Biofeedback Research Articles

Therapeutic Interventions for Music Performance Anxiety: A Systematic Review and Narrative Synthesis

The aim of this systematic review was to summarise and evaluate the published literature on interventions for treating music performance anxiety (MPA). Adhering to the PRISMA guidelines, a comprehensive literature search of three electronic databases was conducted: PubMed, Web of Science, and PsychInfo (Ovid). Records were included in this review if they were quantitative pre–post interventional studies that utilised a recognised outcome measure or a clinical diagnosis for evaluating MPA. A narrative synthesis was orchestrated on 40 extracted studies assessing 1365 total participants. The principal intervention types observed included cognitive behavioural therapy, acceptance and commitment therapy, music therapy, yoga and/or mindfulness, virtual reality, hypnotherapy, biofeedback, and multimodal therapy. Although most of the reviewed studies demonstrated encouraging improvements in musicians’ MPA following delivered interventions, the current evidence base remains in its infancy, and numerous methodological weaknesses exist across studies. Small sample sizes, heterogeneity amongst treatment programmes, lack of follow-up data, a scarcity of standardised MPA assessments, and few randomised controlled designs render it imprudent to draw definitive recommendations concerning the interventions’ efficacy.

Biofeedback rehabilitation in patients with binocular inhibition due to macular disease.

To investigate whether patients with binocular reading inhibition due to central vision loss benefit from a new biofeedback (BF) rehabilitation method that aimed at improving fixation stability and at establishing a correspondence between the monocular preferred retinal loci (PRLs) on functioning retina in both eyes. Thirty-three patients with bilateral macular disease and with binocular reading inhibition participated in 10 training sessions consisting of 10-min visual stimulation for each eye to stabilize fixation and relocate the PRL (if needed) using the BF module of the MP-1 microperimeter (Nidek Technologies Srl., Vigonza, PD, Italy). Binocular and monocular reading performance, contrast sensitivity, and visual acuity were evaluated pre and post training. Binocular summation/inhibition was evaluated with binocular ratio (BR). Fixation stability improved significantly post training in both eyes. Maximum reading speed during binocular viewing increased from 57 ± 24wpm pre training to 67 ± 24wpm post training. BR increased for all parameters of reading, visual acuity, and contrast sensitivity. Training resulted in a complete reversal of binocular reading inhibition in 30% of patients. For patients with binocular inhibition due to central vision loss, BF training to stabilize fixation and to bring the monocular PRLs into correspondence on functioning retina in both eyes is an efficient rehabilitation method to improve binocular performance.

Movement Pattern Biofeedback Training After Total Knee Arthroplasty: A Randomized Controlled Trial.

Habitual movement compensations, such as decreased surgical peak knee extension moments (pKEM), persist years after total knee arthroplasty (TKA), are linked to poorer recovery, and may influence contralateral osteoarthritis progression. The purpose of this randomized clinical trial was to determine if a movement training program (MOVE) improves movement quality and recovery after TKA compared to a standardized rehabilitation program without movement training (CONTROL). One hundred thirty-eight individuals were randomized to either MOVE or CONTROL groups after TKA. Participants were assessed preoperatively, 10 weeks after (end of intervention), and six months after (primary endpoint) TKA. Outcomes assessed were pKEM during walking, six-minute walk test, stair climb test, 30-second sit to stand test (30STS), timed up and go test (TUG), physical activity level, strength, range of motion, and self-reported outcomes. At six months, there were no between-group differences in surgical pKEM during walking (primary outcome). The MOVE group exhibited less contralateral pKEM compared to CONTROL during self-selected gait speed (d = 0.44, P = 0.01). CONTROL performed better on TUG and 30STS at 10 weeks (P < 0.05), but differences attenuated at six months. The MOVE intervention did not lead to improved surgical pKEM during walking after TKA compared to CONTROL. However, the MOVE group did demonstrate less contralateral pKEM during walking. The CONTROL group demonstrated faster recovery on the TUG and 30STS, but it is unknown if this is due to improved recovery in the surgical knee or increased movement compensation relying on contralateral knee function.

The role of technologies with biofeedback in afterstroke muscle strength and muscle tone correction: an open-label randomized controlled prospective study

Relevance. Stato-locomotor disorders are associated with poor quality of life and risk of premature death in afterstroke patients.Aim. To evaluate the effect of functional electrical stimulation (FES) and biofeedback (BFB) stabilometric training on muscle strength and muscle tone in the chronic period of ischemic stroke (IS) patients.Matherials and Methods. The 160 patients in the chronic period of IS were randomized into four equal groups (n=40) depending on the rehabilitation programm: 1 group of FES, 2 group using BFB-stabilometric training, 3 group of combined application of FES and BFB-stabilometric training, and 4 control group receiving the standard medical rehabilitation (MR). The follow-up period was 6 months. Muscle strength was assessed using the MRC scale, muscle tone – by the modified Ashworth scale, and patients' functional independence in daily life – by the Barthel index (BI).Results. Complex MR with the FES and BFB-stability training significantly (p &lt;0.05) improved muscle strength: in the group with FES, thigh muscles – from 3.48±0.17 to 4.22±0.15 points (hip); in the group of FES and BFB-stability training – from 3.33±0.22 to 4.3±0.12 (hip) and from 3.18±0.14 to 3.52±0.12 points (shin). The positive statistically significant dynamics were determined by week 5 and 6 months of follow-up in groups 1 and 3 of patients and was associated with an improvement in functional independence according to the BI (p &lt;0.05).Conclusions. The use of BFB-based methods in the MR process contributes to a recovery of motor functions and functional independence of the patient in the chronic stroke period.

Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke

BackgroundBiomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumption that reducing propulsion asymmetry will improve overall gait symmetry, as paretic propulsion has been related to numerous biomechanical impairments. However, no work has investigated the impact of reducing propulsion asymmetry on overall gait asymmetry. We aimed to understand how within-session changes in propulsion asymmetry affect overall gait asymmetry in individuals post-stroke, operationalized as the combined gait asymmetry metric (CGAM). We hypothesized that decreasing propulsion asymmetry would reduce CGAM. Methods. Participants completed twenty minutes of biofeedback training designed to increase paretic propulsion. We calculated the change in propulsion asymmetry magnitude (Δ|PA|) and the change in CGAM (ΔCGAM) during biofeedback relative to baseline. Then, we fit a robust linear mixed-effects model with ΔCGAM as the outcome and a fixed effect for Δ|PA|. Results. We found a positive association between Δ|PA| and ΔCGAM (β = 2.6, p = 0.002). The average Δ|PA| was -0.09, suggesting that, on average, we would expect a CGAM change of 0.2, which is 0.5% of the average baseline CGAM value. Conclusions. Reducing propulsive asymmetry using biofeedback is unlikely to produce substantial reductions in overall gait asymmetry, suggesting that biofeedback-based approaches to reduce propulsion asymmetry may need to be combined with other interventions to improve overall gait asymmetry. Clinical Trial Registration. NCT04411303.

Outlet type constipation in adult patients treated with type A botulinum toxin: a cohort study

PurposeChronic constipation is a common symptom. Constipation due to pelvic floor disorders remain a therapeutic challenge. Biofeedback therapy is considered as the first-choice treatment for pelvic floor disorders, whenever dedicated expertise is available. Type A botulinum toxin has been used to selectively weaken the external anal sphincter and puborectalis muscle in constipated patients.MethodEighty-two patients with chronic outlet obstruction constipation were treated with 100 units type A botulinum toxin, injected into the puborectalis muscle and the external anal sphincter.ResultsAt the 2-month evaluation, a symptomatic improvement was noted in 69 patients. Seven (8.5%) patients had mild flatus incontinence. Stool frequency per week increased from 2.4 ± 0.9 to 5.1 ± 1.0 (P = 0.0001). Anorectal manometry demonstrated decreased tone during straining from 91 ± 28 mmHg to 61 ± 27 mmHg (P = 0.0001). Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 96 ± 12° to 124 ± 14° (P = 0.0001).ConclusionType A botulinum toxin relaxes the puborectalis muscle. Pressure values decline after the treatment. Transrectal ultrasonography to guide injections is a safe procedure. Repeated injections were needed to maintain the clinical improvement.

Controversies in fecal incontinence

Fecal incontinence is a common condition that can significantly impact patients’ quality of life. Obstetric anal sphincter injury and anorectal surgeries are common etiologies. Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients. There are various treatment options, including diet, lifestyle modifications, drugs, biofeedback therapy, tibial and sacral nerve neuromodulation therapy, and surgery. In this editorial, we will discuss current controversies and novel approaches to fecal incontinence. Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended, but may be helpful in selected patients. The Garg incontinence score is a new score that includes the assessment of solid, liquid, flatus, mucous, stress and urge fecal incontinence. Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options, for both fecal incontinence and neuropathy. Home biofeedback therapy can overcome some limitations of the office-based therapy. Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option. Sacral neuromodulation may be useful in scleroderma, congenital fecal incontinence and inflammatory bowel disease but merits further study.

Retrospective Study of the Efficacy of Biofeedback Therapy for Pediatric Persistent Posttraumatic Headache.

Posttraumatic headache is common in pediatrics. Studies have examined treatment of postconcussion symptoms, but few target posttraumatic headache. Biofeedback therapy has been studied in children and teens with primary headaches, but not posttraumatic headache. Our goal was to examine the changes in posttraumatic headache associated with biofeedback therapy in pediatric patients. This retrospective study included 74 children aged 10-18 years who received biofeedback therapy for posttraumatic headache. "Positive response" to biofeedback therapy was defined as ≥50% reduction in headache days per week, or 3-point drop in pain rating between the first and last biofeedback therapy visits. Patient characteristics were analyzed using logistic regression to identify factors associated with response. In our cohort, 42% of all patients with posttraumatic headache had a positive response to biofeedback therapy. Thirty-six percent experienced ≥50% decrease in headache frequency, 13% had a ≥3-point decrease in headache severity and 8% reported both changes. For those with daily headaches, 36% had a positive response to biofeedback therapy. School absences, selective serotonin reuptake inhibitor or prescription preventive medication use were associated with nonresponse. Biofeedback therapy is a reasonable treatment to consider to manage pediatric posttraumatic headache because more than 40% of our cohort had a beneficial response and biofeedback therapy has few adverse effects.

Intra- and inter-rater reliability, standard error of measurement, and minimal detectable change of the cranio-cervical flexion test in individuals with non-specific chronic neck pain.

The cranio-cervical flexion test (CCFT) is used in clinical practice to measure the activation of deep cervical flexor muscles. However, the reliability of the test has not been conducted on an adequate sample size, specifically in individuals with non-specific chronic neck pain (CNP). The aim of the present study is to investigate the intra- and inter-rater reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the CCFT in individuals with non-specific CNP. A cross-sectional study of reliability conducted at the UFSCar. Fifty-one individuals (17 men and 31 women) with non-specific CNP and aged over 18 years participated in this study. The CCFT was assessed with the Stabilizer pressure biofeedback device. Two raters conducted the test over two days, with a 5-7-days interval and a 10-min rest between raters. The activation score was determined by the level at which the participant kept activation for 10s in a single stage (22, 24, 26, 28 and 30mmHg). Appropriate statistical analysis was performed to calculate the intraclass correlation coefficient (ICC), SEM and MDC. Both intra-rater (ICC=0.65; 95% CI=0.46-0.78) and inter-rater reliability (ICC=0.72; 95% CI=0.55-0.83) were considered moderate. The SEM was 1.73 and 1.66 for intra-rater and inter-rater reliability, and the MDC was 4.81 to 4.60, respectively. The results of the present study indicate that CCFT is a reliable test to evaluate the activation score in individuals with chronic neck pain.

Quantifying Stress and Relaxation: A New Measure of Heart Rate Variability as a Reliable Biomarker.

Background/Objectives: For the rapid, objective characterization of the physiological stress response, there is currently no generally recognized standard. The stress measurement methods used in practice (e.g., for psychological measures of stress) are often subjective, or in the case of biological markers (e.g., cortisol, amylase), they usually require a blood test. For this reason, the use of heart rate variability (HRV) to characterize stress has recently come to the fore. HRV is the variability in the length of heartbeat intervals, which indicates the ability of the heart to respond to various physiological and environmental stimuli. However, the conventional HRV metrics are not corrected for heart rate dependence; hence, they fail to fully account for the complex physiology of stress and relaxation. In order to remedy this problem, here we introduce a novel HRV parameter, the normalized variability derived from an RMSSD "Master Curve", and we compare it with the conventional metrics. Methods: In Study 1, the relaxation state was induced either by heart rate variability biofeedback training (N = 21) or by habitual relaxation (N = 21), while in Study 2 (N = 9), the Socially Evaluated Cold Pressor Test and the Socially Evaluated Stroop Test were used to induce stress in the subject. For a statistical evaluation of the data, the Kolmogorov-Smirnov test was used to compare the distributions of mean HR, log(RMSSD), log(SDNN), and normalized variability before, during, and after relaxation and stress. Results: The results of this study indicate that while log(RMSSD) and log(SDNN) did not change significantly, the normalized variability did undergo a significant change both in relaxation states and in stress states induced by the Socially Evaluated Cold Pressor Test. Conclusions: Overall, we suggest this novel type of normalized variability ought to be used as a sensitive stress indicator, and in general, for the characterization of the complex processes of the vegetative nervous system.

Assessing Donor Site Morbidity and Impact on Quality of Life in Free Flap Microsurgery: An Overview.

Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients' long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients.

Rome IV Functional Defecation Disorder: Time for a Change in Symptom Criteria for Improved Clinical Relevance?

Defecatory disorders are common affecting up to 8% of the population. Rome IV diagnostic criteria are used to define this condition and, therefore, select patients for the gold standard therapy, anorectal biofeedback. The aim of this study was to test the current Rome IV Functional Defecation Disorder (FDD) criteria in a real-world population by using the response to biofeedback as a validation tool. A total of 485 patients (female 437, mean age 50 ± 17.6 years) with defecatory symptoms presenting to a neurogastroenterology clinic underwent anorectal biofeedback therapy regardless of whether they met formal Rome IV FDD criteria or not. Patients were assessed extensively with the Rome questionnaire, constipation questionnaire, and visual analog scales for satisfaction, control, quality of life, and anorectal manometry. Rome IV FDD was no better at predicting response to biofeedback compared with non-Rome IV FDD ( P = NS). Digitation ( P = 0.043) and increasing cumulative number of defecatory symptoms ( P = 0.038) were correlated with improvement in biofeedback (≥2-point increase in bowel satisfaction). Those with abnormal physiology only responded well to biofeedback (83% response rate), but this was not statistically different from no Rome IV physiology patients (73%). There was a trend for increasing cumulative number of abnormal physiology factors to correlate with biofeedback ( P = 0.086). Rome IV symptom criteria need revision to include more defecatory symptoms, include all subtypes of irritable bowel syndrome, and be inclusive of those with either loose stools or more frequent stools such as those previously labeled with "pseudodiarrhea" or "hyperdefecation." Continuing to include physiology criteria in the Rome diagnosis of FDD seems valid.

Brain Bioelectric Responses to Short-Term Heart Rate Variability Biofeedback Training in Indian and Russian University Students Studying in the Russian Arctic.

Heart rate variability biofeedback (HRV BF) training aids adaptation to new climatic, geographical, and social environments. Neurophysiological changes during the HRV BF in individuals from tropical regions studying in the Arctic are not well understood. The aim of this study was to research electroencephalographic (EEG) changes during a single short-term HRV BF session in Indian and Russian students studying in the Russian Arctic. The Indian (n = 40) and Russian (n = 40) healthy students (age 19-21 years) at a medical university in Arkhangelsk (64°33' N 40°32' E) were studied. HRV and EEG parameters were measured at baseline (5 min) and during a short-term HRV BF session (5 min) to increase the total power (TP, ms2) of the HRV spectrum. The baseline heart rate and stress index levels were significantly higher in the Indian students. During the HRV BF sessions, the sympathetic activity decreased more significantly in Russian students, while the alpha EEG activity significantly increased across all brain regions in both groups. In Indian students, there was a notable increase in theta and beta1 EEG spectral power in the frontal, central, and temporal regions. HRV BF training in Indian students was associated with a more pronounced activation of brain systems compared with Russian students.

Biofeedback rehabilitation in children with encopresis due to retentive constipation using simple tools: a real-world study in a French paediatric centre.

This study aimed to describe the effectiveness of biofeedback (BFB) rehabilitation in children with retentive encopresis (RE). A retrospective, single-institution study was conducted in children with BFB sessions for RE between 2017 and 2020. Manometry data and associated envy scores were analysed. BFB was a success (recovery from RE or ≥50% reduction in faecal soiling) in 37/44 (84%) children at the last session and in 32/44 (73%) 6 months later. The median age of children was higher in the success group at 6 months (p=0.013). BFB could then be clinically effective in children with RE.

Research progress of colonic electrical stimulation in the treatment of chronic constipation

Chronic constipation refers to a reduction in the frequency of bowel movements and difficulty in defecation lasting for more than 6 months, with a comprehensive incidence rate of 15% in the population. Chronic constipation is a significant health concern that greatly affects the quality of life of patients and results in substantial healthcare resource consumption. Current common treatment strategies include lifestyle modifications, pharmacological therapy, biofeedback therapy, enemas, and surgical procedures, but the effectiveness of these approaches remains limited. Colonic electrical stimulation therapy is a newly proposed treatment strategy in recent years, which involves the application of external electrical current to correct abnormal physiological activities related to defecation. This article provides an overview of the mechanisms, efficacy, and factors influencing the use of colonic electrical stimulation in the treatment of chronic constipation, as well as a summary of the advantages of colonic electrical stimulation and possible challenges for future development.

Chinese expert consensus on pelvic floor biofeedback for anorectal dysfunction (2024 edition)

Pelvic floor biofeedback is a major non-surgical treatment for anorectal dysfunction and has been recommended in several foreign guidelines. There is no consensus on the clinical practice of pelvic floor biofeedback in China currently. There are controversies in indications, contraindications and formulation of protocols. Launched by Pelvic Floor Medicine Specialty Committee of World Federation of Chinese Medicine Societies and Anorectal Branch of Chinese Medical Doctor Association, Chinese experts on this field were convened to write the Chinese expert consensus on pelvic floor biofeedback for anorectal dysfunction based on relevant references and combined the latest evidence and experts' clinical experience. This consensus recommends that before the use of pelvic floor biofeedback therapy, the patient's condition and pelvic floor function should be fully evaluated, and the guiding role of doctors and pelvic floor therapists should be emphasized to guide the standardized use of pelvic floor biofeedback therapy.

Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke.

Biomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumption that reducing propulsion asymmetry will improve overall gait symmetry, as paretic propulsion has been related to numerous biomechanical impairments. However, no work has investigated the impact of reducing propulsion asymmetry on overall gait asymmetry. We aimed to understand how within-session changes in propulsion asymmetry affect overall gait asymmetry, operationalized as the combined gait asymmetry metric (CGAM). We hypothesized that decreasing propulsion asymmetry would reduce CGAM. Methods. Participants completed twenty minutes of biofeedback training designed to increase paretic propulsion. We calculated the change in propulsion asymmetry magnitude (Δ|PA|) and the change in CGAM (ΔCGAM) during biofeedback relative to baseline. Then, we fit a robust linear mixed-effects model with ΔCGAM as the outcome and a fixed effect for Δ|PA|. Results. We found a positive association between Δ|PA| and ΔCGAM (β = 2.6, p = 0.002). The average Δ|PA| was - 0.09, suggesting that, on average, we would expect a CGAM change of 0.2, which is 0.5% of the average baseline CGAM value. Conclusions. Reducing propulsive asymmetry using biofeedback is unlikely to produce substantial reductions in overall gait asymmetry, suggesting that biofeedback-based approaches to reduce propulsion asymmetry may need to be combined with other interventions to improve overall gait asymmetry. Clinical Trial Registration . NCT04411303.

Change gently: an agent-based virtual interview training for college students with great shyness

Virtual Reality (VR) training systems are gaining popularity for psychological and skills training. Shy college students may perform poorly in interviews due to a fear of being evaluated, anxiety about real interview scenarios, and a lack of interviewing skills. In response, a pre-training environment (VR training system) was designed and developed, combining Virtual Reality Exposure Therapy (VRET, simulating a safe and controlled real interview environment) with biofeedback therapy (intuitive multimodal assessment and feedback). Virtual agents can play a positive role in psychological intervention and skill training. Different personalities of interviewers may help shy individuals overcome interview anxiety and enhance their interviewing skills. Therefore, we created virtual interviewer agents with three distinct personalities based on Eysenck’s personality theory. We improved on existing methods for designing agent personality traits by defining expressive traits (e.g., different physical, behavioral, and verbal traits) and reactive traits (differential evaluative feedback based on the user’s mental state). This self-training system requires no additional labor and provides initial training for shy college students prior to actual interviews. Ultimately, we recruited and selected 16 shy college students who underwent three VR-simulated interviews using our system. Expert evaluation and physiological measurements were employed to assess their interview anxiety and performance. The results of the user study indicate that our agent-based VR training system effectively assists shy college students in overcoming interview anxiety and improving interview performance.

Effectiveness of Biofeedback with Dilator Therapy for Sexual Function in Women with Primary Vaginismus: Randomized Controlled Trial Study.

Vaginismus is characterized by the involuntary spasm of the pelvic floor muscles (PFMs) around the outer third of the vagina, leading to difficulties in vaginal penetration. Physical therapists often use biofeedback to help individuals to gain better control over their muscles. This study was aimed at assessing the impact of biofeedback with dilator therapy on sexual function in women with primary vaginismus. In this randomized controlled trial study, 32 women with primary vaginismus, aged 18 to 45, were randomly assigned to either the experimental group (n = 16) or the control group (n = 16). The experimental group received both dilator therapy and biofeedback training, whereas the control group only received dilator therapy. Both groups followed a 6-week, twice-a-week session program. The Female Sexual Function Index (FSFI) questionnaire, which includes six dimensions (desire, arousal, lubrication, orgasm, satisfaction, and pain), was administered before and after the 6-week treatment, as well as 1month after completion. The analysis of variance test showed that the interaction effect of the group and time on the overall score of sexual function (p < 0.001) and the aspects of desire (p < 0.001), arousal (p < 0.001), orgasm (p = 0.028), satisfaction (p < 0.001), and pain (p = 0.003) were significant; however, the interaction between group and time (p = 0.182) was not observed for lubrication. Biofeedback therapy combined with dilator therapy and dilator therapy alone are both effective in improving sexual function in women with primary vaginismus. However, women undergoing biofeedback combined with dilator therapy seem to benefit more than those receiving dilators alone.

Biofeedback neurotraining in the correction of emotional changes in early cerebral small vessel disease

Cerebral small vessel disease (CSVD) associated with age and vascular risk factors has a high prevalence and social significance. Psychoemotional changes are an early manifestation of CSVD that require methods for their correction. Objective: to evaluate and compare the efficacy of biofeedback (BF) at infra-low frequencies and alpha waves frequencies in correcting emotional changes in patients with early CSVD. Material and methods. The study included 71 patients (85% women; mean age 52.8±6.3 years) with early CSVD and 21 healthy volunteers (71% women; mean age 53.2±4.8 years). Patients were randomized into three groups using the envelope method with double-blind placebo control: BF-neurotraining at infra-low frequencies (n=25), alpha waves (n=22) and imitation of BF based on electroencephalography parameters (placebo; n=24). Fifteen 30-minute individual sessions were conducted 2–5 times per week. Clinical symptoms, brain MRI data and psychoemotional status were assessed in all participants before and immediately after the BF course and 6–8 weeks later. Results. Patients with early-stage CSVD were characterized by an medium level of situational and a high level of personal anxiety, mild symptoms of depression and an medium level of alexithymia. Infra-low frequencies and alpha waves BF-neurotrainings were comparable in terms of their efficacy in reducing personal anxiety. Alpha waves training also showed an effect in reducing situational anxiety in the long term. Infralow frequencies training also reduced the level of depression. Placebo training had no effect on the parameters studied. Conclusion. In patients with early CSVD, BF-neurotraining at infra-low frequencies and alpha waves may be one of the methods for correcting the emotional changes associated with CSVD.