Biofeedback of muscle activity is commonly used as an adjunct to physical therapy, but it has not previously been used for long-term treatment of movement disorders. The authors hypothesized that chronic daily use of biofeedback of muscle electrical activity might promote improved use of the upper extremity in children with cerebral palsy and upper extremity motor deficits. They constructed a portable electromyography (EMG) unit that includes a surface EMG sensor and amplifier, microcontroller-based nonlinear signal processing, and vibration feedback of muscle activity. A total of 11 children ages 6 to 16 years, with cerebral palsy or acquired static brain injury, wore the device at least 5 hours per day for 1 month. Changes in upper extremity function were assessed using an individualized Goal Attainment Scale. Results showed significant clinical improvement in all 10 children who completed the study. These results suggest that further testing of prolonged surface EMG biofeedback is warranted.

SummarySevere arterial insufficiency of the lower extremity secondary to atherosclerosis is manifested in the clinical setting by the development of gangrene and ulceration. Clinicians caring for the spinal cord injured (SCI ) patient with a threatened ischaemic extremity have previously advocated primary amputation. At our insti tution, we have adopted an alternative approach to the clinical problem utilising vascular reconstruction for limb salvage. During the period October 1980 to Febru ary 1988, 6 spinal cord injured patients were identified who were treated for limb threatening ischaemia by vascular reconstruction in lieu of primary amputation. A combined approach of local wound care (debridement) and improvement of the arterial inflow by percutaneous transluminal angioplasty and/or operative vascular reconstruction successfully avoided major amputation in 6 of 7 threatened extremities. Follow-up data was complete in all patients and ranged from 4 to 52 months with an average of 20 months. In the review period, there was no operative mortality with a cumulative limb salvage rate of 86%. The clinician caring for the spinal cord injury patient with an ischaemic limb should: (1) proscribe the patient's use of tobacco products; (2) consider vascular reconstruction in lieu of primary amputation whenever feasible. Limb salvage may be of benefit to the SCI population with improvements in body image, sedentary stability and the activities of daily living. Key words: Spinal cord injury; Atherosclerosis; Amputation.The clinical development of arterial insufficiency secondary to progressive arteriosclerosis obliterans is frequently manifested by ulceration, infection and gangrene of the lower extremity. In the spinal cord injured (SCI) patient, management of the threatened ischaemic limb has frequently involved primary amputation. Clinicians who advocate this therapeutic approach cite the advantages of expeditious control of the problem in the 'anaesthetic and func-