bio feedback

8/3/2019 Bio Feedback

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BIO-FEEDBACK

Hardik P Parab

Moderator: Preetha R John


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Definition:

use of electronic instrumentation to provide

objective information (feedback) to an

individual about a physiological function or

response so that the individual becomes awareof his or her response.

Individual then attempts to alter the feedbacksignal in order to modify the physiologic

response.


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3

THERAPISTBIOFEEDBACK

INSTRUMENTATION

PATIENT

Middaughs conceptual framework for

Biofeedback Therapy


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Principle:


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Motor learning:

Set of process associated with practice or

experience leading to relatively permanent

changes in capability for perform or respond.


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Physiology of feedback:

Open loop control- pre planning

Biofeedback in rehabilitation-closed loop control.

Scheduled feedback- open + closed loop control


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Technical limitation

Relevancy

Accuracy

Speed of information


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FEEDBACK

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INTRINSIC Bodys internal

feedback mechanism

which uses

Visual

Auditory

Vestibular

Proprioceptive

EXTRINSIC

Any feedback derived from an

external source that augments

intrinsic feedback.

2 types

KR

Feedback givenafterperformance ofa task

Related tooverall result oftask

KP

Feedback given

during or afterperformance of atask

Related to how atask wasperformed


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Clinical application ofbiofeedback:

EMG

EEG

Blood pressure

Heart rate

Visceral & vasomotor response

Biofeedback for neuromotor disturbances

Biofeedback in stroke rehabilitation Combined behavioral therapy for hemiplegic arm

& hand.


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bf strategies of the OT in total hand rehabilitation

BF with EMG in muscle reeducation

BF in spasticity control

BF with EMG in SCI Pts.

BF with behavioral techniques in Rx of voluntary

movement.

BF training in pelvic floor & continence.


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EMGBF in communication disorder

Dental application of BF

Therapeutic EMG in chronic back pain

BF training of primary raynauds disease

BF for psychotherapeutics application- general

relaxation, headache Rx, general psychiatry,

psychosomatic disorder.


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Contraindication:

Absence of voluntary control

Uncooperative

Lack of understanding


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EMG BIOFEEDBACK

EMG activity of a particular muscle group is

presented in a visual or auditory form to a patient,

who uses the feedback signal to learn discriminative

control of the muscle.

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Electrode placement inEMGBF:


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Temporalis, frontalis, masserter,

zygomaticus & levator anguli


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SCM P. major


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Deltoid Serratus ant


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Supraspinatus, trapezius, lats


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Basic biofeedback circuit:-

AMPLIFIER SIGNAL FILTER

INTEGRATOR RECTIFIER

LEVEL DETECTOR FEEDBACK

DATA RECORD


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CIRCUIT

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Amplifier FiltersA/D

ConverterCRT

Speaker

StimulatorPatient

A R G


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Biofeedback in stroke rehabilitation

Main 3 types-

EMG feedback

Force feedback

Position feedback

Combination of treatment.


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Preparation of clinicians

Strong knowledge

Anatomy & neurophysiology of rehabilitation

program

Biofeedback knowledge


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Training strategies:

Order of progression of treatment

Goal selection

Dual channel monitoring

Supplemental techniques

Weaning of biofeedback

Training methods


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Multiple joint training

clinical example-

Wrist & finger extensors

Ankle dorsiflexors

Position feedback for ankle

Gait training


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EMG biofeedback & neuromuscular stimulation.

Concurrent assessment of muscle activity (CAMA)

Limb load monitor


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Combined behavioral Rx forhemiplegics arm & hand:-

1960 sbiofeedback were started to use for

hemiplegic arms

Behavioral therapy programe + EMGBF

Cognitive behavioral model- 4 phase

Conceptualization

Skill acquisition

Skill rehearsal

Skill transfer


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Exercise physiotherapy

Bobath concept

Neurofacilitatory technique

Fascilitatory + inhibitory technique


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EMGBF in muscle reeducation:

Facial muscle- facial palsy

Repair of facial palsy

Nerve graft

Nerve transfer

Muscle transfer

Dynamic + static procedure


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Facial nerve graft

Masserter muscle transfer

Gracilis transfer for anal incontinence

Gracilis for facial palsy or VIC


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EMGBF in SCI patients

Traditional physiotherapy treatment for SCI

patients

EMGBF can be used to

Identifying muscle with low measurable potentials

Identify type of reflexely induced movement

capable of producing measurable musclecontraction


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Evaluate improvement in muscle strength

Provide feedback to patient & therapist during

exercise


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Goal of treatment

Reduce hypermotor response in spastic muscle

When patient is able to reduce the response in

supine , sitting & standing posture start to recruitthe weak muscles.

For paraplegic-

decrease activity of adductors & calfincrease activity of abd, lumbar paravert.

Muscles, gluteus, rectus femoris, sartorius, hams &

TA.


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Quadriplegic patients-

increase activity of upper trapezius, middle

+ant deltoid, triceps, biceps, pect major, wrist

+finger extensors in forearm.

FES + EMGBF can be used for SCI patients.


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Standingbalance feedback:


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Posturography feedback

Useful in treatment of

Geriatric population patients with balance impairments

Consists of force-measuring scales on which

subject is requested to stand as still as possible COP

COM


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BF & other behavioraltechniques in Rx of voluntarymovement disorder


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Isolated muscle involvement:

Neck- spasmodic torticolis

Jaw- oromandibular dystonia Muscle used in protective blinking-

blepharospasm

Writing- dystonicwriters cramp Muscle of one side of face- hemifacial spasm


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EMGBF + behavioral control therapy

Rx of dystonia spasmodic torticolis-

Rx with cutaneous shock where pt wore position

sensitive switch on head band which will +ed by

head deviation.

stimulation of head switch provide shock to

finger tips & temporary reduction of shock willoccur.


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Use of spasm- contingent cutaneous shock:

EMGBF + spasm-contingent cut. Shock

2 electrodes will be applied to 1st 2 fingers of either

hand Tactile biofeedback

Rx of spasmodic torticollis:

4 channel surface EMG electrode

During walking-portable EMGBF


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Hemifacial spasm

EMGBF + spasm triggered cut. Shock

TremorsEMGBF

Parkinsonian symptoms:

BF + progressive relaxation training + stress

management training


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Facial rigidity (mask like face)- frontalis EMGBF

Micrographia- extensor EMGBF

Tremor (pill rolling movement)- flexor EMGBF.


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Feedback goniometer in

rehabilitation:


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Clinical goniometer: measure only spot

measurementof joint angle & only contains of

simple hinge.

Feedback goniometer: measure continously

changing joint angles to analyse complex motion of

joint.


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Finger goniometer

Wrist goniometer

Ankle goniometer

Back goniometer

Elbow goniometer

Pronation-supination goniometer

Also measures Propioception & kinestheticsensation.


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Limb load monitor:


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Indication:

Musculoskeletal

Neurological

Uses:

For precise monitoring of partial weight bearing

To provide an orderly progression in weightbearing

To sustain max weight bearing

To regulate postural & vestibular reaction


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Different studies had shown sensory feedback

during locomotion improve more precise & sustain

response.

Can be done with 2 weight machines on parallel

bar.


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Technical limitations

Only the vertical ground reaction componentsare registered by LLMs

LLMs may feedback invalid signals becausebefore and after, torsional and horizontal sheerforces are not monitored separately in presentdevices

Just an indication of gross errors in timing andweight bearing

LLM provides only part of the picture withinformation on GRF


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Head position trainer:


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For CP babies, child with torticollis & habitual

head tilt.

Made up of mercury cluster switch, ear phones &

electronic buzzer.

Head position monitor


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Joint position trainer:


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Correction of hyperextension/ excessive flexion of

knees

To correct gait pattern in CVA patients

CP babies- control jaw closure & drooling.

Knee angle monitor: 2 parts

Knee electrogoniometer (elgon)

Control box


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Treatment if communication

disorders:


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Doctors speech

EMGBF:

Decreased muscle tone- LMN disease

Increased muscle tone- UMN disease

Poor volitional control of incoordination- apraxia

Dysarthria


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Training of pelvic floor &incontinence:


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BF in fecal

incontinence:

Biofeedback Rx-

Sphincter exercise

Training synchrony of internal & external sphincter

Training discrimination of rectal sensation

Study- EMG signals with electrode mounted on a

plug placed in anus has shown improvement infecal incontinence.

BF is Rx of choice in fecal incontinence.


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Urinary incontinence:


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Urinary incontinence:

Behavioral habits- biofeedback, habit training,

bladder retraining, reinforcement of good toilet

habit.

Biofeedback will acts on 2 muscle groups in pelvic

floor

Bladder wall (smooth muscle) Pelvic flooor


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Kegel developed exercise plan + perineometer.

Perineometer- biofeedback device.

Study- EMGBF- in myelomeningiocele pts.

training given with perineal electrode to pelvicfloor & shown improvement in incontinence.

Female micturition syndrome-

EMGBF improve coordination of detrusur &sphincter + increase urine outflow.


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Pressure biofeedback

core muscle strengthening

Pressure cuff, inflator, pressure reading indicator

Maintain the pressure by contracting themuscle

Gives visual feedback


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References

Biofeedback-principles & practice for

clinicians.-Basmajian.

Physical rehabilitation- Susan b o sullivan

Electrophysiology by Robinson.

bio feedback

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