Biofeedback is a technique that measures bodily functions and provides feedback to help people learn to control them. It involves sensors attached to the body to detect physiological activity like muscle tension, heart rate, breathing, and skin temperature. Signals from the sensors provide visual or auditory feedback to help users recognize mind-body connections and learn to control targeted responses through relaxation or other techniques. Over time with training, people can self-regulate physiological responses without the external feedback equipment. Biofeedback has applications for treating conditions like chronic pain, hypertension, seizure disorders, incontinence, and more by enhancing awareness of stress responses and developing self-regulation skills.

1. BIOFEEDBACK
Anant K. Rathi

2. Definitions
 "Bio" - life.
 "Feedback“ - 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.
 Biofeedback is a technique that measures
bodily functions and gives you information
about them in order to help train you to control
them.

3. Association for Applied Psychophysiology and Biofeedback
(AAPB), Biofeedback Certification International
alliance (BCIA), and the International Society for
Neurofeedback and Research (ISNR),
“is a process that enables an individual to learn how
to change physiological activity for the purposes
of improving health and performance. Precise
instruments measure physiological activity such
as brainwaves, heart function, breathing, muscle
activity, and skin temperature. These instruments
rapidly and accurately 'feed back' information to
the user. The presentation of this information—
often in conjunction with changes in thinking,
emotions, and behavior—supports desired
physiological changes. Over time, these changes
can endure without continued use of an
instrument.

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. 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.

7.  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.

8.  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.

9.  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.

10. Three stages of
biofeedback training

11. Types of sensory modalities
 Electromyograph (EMG)
 Galvanic skin response (GSR)
 Temperature or thermal sensors
 Heart rate sensors
 Capnometry (CAP)
 Photoplethysmograph
 Pneumograph
 Electroencephelograph
 Rheoencephalograph
 Hemoencephalograph

12. Electromyography
 The most frequently used biofeedback method
 for treating anxiety and worry, chronic pain,
essential hypertension, headache (migraine,
mixed headache, and tension type), low
backache, physical rehabilitation (cerebral
palsy, incomplete spinal cord lesions, and
stroke), temporomandibular joint disease
(TMD), torticollis, fecal & urinary incontinence
and pelvic pain.

13. Electromyography
 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.

14. 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.

15. 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

16. 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.

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

18. 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.

19. Capnometry/Respiratory rate
 Respiratory sensors monitor oxygen intake
and carbon dioxide output, rate of respiration.
 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.

20. 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.

21. 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, addiction, depression
and sleep disorders.

22. Neurofeedback

23. Main Clinical
Applications of BF

24. 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.

25. 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

26. Chronic pain disorders
 If lower back pain is related to muscle tension
or spasm, BF application can be effective.
 EMG BF can be used especially in back,
cervical and forehead muscles relaxation.

27. 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

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

29. 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.

30. 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

31. 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.

32. 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.

33. Post-Orthopedic Surgery
 Muscle weakness occurring after orthopedic
surgeries benefit from BF treatment. EMG BF
is found to be effective in improving
quadriceps muscle strength after
meniscectomy

34. 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.
 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

35. Role of biofeedback in other
conditions
ADD &
ADHD
Alcoholism
Anxiety
Arthritis
Asthma
Breathing Problems
Chest Pain
Chronic Pain
Constipation
Drug Addiction
Epilepsy/Seizure
Fecal Elimination Disorder
Headaches
Hypertension
Hyperventilation
Incontinence
Jaw Area Pain
Knee Pain
Low Back Pain
Non-Cardiac Chest Pain
Pain
Phantom Limb Pain
Posture Related Pain
Raynaud's Syndrome
Stump Pain
Subluxication of the Patella
Substance Abuse
Temporomandibular Disorder
Traumatic Brain Injury
TMJ/TMD
Urinary Elimination Disorders
Vulvar Vestibulitis

36. 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

37. 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

38. Thank you