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  2. 2. What is Biofeedback? <ul><li>A clinical technique that involves recording electrical activity generated in a muscle for diagnostic purposes </li></ul><ul><li>Utilizes an instrument that measures, processes & provides feedback reinforcing information via visual or auditory signals </li></ul><ul><ul><li>Does not monitor actual response (strength of contraction) but rather the conditions associated with the response </li></ul></ul><ul><li>Not used as a modality like heat or cold, but can be used for rehabilitation & research purposes </li></ul><ul><li>Can be used to help regain function of a muscle that may have been lost </li></ul>
  3. 3. Biofeedback Units <ul><li>4 types of Units: </li></ul><ul><ul><li>Peripheral temperature, </li></ul></ul><ul><ul><li>Finger Phototransmission, </li></ul></ul><ul><ul><li>Electrical resistance units/ Skin Conductance Activity </li></ul></ul><ul><ul><li>Electromyography (EMG), </li></ul></ul><ul><li>EMG - most typically used form of biofeedback </li></ul><ul><li>Scale on unit can be both visual and audio </li></ul><ul><li>Measured in microvolts, 0-10 scale, or some form of pitch </li></ul>
  4. 4. EMG & Other Units <ul><li> </li></ul><ul><li> = emg </li></ul>
  5. 5. Biofeedback Units <ul><li>Peripheral temperature units </li></ul><ul><ul><li>Indirect measure of the diameter of peripheral blood vessels </li></ul></ul><ul><ul><ul><li>Easily seen in toes & fingers </li></ul></ul></ul><ul><ul><li>Variations in body reactions change temperature </li></ul></ul><ul><ul><ul><li> temperature indicates relaxed state </li></ul></ul></ul><ul><ul><ul><li> temperature indicates stress, fear, anxiety </li></ul></ul></ul><ul><ul><li>Measured in degrees Fahrenheit </li></ul></ul>
  6. 6. Biofeedback Units <ul><li>Finger Phototransmission </li></ul><ul><ul><li>Measured indirectly using a Photoplethysmograph </li></ul></ul><ul><ul><li>Monitors amount of light reflected by subcutaneous tissues based on amount of blood flow </li></ul></ul><ul><ul><li>As blood volume increases the amount of light detected decreases </li></ul></ul><ul><ul><li>Monitor finger pulse </li></ul></ul>
  7. 7. Biofeedback Units <ul><li>Electrical resistance units/ Skin Conductance Activity </li></ul><ul><ul><li>Measures amount of perspiration on the skin </li></ul></ul><ul><ul><ul><li>Sweat contains salt which increases electrical conductivity </li></ul></ul></ul><ul><ul><li>Passes a small current through the fingers (volar surface) and/or palm </li></ul></ul><ul><ul><li>Measures impedance of electrical current </li></ul></ul><ul><ul><li>Lie detector testing </li></ul></ul>
  8. 8. Lie Detectors
  9. 9. Biofeedback Units <ul><li>Electromyographic (EMG) </li></ul><ul><ul><li>Measures electrical activity in skeletal muscle </li></ul></ul><ul><ul><li>May be very simple to very complex </li></ul></ul><ul><ul><li>Take-home models </li></ul></ul><ul><li>Electrodes – you will mostly see surface electrodes </li></ul><ul><ul><li>Active electrodes : </li></ul></ul><ul><ul><ul><li>Detects electrical activity from muscle contraction & converts into visual or auditory signals </li></ul></ul></ul><ul><ul><li>Reference electrode (ground electrode): </li></ul></ul><ul><ul><ul><li>Filters “noise” or unwanted electrical activity in the environment (other electromagnetic energy); </li></ul></ul></ul><ul><ul><ul><li>Point of reference to compare the electrical activity recorded by the active electrodes </li></ul></ul></ul>
  10. 10. EMG Units
  11. 11. Indications for EMG Use <ul><li>Facilitation for muscle reeducation </li></ul><ul><li>Restoration of neuromuscular function </li></ul><ul><li>Increase muscular strength </li></ul><ul><li>Promotion of relaxation of spasm </li></ul><ul><li>Reduction of muscle guarding </li></ul><ul><li>Assistance with pain control </li></ul><ul><li>Neurological Conditions (following stroke, spinal cord injury, cerebral palsy, incontinence) </li></ul>
  12. 12. Advantages for using EMG <ul><li>Provides feedback with a chance to make appropriate small changes in performance that are immediately noted & rewarded </li></ul><ul><li>Patient learns early in rehab to do something for him/herself instead of relying on the athletic trainer </li></ul><ul><li>Proven to reduce myofascial pain, migraine & tension headache pain and stress reduction </li></ul><ul><li>With neuromuscular effects, biofeedback helps with input that is lost from receptor </li></ul>
  13. 13. Contraindications <ul><li>If movement of a joint or isometric contractions are contraindicated </li></ul><ul><li>Conditions in which muscle contractions might exacerbate the condition </li></ul><ul><ul><li>Unhealed tendon grafts, avulsed tendons, 3 rd degree tears of muscle fibers </li></ul></ul><ul><li>Unstable fractures, injury to joint structure, ligaments, capsule or articulating surfaces </li></ul>
  14. 14. Patient Set-up & Application <ul><li>Shave area if applicable </li></ul><ul><li>Clean skin to remove all dirt, oil, lotion, etc. </li></ul><ul><li>Area may have to be mildly abraded if unit is sensitive </li></ul><ul><li>Secure electrodes OVER the muscle belly. The active electrodes MUST be on target area. Reference electrode may be secured anywhere on the body, but is usually in between the two active electrodes </li></ul><ul><li>Distance between active electrodes is usually close </li></ul>
  15. 15. Patient Set-up & Application <ul><li>Plug electrode lead(s) into unit </li></ul><ul><li>Turn unit on </li></ul><ul><li>Adjust output to desired mode </li></ul><ul><li>THE PATIENT SHOULD NOT BE DISTRACTED BY OUTSIDE NOISES DURING SESSION. </li></ul><ul><li>Various protocols </li></ul>