BIOFEEDBACK

Amani M. Abdussalam

History and Philosophy

Biofeedback is one of the earliest behavioral medicine treatments and has been practiced in clinical settings since the 1970’s.

Biofeedback achieves its results through psychophysiological (mind-body) self-regulation.

Today, biofeedback is used widely by physicians, nurses, psychologists, physical therapists, drug rehabilitation counselors, dentists and other professionals to treat an array of disorders.

History and Philosophy

In biofeedback therapy, individuals are trained on electronic monitors to exert control over vital bodily processes, such as heart rate, respiration, blood pressure, muscular tension, and brain activity.

By observing and monitoring shifts in bodily functions or striate muscle activity, patients learn to adapt and modify their mental and emotional responses to alleviate symptoms and help regulate specific health conditions.

Principle of BF

The patient through the artificial proprioception provided by the BF apparatus, is able to gain conscious control over subliminal but undamaged upper neuron pathways which are in turn able to fix the missing function.

Purpose To enhance an

individual's awareness of physical reactions to physical, emotional, or psychological stress , and their influence on their own physiological responses.

To develop self-regulation skills that play a role in improving health and well-being.

Definitions

"Bio" means life. "Feedback" is returning knowledge to origin. Then "biofeedback" (BF) means returning the biological knowledge created by the origin to origin in order to make the origin understand and control that knowledge

Definitions

Biofeedback is a technique that measures bodily functions and gives you information about them in order to help train you to control them.

“.a method of controlling a system by reinserting into it the results of ts past performance.”

How biofeedback works

Biofeedback utilizes electronic sensors, or electrodes, attached to various parts of the body to detect changes in physical responses.

Signals then inform the individual of these changes by means of visual or auditory signals such as a light display or a series of beeps.

While the individual views or listens to feedback, he or she begins to recognize thoughts, feelings, and mental images that influence his or her physical reactions.

By monitoring this mind-body connection, the individual can use the same thoughts, feelings, and mental images as cues or reminders to become more relaxed, or to change heartbeat, brain wave patterns, body temperature, and other body functions.

The individual uses trial-and-error to change the signals change in the desired direction.

For example, individuals trying to control their blood pressure levels may see a light flash whenever the pressure drops below a certain level.

They may then try to remember what their thoughts and feelings were at the moment and deliberately maintain them to keep the blood pressure level low.

Through training, the individual learns to control the targeted physical response and, over time, is able to recognize what is required to reduce problematic symptoms.

Eventually, the external biofeedback becomes unnecessary as the individual learns to perceive internal physical responses and make the desired changes. The individual then has a powerful, portable, and self-administered treatment tool to deal with problematic symptoms.

Three stages of biofeedback training

• rest, • stress, and• recovery

Types of biofeedback equipment

Electromyograph (EMG) Galvanic skin response (GSR) Temperature or thermal sensors Heart rate sensors Capnometry (CAP)

Electromyography

The most frequently used biofeedback method

Used in the treatment of various neurologic disorders such as stroke , cerebral palsy, traumatic brain injury, and multiple sclerosis.

This biofeedback setup uses an EMG sensor to represent muscle tension as a series of beeps and allows you to train your body to adjust muscle tension.

Galvanic skin response ( skin conductance)

Sensors on the fingers monitor perspiration or sweating.

GSR may be used in the treatment of anxiety, fears or phobias, stress, and sleep problems.

Galvanic skin response

The small, hand-held and self contained Galvanic Skin Response monitoring device for home biofeedback.

Precisely monitors stress levels by translating tiny tension-related changes in skin conductance into a rising or falling tone.

By resting two fingers on the sensing plates you learn to lower the pitch and your stress level.

Temperature or thermal BF

Sensors monitor body temperature and changes in blood flow.

Changes in hand temperature, for example, can indicate relaxation when there is increased blood flow to the skin.

Temperature or thermal BF

Temperature biofeedback may be useful for treating migraine headache, Raynaud's disorder, and anxiety disorders.

Heart rate BF

A pulse monitor placed on the fingertip monitors pulse rate.

Increases in heart rate are associated with emotional arousal, such as being angry or fearful.

Decreases in heart rate are associated with relaxation.

Capnometry

Respiratory sensors monitor oxygen intake and carbon dioxide output.

This differentiates correct breathing from problematic breathing practices. Breath control training may be used to treat panic attacks, asthma, and a variety of stress-related conditions.

Capnometry

Biofeedback-based Capnometry-Assisted Respiratory Training (CART) to teach asthma patients to normalize and reverse chronic overbreathing.

A hand-held device called a capnometer measures the amount of CO2 exhaled.

Using this device, patients learn how to breathe more slowly, shallowly and regularly.

Electroencephalographs (EEG) or neurofeedback

Sensors attached to the scalp monitor brain wave activity in different parts of the brain.

It may be used to treat conditions with proven or suspected impact on brain wave patterns such as seizure disorders or epilepsy, ADHD, learning disabilities, migraine headaches, traumatic brain injury, and sleep disorders.

Neurofeedback

Main Clinical Applications of BF

Neuromuscular Rehabilitation The therapeutic goals are those of

physical rehabilitation:  to increase muscle strength, enhance muscle relaxation, improve muscle coordination, decrease pain, and improve function during daily activities and

work.

Chronic pain disorders

BF can help in the prevention or treatment of migraine by promoting diaphragmatic breathing and systematic relaxation.

Patients with fibromyalgia syndrome have benefited from BF treatment involving EMG recording of the trapezius muscle

Chronic pain disorders

If lower back pain is related to muscle tension or spasm, BF application can be effective.

Relaxation of the body muscles with BF is useful in low back pain. EMG BF can be used especially in back, cervical and forehead muscles relaxation.

Chronic pain disorders

Biofeedback combined with cognitive behavioral skills training prevented the symptoms of patients at high risk for acute temporomandibular (TMD)–related pain from progressing to chronic TMD

thermal biofeedback may be useful for treating phantom limb, which occurs in the majority of patients who have amputations

Hypertension

BF is particularly indicated in patients who are hypersensitive to stress and who have difficulty in tolerating or complying with antihypertensive drug regimens.

Seizure disorders

The treatment of epilepsy via conditioning of the sensorimotor EEG dates back more than 3 decades.

Such neurobiofeedback results in an upregulation of excitation thresholds associated with reduced susceptibility to seizures, especially for patients whose conditions are nonresponsive to standard anticonvulsant medications.

Stroke

Treatment of foot drop by relaxation of the gastrocnemius and recruitment of the dorsiflexors.

Shoulder subluxation is a common complication in flask hemiplegic patients.

Strengthening of the upper trapezius and anterior deltoid muscle fibers with EMG BF not only reduces subluxation but also improves the range of motion of the shoulder joint

Spinal cord injury

BF is used for muscle relaxation and/or strengthening of the muscles

In paraplegics relaxation of hip adductors and gastrosoleus muscles is important.

By adding BF treatment to the rehabilitation programme, improvement is achieved in active range of motion and function of the extremities particularly in incomplete paraplegic and tetraplegic patients.

Cerebral palsy

BF is used for spasticity treatment, balance training and strengthening of weak muscles.

Dynamic equinus is a common deformity that worsens the ambulatory ability of both diplegic and hemiplegic conditions.

Post-Orthopeadic Surgery

Muscle weakness occuring after orthopeadic surgeries benefit from BF treatment. EMG BF is found to be effective in improving quadriceps muscle strength after meniscectomy

Incontinence

Pelvic floor muscle training (Kegel exercises), alone or with BF is effective in stress incontinence.

BF enables the patient to improve pelvic muscle strength and coordination through muscle awareness.

Incontinence

BF is advocated as first-line therapy for patients whose symptoms of mild to moderate fecal incontinence have not responded to simple dietary advice or medication

Conclusion

biofeedback is a therapeutic technology that empowers patients to be active participants in their own health care by providing them with immediate insight into the functioning of their bodies

Reference

Biofeedback applications:a survey of clinical research, Sala Horowitz, Ph.D. http://touroinstitute.com/biofeedback.pdf

International encylopedia of rehabilitation http://cirrie.buffalo.edu/encyclopedia/en/article/23/

http://www.encyclopedia.com/topic/biofeedback.aspx