biofeedback is a modality of behavioral therapy that helps patients to gain control over their physical subliminal functions by increasing their awareness of bodily responses to physical, emotional and psychological stress

1. BIOFEEDBACK
Amani M. Abdussalam

2. 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.

3. 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.

4. 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.

5. 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.

6. 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

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

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

9. 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.

10.  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.

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

12.  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.

13.  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.

14. Three stages of
biofeedback training

15. Types of biofeedback equipment
 Electromyograph (EMG)
 Galvanic skin response (GSR)
 Temperature or thermal sensors
 Heart rate sensors
 Capnometry (CAP)

16. 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.

17.  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.

18. 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.

19. 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.

20. 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.

21. Temperature or thermal BF
 Temperature
biofeedback may be
useful for treating
migraine headache,
Raynaud's disorder,
and anxiety
disorders.

22. 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.

23. 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.

24. 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.

25. 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.

26. Neurofeedback

27. Main Clinical
Applications of BF

28. 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.

29. 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

30. 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.

31. 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

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

33. 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.

34. 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

35. 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.

36. 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.

37. 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

38. 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.

39. 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

40. 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

41. 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/biofeedbac
k.aspx