A Game-Based Biofeedback System for Enhancing Masticatory Function in Patients with Stroke: A Case Study

Document Type : Original Articles

Authors
Marzieh Allami-Sanjani 1
Ehsan Tahami 2
Gelareh Veisi 3
Payam Sasannezhad 4
1 PhD Candidate, Department of Biomedical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
2 Assistant Professor, Department of Biomedical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
3 Assistant Professor, Department of Computer Engineering, Islamic Azad University, Mashhad Branch, Mashhad, Iran
4 Associate Professor, Department of Neurology, School of Medicine AND Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran
10.48305/jrrs.2024.42462.1085
Abstract
Introduction: Orofacial functional impairment is a common complication among stroke survivors, often leading to reduced masticatory function and strength, which ultimately results in gastrointestinal (GI) issues. On the other hand, game-based interventions serve as valuable therapeutic tools by integrating principles of motor learning and neuroplasticity into post-stroke rehabilitation of muscle function. The primary objective of this study was to develop a game-based biofeedback system for patients with stroke that utilizes muscle synergy information from the masticatory muscles to provide necessary feedback.
Materials and Methods: Initially, a two-dimensional (2D) game was designed, featuring an avatar that performs mastication of various food items at different speeds. The onset of each chewing cycle was determined using electromyography (EMG) signals from the masseter muscles. Subsequently, using non-negative matrix factorization (NMF), the contribution of each synergy between the masseter and temporal muscles was calculated to generate a score, which was displayed as visual feedback on the monitor. The proposed intervention was evaluated on the affected side of a post-stroke patient with preserved gum-mastication ability.
Results: Throughout the treatment sessions, in addition to an increase in game scores, the contribution rate of the first synergy (primarily associated with masseter muscle activity) showed a statistically significant linear decrease, while the contribution rate of the second synergy (temporal muscle) increased.
Conclusion: The findings demonstrate the effectiveness of game-based biofeedback rehabilitation as a simple, safe, cost-effective, and motivating approach. This method, which eliminates the need for specialized clinical space or constant professional supervision, shows great potential in assisting stroke survivors.
Keywords
Game-based biofeedback
Stroke
Electromyogram
Masticatory muscles
Muscle synergy
Subjects
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Journal of Research in Rehabilitation Sciences
Volume 19, Issue 1
April 2023
Pages 144-153