1266 - Enjoyment of Gamified Electromyographic Biofeedback Therapy for People With Tetraplegia From An Incomplete Traumatic Spinal Cord Injury: A Pilot Study

Objectives: Individuals with tetraplegia due to SCI prioritize therapies to enhance arm function and improve independence, but practical limitations hinder the translation of necessary high-repetition exercises demonstrated in animal studies to maximize the effects in patient populations. We developed two EMG biofeedback games with the goal of producing enjoyable therapies. Our pilot study aimed to assess the feasibility and value of these high-repetition games in patients with tetraplegia from an SCI.

Design: Adult inpatient and outpatient participants with acute or chronic traumatic SCI, exhibiting arm weakness with EMG detectable volitional muscle movement, were included. Exclusions encompassed implantable electronic devices, severe spasticity, and cognitive impairments. Bluetooth-enabled surface EMG sensors enabled gameplay on a smart tablet. Sessions targeted two to four weak muscles for approximately 10 minutes each. We recorded muscle repetitions and assessed enjoyment using the Physical Activity Enjoyment Scale (PACES).

Results: Between July 2022 and June 2023, we enrolled 18 participants, primarily middle-aged (average age: 48.5), male (94.7%), and Caucasian (47.4%). The most common injury level was C6 (37.5%), ASIA D (37.5%), and injury mechanisms were predominantly motor vehicle collisions (36.8%) and falls (31.6%). Participants tolerated the protocol, reported enjoying the games, and found the study beneficial. All achieved over 100 repetitions per session, with some exceeding 1000 over a 40-minute session. Over 90% of individuals scored above 63 on the PACES, and no serious adverse events occurred.

Conclusions: Gamified EMG biofeedback was well-received by our incomplete traumatic SCI patients, demonstrating the potential for its use as a more engaging form of rehabilitation compared to traditional methods. This innovative approach allows patients to participate in very high-dosage therapy sessions, which should theoretically maximize functional gains. Ongoing research will investigate its impact on arm function and suitability for home-based use.