Electromyography biofeedback therapy for spinal cord injury rehabilitation: a systematic review
Published October 13, 2026. Across 10 randomized trials involving 537 people with spinal cord injury, results consistently leaned toward EMG biofeedback for measured muscle activity, strength, selected motor and independence scores, spasticity or balance. The evidence was low or very low certainty for every outcome, however, so this supports further study rather than a conclusion that EMG biofeedback is established or superior rehabilitation.
Liu MW, Liu ZY, Zhang BC, Gao SJ, Peng HD.
Frontiers in Neurology · Publication date: 2026-10-13
Added to site: 2026-11-06
DOI: 10.3389/fneur.2026.1885605
Published October 13, 2026. Added to Neurofeedback.com November 6, 2026 after comparison with fresh and reserve candidates. The source date is separate from the site addition date.
- Modalities
- EMG biofeedback, Biofeedback, Neurorehabilitation
- Clinical focus
- Spinal cord injury, Motor and functional rehabilitation, Balance and spasticity
- Population
- Adults with spinal cord injury represented in 10 randomized controlled trials
- Sample
- 10 randomized controlled trials involving 537 participants
- Intervention / method
- PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP and other databases were searched from inception through January 8, 2026. Two reviewers independently screened, extracted data and assessed risk of bias. Clinical and methodological heterogeneity precluded meta-analysis, so the authors used a structured narrative synthesis.
- Comparator
- Seven trials used conventional-rehabilitation comparators; three used active comparators such as medium-frequency electrotherapy, core-stability training or suspension exercise
Clinician summary
Five RCTs involving 223 participants reported larger surface-EMG signals with EMG biofeedback, and low-certainty ASIA motor and balance results also favored it directionally. No pooled effect estimate was appropriate because populations, muscle targets, comparators and data types differed. All 10 RCTs had some risk-of-bias concerns, most lacked reported allocation concealment and assessor blinding, and only one was prospectively registered.
How to interpret the findings
Every outcome was rated low or very low certainty. The studies were small, most were conducted in one country, and interventions, muscle targets, outcome measures and comparators varied substantially. Some outcomes were surrogate body-function measures rather than patient-important outcomes. Ordinal spasticity data were reported inconsistently, one muscle-strength value appeared implausible and identical to a separate sEMG value, and the lone pain study allowed only within-group comparison. Adverse events were reported too inconsistently for the review to make a safety claim. Publication bias was not formally assessed because fewer than 10 studies contributed to each outcome.
Equipment and disclosures
The review included heterogeneous EMG-biofeedback approaches and did not establish superiority for any device or commercial system. No equipment is attributed to BrainMaster or another vendor.
Supported by the National Natural Science Foundation of China, the Subsidy Project for Introducing High-level Talents in Yunnan Province and the Yunnan Applied Fundamental Research Venture-Union Foundation of China. The authors declared no commercial or financial relationships that could be construed as a conflict of interest and stated that generative AI was not used to create the manuscript. No correction, retraction or expression-of-concern relation appeared in the checked PubMed, Crossref, publisher and bounded DOI/title records on November 6, 2026. AI-assisted source review for Neurofeedback.com, not independent human clinical review.
Related evidence
Compare findings from the same clinical area, including mixed results.
- Motor Cortex rTMS Alleviates Pain and Comorbid Depression After Spinal Cord Injury with a Correlate in M1 Intracortical Inhibition. · Positive with limitations
- Efficacy of combined repetitive transcranial magnetic stimulation and occupational therapy in spinal cord injury patients: a randomized controlled clinical study. · Mixed
- Operant Conditioning of the Motor Evoked Potential in Forearm Extensors of Individuals with Chronic Incomplete Cervical Spinal Cord Injury: Case Studies. · Positive with limitations
Summary prepared with AI assistance. Source verification does not imply an independent replication or a clinician's endorsement. Read our review method.