The Effect of Neurofeedback on Postural Balance and Attention in Patients Suffering From ‎Knee Osteoarthritis With Bilateral Total Knee Replacement: A Pilot Study

Objective: Increasing life expectancy leads to an increase in degenerative diseases such as osteoarthritis One of the important factors that affect the mobility and activity of daily living in patients suffering from knee osteoarthritis with bilateral Total knee replacement, is dynamic balance. Traditional rehabilitation approaches that target pain and the strengthening program of lower extremities are done locally at the site of the knee. Neurofeedback training is a relatively new method of improving balance that works at the CNS level. The main objective of this preliminary pilot study was to examine the effect of neurofeedback training on dynamic stability and sustained attention in patients with bilateral total knee arthroplasty (BTKA). Material & Method: This was a semi experiment with a one-group before/after trial design. The study population were all patients with BTKA that had referred to the outpatient clinic of Occupational Therapy of Shahid Beheshti University of Medical Sciences from April to September 2017 via convenience sampling. A total of 8 female patients with the mean age of 67.5 (The mean elapsed time since surgery was 3 month) were enrolled according to the inclusion and exclusion criteria. Based on the inclusion criteria, participants must be older than 55 years old, the researchers had to acquire the informed consent of all the patients who were going to participate in the study, and make sure of the absence of cognitive impairment (a minimal score of 20 in MMSE). There had to be a lack of operation in the other joints of the lower extremity, and only the use of cement prosthesis could be accepted. Furthermore, there had to be a lack of uncontrolled hypertension or acute vascular heart disease, a lack of visual field deficit, a lack of discrepancy between legs of more than 1 centimeter, the ability to walk, the lack of alcohol or substance use and vestibular disorders that might impair balance. In addition, patients could not have received neurofeedback training before. Exclusion criteria included the following: being absent for more than 2 therapeutic sessions and the patient's unwillingness to collaborate in the research process. All patients received 8 sessions’ standard neurofeedback training with the balance protocol. Assessments and data gathering were done at three times: before training, in the fourth and eighth sessions with vigilance attention test (Vienna test system) and dynamic stability test (level 6 of Biodex system). Data analysis was done with SPSS (version 22) and Repeated Measure, paired-samples T Tests and two-related samples. P < 0.05 was considered as significant. Results: The results showed a significant improvement in the mean score of dynamic stability after neurofeedback training (P<0.05). While the mean scores of sustained attention were not significant (P>0.05), only the mean scores of reaction time of the attention test were significant (P<0.05). Also A gradual increase in beta-wave was seen in the treatment process. But this increase was not statistically significant Conclusion: This pilot study showed there is a preliminary evidence that Neurofeedback training can probably improve dynamic stability in female patients with bilateral total knee arthroplasty rapidly, but it has limited efficiency in sustained attention. Thus it can be used as an adjunctive training for the promotion of postural stability in female patients with bilateral total knee arthroplasty.