterior-lateral direction.
Moreover, no significant difference was found on all
force plate data as a static and dynamic balance between
the two groups. The present study showed the use of sensory feedback, such as visual sense and its integration
with muscle activity can increase proprioception, which
is also directly related to balance. Considering that the
proprioception exercises of the intervention group were
performed at 30, 45, and 90 angles and due to the effect
of biofeedback on the motor learning pattern [28, 29], it
can be justified that the improvement of proprioception
could occur following the training. It seems that because
the exercises performed were not specifically balance
exercises, it could not create a significant difference in
the balance outcomes between the two groups. Dadfar’s
study also indicated that six weeks of corrective-plyometric exercises without visual feedback could effectively improve dynamic balance in adolescent athletes
with dynamic knee valgus [30]. We assume that more
treatment sessions using biofeedback while exercising may detect enough change between interventions,
as strengthening the muscles around the knee plays an
effective role in improving balance [31]. However, this
possibility should be studied further.
In the present study, we investigated the effect of
electromyography biofeedback on the accuracy of proprioception and functional balance in healthy athletes.
Regarding proprioception, this study showed that the absolute error rate in knee joint reconstruction after the intervention decreased at 30, 45, and 90° angles in the group
with the visual feedback compared to the control group
without the visual feedback. Thus, the present study confirmed that visual feedback could increase proprioception. Visual feedback helps to learn precise movements
by correcting observed errors during exercise. This is
in agreement with previous studies that applying visual
feedback training could improve proprioception in patients after stroke [21] and total knee arthroplasty [22].
Therefore, these results point to balance improvement
through visual information obtained through visual feedback and can be used as a sensory replacement to compensate for the affected proprioception. In other studies
by In et al. [25] and Pellegrino et al. [26], it has been suggested that if postural training is accompanied by visual
feedback, it can improve a person’s ability to maintain a
relaxed standing balance on unstable surfaces. However,
positive results can be found during training to justify
that the integration of technology-based protocols with
the current approach of rehabilitation education may result in improved performance. In the present study, we
focused on the biofeedback modality in healthy young
athletes associated with the improvement of proprioception in these populations. Therefore, as the risk of injuries is high in athletes using their lower limbs, increasing
340
5. Conclusion
Based on the findings, no changes were found in most
results of the balance function of SEBT scores between
the two groups, which could be due to appropriate pos-
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
July 2023, Volume 17, Number 3
tural control in healthy neuromuscular and musculoskeletal structures of the participants. The findings showed
that absolute error in knee reconstruction significantly
decreased after the intervention in the study group compared to the control group, which can result from the
enhanced sensory information with electromyography
biofeedback; thereby increasing the accuracy of proprioception was increased.
[2] Grace Gaerlan M, Alpert PT, Cross C, Louis M, Kowalski
One of the limitations of this study was short-term
follow-up. Studying individuals with balance disorders,
examining the muscle strength of the participants, and
recording the electrical activity of the vastus medialis
muscle are recommended.
[4] Cameron ML, Adams RD, Maher CG. The effect of neoprene
Ethical Considerations
Compliance with ethical guidelines
This research was approved by the Research and Ethics
Committee of Shahid Beheshti University of Medical Sciences (Code: IR.SBMU.RETECH.REC.1397.206306).
S. Postural balance in young adults: The role of visual, vestibular and somatosensory systems. Journal of the American Academy of Nurse Practitioners. 2012; 24(6):375-81.
[DOI:10.1111/j.1745-7599.2012.00699.x] [PMID]
[3] Hughes T, Rochester P. The effects of proprioceptive exercise and taping on proprioception in subjects with functional
ankle instability: A review of the literature. Physical Therapy
in Sport. 2008; 9(3):136-47. [DOI:10.1016/j.ptsp.2008.06.003]
[PMID]
shorts on leg proprioception in Australian football players.
Journal of Science and Medicine in Sport. 2008; 11(3):345-52.
[DOI:10.1016/j.jsams.2007.03.007] [PMID]
[5] Lephart SM, Pincivero DM, Giraido JL, Fu FH. The role of
proprioception in the management and rehabilitation of athletic injuries. The American Journal of Sports Medicine. 1997;
25(1):130-7. [DOI:10.1177/036354659702500126] [PMID]
[6] Bark K, Wheeler JW, Premakumar S, Cutkosky MR. Comparison of skin stretch and vibrotactile stimulation for feedback of proprioceptive information. Paper presented at: 2008
Symposium on Haptic Interfaces for Virtual Environment
and Teleoperator Systems. 13-14 March 2008; Reno, NV, USA.
[DOI:10.1109/HAPTICS.2008.4479916]
[7] Vaugoyeau M, Viel S, Amblard B, Azulay JP, Assaiante C.
Funding
This research did not receive any grant from funding
agencies in the public, commercial, or non-profit sectors.
Proprioceptive contribution of postural control as assessed
from very slow oscillations of the support in healthy humans.
Gait & Posture. 2008; 27(2):294-302. [DOI:10.1016/j.gaitpost.2007.04.003] [PMID]
[8] Ergen E, Ulkar B. Proprioception and ankle injuries in
soccer. Clinics in Sports Medicine. 2008; 27(1):195-217.
[DOI:10.1016/j.csm.2007.10.002] [PMID]
Authors' contributions
Conceptualization: Aliasghar Jamehbozorgi; Methodology: Javad Naghizad, Aliyeh Daryabor; Writing the
original draft: Khosro Khademi Kalantari; Writing, review, and editing: Aliyeh Daryabor and Mehdi Rezaei.
[9] Kalirtahinam D, Ismail MS, Singh TSP, Saha S, Hashim HA.
Does neuromuscular exercise training improve proprioception in ankle lateral ligament injury among athletes? Systematic review and meta-analysis. Scientia Medica. 2017; 27(1):3.
[DOI:10.15448/1980-6108.2017.1.25082]
[10] Huang H, Zhao J. Effect of sensory reeducation on func-
Conflict of interest
tional rehabilitation of stroke patients with proprioception
disturbance. Chinese Journal of Physical Medicine and Reha-
The authors declared no conflict of interest.
bilitation. 2008; 30(11):764-7. [Link]
[11] Latham NK, Anderson CS, Bennett DA, Stretton C. Pro-
Acknowledgments
We would like to thank all the individuals who helped
us in this research and also the Shahid Beheshti University of Medical Sciences for its full-pledged support.
gressive resistance strength training for physical disability
in older people. Cochrane Database of Systematic Reviews.
2003. [DOI:10.1002/14651858.CD002759]
[12] Chang NJ, Tsai IH, Lee CL, Liang CH. Effect of a six-week
core conditioning as a warm-up exercise in physical education classes on physical fitness, movement capability, and
balance in school-aged children. International Journal of Environmental Research and Public Health. 2020; 17(15):5517.
[DOI:10.3390/ijerph17155517] [PMID] [PMCID]
[13] Barnett A, Smith B, Lord SR, Williams M, Baumand A.
References
[1] Lacour M, Bernard-Demanze L, Dumitrescu M. Posture
control, aging, and attention resources: Models and posture-analysis methods. Neurophysiologie Clinique/Clinical
Neurophysiology. 2008; 38(6):411-21. [DOI:10.1016/j.neucli.2008.09.005] [PMID]
Community‐based group exercise improves balance and reduces falls in at‐risk older people: A randomised controlled
trial. Age and Ageing. 2003; 32(4):407-14. [DOI:10.1093/ageing/32.4.407] [PMID]
Daryabor A, et al. Biofeedback Effect on Proprioception and Balance. JMR. 2023; 17(3):334-342
341
July 2023, Volume 17, Number 3
[14] Darekar A, McFadyen BJ, Lamontagne A, Fung J. Efficacy
[27] Fu AS, Hui-Chan CW. Ankle joint proprioception and pos-
of virtual reality-based intervention on balance and mobility
disorders post-stroke: A scoping review. Journal of Neuroengineering and Rehabilitation. 2015; 12:46. [DOI:10.1186/
s12984-015-0035-3] [PMID] [PMCID]
tural control in basketball players with bilateral ankle sprains.
The American Journal of Sports Medicine. 2005; 33(8):1174-82.
[DOI:10.1177/0363546504271976] [PMID]
[15] Afzal MR, Oh MK, Choi HY, Yoon J. A novel balance training system using multimodal biofeedback. Biomedical Engineering Online. 2016; 15:42. [DOI:10.1186/s12938-016-0160-7]
[PMID] [PMCID]
[28] Hasegawa N, Asaka T. Motor learning on postural control
using auditory biofeedback training. Impact. 2021; 2021(8):557. [DOI:10.21820/23987073.2021.8.55]
[29] Jonsdottir J, Cattaneo D, Regola A, Crippa A, Recalcati M,
biofeedback on balance in elderly population: A systematic review. Clinical Interventions in Aging. 2017; 12:487-97.
[DOI:10.2147/CIA.S127023] [PMID] [PMCID]
Rabuffetti M, et al. Concepts of motor learning applied to a
rehabilitation protocol using biofeedback to improve gait in
a chronic stroke patient: An A-B system study with multiple
gait analyses. Neurorehabilitation and Neural Repair. 2007;
21(2):190-4. [DOI:10.1177/1545968306290823] [PMID]
[17] Tate JJ, Milner CE. Real-time kinematic, temporospatial,
[30] Dadfar M, Sheikhhoseini R, Eslami R, Farivar N. The ef-
and kinetic biofeedback during gait retraining in patients:
A systematic review. Physical Therapy. 2010; 90(8):1123-34.
[DOI:10.2522/ptj.20080281] [PMID]
fects of corrective exercise with and without visual feedback
on lower extremity biomechanics and dynamic balance
in adolescent female athletes with dynamic knee valgus:
A pilot study. Modern Rehabilitation. 2022; 16(1):31-44.
[DOI:10.18502/jmr.v16i1.8560]
[16] Alhasan H, Hood V, Mainwaring F. The effect of visual
[18] Onate JA, Guskiewicz KM, Sullivan RJ. Augmented feedback reduces jump landing forces. Journal of Orthopaedic
& Sports Physical Therapy. 2001; 31(9):511-7. [DOI:10.2519/
jospt.2001.31.9.511] [PMID]
[19] Mirelman A, Herman T, Nicolai S, Zijlstra A, Zijlstra W,
[31] Ambegaonkar JP, Mettinger LM, Caswell SV, Burtt A, Cortes N. Relationships between core endurance, hip strength,
and balance in collegiate female athletes. International Journal of Sports Physical Therapy. 2014; 9(5):604-16. [PMID]
Becker C, et al. Audio-biofeedback training for posture
and balance in patients with Parkinson’s disease. Journal of Neuroengineering and Rehabilitation. 2011; 8:35.
[DOI:10.1186/1743-0003-8-35] [PMID] [PMCID]
[20] Barcala L, Grecco LAC, Colella F, Lucareli PRG, Salgado
ASI, Oliveira CS. Visual biofeedback balance training using
wii fit after stroke: A randomized controlled trial. Journal of
Physical Therapy Science. 2013; 25(8):1027-32. [DOI:10.1589/
jpts.25.1027] [PMID] [PMCID]
[21] Jeon SN, Choi JH. The effect of ankle strategy exercise
and visual feedback training on proprioception and balance ability in stroke patients. Research Journal of Pharmacy
and Technology. 2019; 12(9):4283-6. [DOI:10.5958/0974360X.2019.00736.4]
[22] Oh HT, Hwangbo G. The effects of proprioception exercise
with and without visual feedback on the pain and balance
in patients after total knee arthroplasty. Journal of Physical
Therapy Science. 2018; 30(1):124-6. [DOI:10.1589/jpts.30.124]
[PMID] [PMCID]
[23] Hamdolah H, Farhadi H, Bashiri M. [Effect of six week
strength and plyometric training on dynamic balance of male
athletic student (Persian)]. Journal of Research in Rehabilitation Sciences. 2011; 7(2):215-24. [Link]
[24] Gribble PA, Hertel J, Plisky P. Using the Star Excursion
Balance Test to assess dynamic postural-control deficits and
outcomes in lower extremity injury: A literature and systematic review. Journal of Athletic Training. 2012; 47(3):339-57.
[DOI:10.4085/1062-6050-47.3.08] [PMID] [PMCID]
[25] In TS, Cha YR, Jung JH, Jung KS. Effects of visual feedback
with a mirror on balance ability in patients with stroke. Journal
of Physical Therapy Science. 2016; 28(1):181-5. [DOI:10.1589/
jpts.28.181] [PMID] [PMCID]
[26] Pellegrino L, Giannoni P, Marinelli L, Casadio M. Effects
of continuous visual feedback during sitting balance training in chronic stroke survivors. Journal of Neuroengineering
and Rehabilitation. 2017; 14(1):107. [DOI:10.1186/s12984-0170316-0] [PMID] [PMCID]
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