Biofeedback Treatment Research Articles

Brain-computer interface game applications for combined neurofeedback and biofeedback treatment for children on the autism spectrum.

Individuals with autism spectrum disorder (ASD) show deficits in social and communicative skills, including imitation, empathy, and shared attention, as well as restricted interests and repetitive patterns of behaviors. Evidence for and against the idea that dysfunctions in the mirror neuron system are involved in imitation and could be one underlying cause for ASD is discussed in this review. Neurofeedback interventions have reduced symptoms in children with ASD by self-regulation of brain rhythms. However, cortical deficiencies are not the only cause of these symptoms. Peripheral physiological activity, such as the heart rate and its variability, is closely linked to neurophysiological signals and associated with social engagement. Therefore, a combined approach targeting the interplay between brain, body, and behavior could be more effective. Brain–computer interface applications for combined neurofeedback and biofeedback treatment for children with ASD are currently nonexistent. To facilitate their use, we have designed an innovative game that includes social interactions and provides neural- and body-based feedback that corresponds directly to the underlying significance of the trained signals as well as to the behavior that is reinforced.

Special Issue: Advances in the Use of QEEG and Neurofeedback for ADHD

The cover of this special issue shows a three-dimensional graphic of a brain depicting the “reward network” as a target for biofeedback intervention. The article by Robert Thatcher in this issue discusses the use of functional network analyses and a Z-score approach to selectively target a network of brain areas for training. (The editors are grateful to Dr. Thatcher for this graphic.)

Single case methodology in neurobehavioural rehabilitation: Preliminary findings on biofeedback in the treatment of challenging behaviour

The use of single-case methodology (SCM) in brain injury rehabilitation is described and contrasted with other methodologies. SCM is optimal when attempting to meet highly individual presentations or to trial innovative solutions. Portable biofeedback is a potentially effective means of helping persons with brain injury to recognise and regulate emotional states. Emotional dysregulation, associated with disinhibition on tests of executive function, is hypothesised to underpin aggressive challenging behaviour and may be amenable to feedback on heart rate variability, a marker for stress. Two case studies of a novel biofeedback intervention, emWave2, to address aggression directed towards the self and towards others are presented. Data from two A-B designs were analysed using the non-overlap all pairs (NAP) statistical method. Clinical significance of outcome is reported in both cases but only Case 2 reached statistical significance. The discussion highlights limitations of the methodology. Results are discussed in relation to the device helping participants differentiate the physiological state associated with stress. The future application of wearable physiological sensing and feedback systems is explored.

Biofeedback for psychiatric disorders: a systematic review.

Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventions have been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders, depression, dissociation, eating disorders, schizophrenia and psychoses] to date and provide a useful reference for consultation by clinicians and researchers planning to administer a biofeedback treatment. A systematic search of EMBASE, MEDLINE, PsycINFO, and WOK databases and hand searches in Applied Psychophysiology and Biofeedback, and Journal of Neurotherapy, identified 227 articles; 63 of which are included within this review. Electroencephalographic neurofeedback constituted the most investigated modality (31.7%). Anxiety disorders were the most commonly treated (68.3%). Multi-modal biofeedback appeared most effective in significantly ameliorating symptoms, suggesting that targeting more than one physiological modality for bio-regulation increases therapeutic efficacy. Overall, 80.9% of articles reported some level of clinical amelioration related to biofeedback exposure, 65.0% to a statistically significant (p < .05) level of symptom reduction based on reported standardized clinical parameters. Although the heterogeneity of the included studies warrants caution before explicit efficacy statements can be made. Further development of standardized controlled methodological protocols tailored for specific disorders and guidelines to generate comprehensive reports may contribute towards establishing the value of biofeedback interventions within mainstream psychiatry.

Interest of assessment and rehabilitation by visual biofeedback in treatment of postural trouble of fallers’ elderly subjects

Interest of assessment and rehabilitation by visual biofeedback in treatment of postural trouble of fallers’ elderly subjects

Biofeedback and behavioral treatments: filling some gaps.

Biofeedback and related behavioral approaches have been employed for decades in the management of recurrent headache conditions, with ample evidence to support their clinical utility. Initially, these treatments were employed entirely in the office and required an extended number of face-to-face sessions. Researchers have entered a new era wherein they are focusing on ways to make these treatments less intensive on the part of therapists, less expensive on the part of patients, more widely available and accessible, and retain their level of effectiveness. Initial efforts have focused on PLOT, group, internet, and mass media delivery approaches. This article discusses further approaches being explored to continue to extend behavioral treatment options for patients, focusing on alternative approaches for managing headaches, discussing the value of exercise, addressing depression and sleep problems more directly, and incorporating techniques of motivational interviewing. The importance, role, and value of patient education are stressed throughout.

Assessment of biofeedback rehabilitation in post-stroke patients combining fMRI and gait analysis: a case study

BackgroundThe ability to walk independently is a primary goal for rehabilitation after stroke. Gait analysis provides a great amount of valuable information, while functional magnetic resonance imaging (fMRI) offers a powerful approach to define networks involved in motor control. The present study reports a new methodology based on both fMRI and gait analysis outcomes in order to investigate the ability of fMRI to reflect the phases of motor learning before/after electromyographic biofeedback treatment: the preliminary fMRI results of a post stroke subject’s brain activation, during passive and active ankle dorsal/plantarflexion, before and after biofeedback (BFB) rehabilitation are reported and their correlation with gait analysis data investigated.MethodsA control subject and a post-stroke patient with chronic hemiparesis were studied. Functional magnetic resonance images were acquired during a block-design protocol on both subjects while performing passive and active ankle dorsal/plantarflexion. fMRI and gait analysis were assessed on the patient before and after electromyographic biofeedback rehabilitation treatment during gait activities. Lower limb three-dimensional kinematics, kinetics and surface electromyography were evaluated. Correlation between fMRI and gait analysis categorical variables was assessed: agreement/disagreement was assigned to each variable if the value was in/outside the normative range (gait analysis), or for presence of normal/diffuse/no activation of motor area (fMRI).ResultsAltered fMRI activity was found on the post-stroke patient before biofeedback rehabilitation with respect to the control one. Meanwhile the patient showed a diffuse, but more limited brain activation after treatment (less voxels). The post-stroke gait data showed a trend towards the normal range: speed, stride length, ankle power, and ankle positive work increased. Preliminary correlation analysis revealed that consistent changes were observed both for the fMRI data, and the gait analysis data after treatment (R > 0.89): this could be related to the possible effects BFB might have on the central as well as on the peripheral nervous system.ConclusionsOur findings showed that this methodology allows evaluation of the relationship between alterations in gait and brain activation of a post-stroke patient. Such methodology, if applied on a larger sample subjects, could provide information about the specific motor area involved in a rehabilitation treatment.

Anxiety Misdiagnosed as Dementia? A Complex Case Successfully Treated Using a Multimodal Biofeedback Approach

A sixty-three year old woman with a recent diagnosis of dementia sought biofeedback treatment for depression, anxiety, and cognitive impairment. Quantitative electroencephalography (QEEG) revealed brainwave patterns that could be associated with anxiety as well as possible dementia. The context of her forgetfulness and disorientation was explored and discovered to coincide with anxiety-related hyperarousal. Following a combination of heart rate variability (HRV) and neurofeedback (EEG biofeedback), she reported significant reductions in depression, anxiety, and cognitive impairment.

Non-pharmacological Intervention for Chronic Pain in Veterans: A Pilot Study of Heart Rate Variability Biofeedback.

Objective:Chronic pain is an emotionally and physically debilitating form of pain that activates the body's stress response and over time can result in lowered heart rate variability (HRV) power, which is associated with reduced resiliency and lower self-regulatory capacity. This pilot project was intended to determine the effectiveness of HRV coherence biofeedback (HRVCB) as a pain and stress management intervention for veterans with chronic pain and to estimate the effect sizes. It was hypothesized that HRVCB will increase parasympathetic activity resulting in higher HRV coherence measured as power and decrease self-reported pain symptoms in chronic pain patients.Study design:Fourteen veterans receiving treatment for chronic pain were enrolled in the pre-post intervention study. They were randomly assigned, with 8 subjects enrolled in the treatment group and 6 in the control group. The treatment group received biofeedback intervention plus standard care, and the other group received standard care only. The treatment group received four HRVCB training sessions as the intervention.Measures:Pre-post measurements of HRV amplitude, HRV power spectrum variables, cardiac coherence, and self-ratings of perceived pain, stress, negative emotions, and physical activity limitation were made for both treatment and control groups.Results:The mean pain severity for all subjects at baseline, using the self-scored Brief Pain Inventory (BPI), was 26.71 (SD=4.46; range=21–35) indicating a moderate to severe perceived pain level across the study subjects. There was no significant difference between the treatment and control groups at baseline on any of the measures. Post-HRVCB, the treatment group was significantly higher on coherence (P=.01) and lower (P=.02) on pain ratings than the control group. The treatment group showed marked and statistically significant (1-tailed) increases over the baseline in coherence ratio (191%, P=.04) and marked, significant (1-tailed) reduction in pain ratings (36%, P<.001), stress perception (16%, P=.02), negative emotions (49%, P<.001), and physical activity limitation (42%, P<.001). Significant between-group effects on all measures were found when pre-training values were used as covariates.Conclusions:HRVCB intervention was effective in increasing HRV coherence measured as power in the upper range of the LF band and reduced perceived pain, stress, negative emotions, and physical activity limitation in veterans suffering from chronic pain. HRVCB shows promise as an effective non-pharmacological intervention to support standard treatments for chronic pain.

Biofeedback Treatment for Tourette Syndrome

To study the clinical effectiveness of biofeedback treatment in reducing tics in patients with Tourette syndrome. Despite advances in the pharmacologic treatment of patients with Tourette syndrome, many remain troubled by their tics, which may be resistant to multiple medications at tolerable doses. Electrodermal biofeedback is a noninvasive biobehavioral intervention that can be useful in managing neuropsychiatric and neurologic conditions. We conducted a randomized controlled trial of electrodermal biofeedback training in 21 patients with Tourette syndrome. After training the patients for 3 sessions a week over 4 weeks, we observed a significant reduction in tic frequency and improved indices of subjective well-being in both the active-biofeedback and sham-feedback (control) groups, but there was no difference between the groups in these measurements. Furthermore, the active-treatment group did not demonstrably learn to reduce their sympathetic electrodermal tone using biofeedback. Our findings indicate that this form of biofeedback training was unable to produce a clinical effect greater than placebo. The main confounding factor appeared to be the 30-minute duration of the training sessions, which made it difficult for patients to sustain a reduction in sympathetic tone when their tics themselves were generating competing phasic electrodermal arousal responses. Despite a negative finding in this study, electrodermal biofeedback training may have a role in managing tics if optimal training schedules can be identified.

Efectividad de la intervención con biofeedback en el tratamiento conservador de la incontinencia urinaria posprostatectomía. Una revisión sistemática

ObjectiveTo determine the effectiveness of biofeedback for the treatment of post-prostatectomy urinary incontinence. Materials and methodsA systematic review was conducted in the CENTRAL, Pubmed/MEDLINE, EMBASE and CINAHL data bases. Risk of bias in the studies included was assessed with the PEDro scale (Rating Quality of Randomized Controlled Trials). Study selectionRandomized controlled trials with adult patients diagnosed of post-prostatectomy urinary incontinence involving biofeedback for the conservative management were included. ResultsEight studies met the inclusion criteria. Biofeedback interventions included verbal and written instructions, electromyography and anal catheter. ConclusionsThere is limited evidence supporting the effectiveness of biofeedback on the treatment of post-prostatectomy urinary incontinence.

Preparation for action: psychophysiological activity preceding a motor skill as a function of expertise, performance outcome, and psychological pressure.

Knowledge of the psychophysiological responses that characterize optimal motor performance is required to inform biofeedback interventions. This experiment compared cortical, cardiac, muscular, and kinematic activity in 10 experts and 10 novices as they performed golf putts in low- and high-pressure conditions. Results revealed that in the final seconds preceding movement, experts displayed a greater reduction in heart rate and EEG theta, high-alpha, and beta power, when compared to novices. EEG high-alpha power also predicted success, with participants producing less high-alpha power in the seconds preceding putts that were holed compared to those that were missed. Increased pressure had little impact on psychophysiological activity. It was concluded that greater reductions in EEG high-alpha power during preparation for action reflect more resources being devoted to response programming, and could underlie successful accuracy-based performance.

Regulation of arousal and heart rate variability via biofeedback in severe traumatic brain injury.

Event Abstract Back to Event Regulation of arousal and heart rate variability via biofeedback in severe traumatic brain injury. Jacqueline A. Rushby1*, Heather Francis1, Alana Fisher1 and Skye McDonald1 1 University of New South Wales, Psychology, Australia Background: Severe traumatic brain injury (TBI) is known to result in impaired emotion regulation and arousal. Heart rate variability (HRV) is an index of autonomic (dys)regulation, reflecting the balance between sympathetic and parasympathetic influences on the central nervous system. Biofeedback techniques have been found to regulate disrupted HRV and alleviate symptoms in disorders associated with impaired arousal. The present study aimed to examine, whether adults with severe TBI show: i) HRV dysregulation at rest; ii) improved HRV regulation via a biofeedback intervention; as well as how these relate to aspects of emotion regulation. Methods: Thirty adults with severe TBI (Mean posttraumatic amnesia = 49.10 days; Range: 2.00 - 180) and 30 age-, education-, and gender-matched controls participated. Participants completed self-report measures of mood, emotional and cognitive empathy, and trait alexithymia. Relative reports of emotion regulation were also provided for TBI participants. Participants’ HRV and skin conductance levels (SCL) were measured under two 5-minute conditions: i) ’free-breathing’ (resting baseline); ii) ‘biofeedback’ (paced at 6 breaths per minute). Results: Among TBI participants, emotional empathy levels (p = .026), cognitive empathy levels (p < 0.01), and ability to identify and describe one’s own feelings, were all significantly lower compared to controls (p < 0.01). On the autonomic measures, HRV and SCL, there were no differences between the TBI and Control groups, either at rest or during biofeedback (all p > 0.05). Biofeedback training lead to significant increases (improvement) on all HRV measures (p < 0.05) and SCL (p = 0.014) for both groups. Higher HRV during biofeedback, and higher SCLs at rest and during biofeedback, correlated negatively with trait alexithymia subscales in both the overall sample and separate groups (p < 0.05), but not empathy, nor relative reports of emotion regulation (p > 0.05). Conclusion: These results suggest that HRV shows promise as an index of impaired autonomic regulation in severe TBI. Biofeedback training may help normalise HRV in severe TBI; improved autonomic regulation may ameliorate impairments on emotional self-awareness. Keywords: Traumatic Brain Injury, Heart rate variability, social cognition, emotion, Arousal Conference: Australasian Society for Psychophysiology, Inc, Coffs Harbour, Australia, 26 Nov - 28 Nov, 2014. Presentation Type: Oral Presentation Topic: Psychophysiology Citation: Rushby JA, Francis H, Fisher A and McDonald S (2014). Regulation of arousal and heart rate variability via biofeedback in severe traumatic brain injury.. Conference Abstract: Australasian Society for Psychophysiology, Inc. doi: 10.3389/conf.fnhum.2014.216.00024 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 23 Oct 2014; Published Online: 02 Dec 2014. * Correspondence: Dr. Jacqueline A Rushby, University of New South Wales, Psychology, Sydney, Australia, j.rushby@unsw.edu.au Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Jacqueline A Rushby Heather Francis Alana Fisher Skye McDonald Google Jacqueline A Rushby Heather Francis Alana Fisher Skye McDonald Google Scholar Jacqueline A Rushby Heather Francis Alana Fisher Skye McDonald PubMed Jacqueline A Rushby Heather Francis Alana Fisher Skye McDonald Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Infra-slow Fluctuation Training in Clinical Practice: A Technical History

Infra-slow Fluctuation (ISF) electroencephalogram (EEG) biofeedback is a recent development in neurofeedback training. This form of training is focused on the lowest energy the brain produces (< 0.1 Hz). The intervention is performed with a Direct Current (DC) coupled neurofeedback amplifier. It is distinct from Slow Cortical Potential (SCP) training and Infra-Low Frequency (ILF) training. It shares a similar optimization process with ILF that focuses on emergent state shifts within sessions. These state shifts require frequency adjustments that optimize client response to the training in real time. Due to the technical difficulties inherent in recording these frequencies, EEG investigators largely neglected this low energy until recently. As DC amplifiers improved, the slow frequencies became a signal of increasing interest to researchers. Research has demonstrated an important role for the infra-slow oscillations in clinical work. Positive clinical case outcomes suggest that a larger controlled study is warranted. The technical, clinical, and equipment requirements of the intervention make this form of neurofeedback unique in the pantheon of EEG biofeedback interventions.

Dynamic three-dimensional ultrasound study on levator ani muscle fissures for female pelvic floor relaxation syndrome

To explore the value of dynamic three-dimensional ultrasound in detecting the levator ani muscle fissures morphological changes of female pelvic floor relaxation syndrome after biofeedback and acupuncture treatments. Forty female constipation patients with pelvic floor relaxation syndrome were screened from the Constipation Designed Disease Clinic in our hospital between October 2011 and September 2012. Cleveland Constipation Score (CCS) scale was used. Anteroposterior and transverse diameters of the levator ani muscle fissures were measured by dynamic three-dimensional ultrasound in Valsalva maneuver. After a course (10 days) of biofeedback and acupuncture treatments, CCS scale was filled, and dynamic three-dimensional ultrasound was performed in Valsalva maneuver as well. Associated data before and after treatment were compared. Twenty-five patients completed the trial. As compared to pre-treatment, the longitudinal axes of levator ani muscle fissure [(4.89±0.89) cm vs. (5.13±0.82) cm, P<0.01], the horizontal axes of the levator ani muscle fissure [(4.62±0.75) cm vs. (4.86±0.74) cm, P<0.01], and the area of the levator ani muscle fissure [(18.16±6.42) cm(2) vs. (19.92±6.33) cm(2), P<0.01] decreased significantly after treatment, while CCS scale (9.52±2.50 vs. 15.80±3.42, P<0.01) declined significantly as well. The dynamic three-dimensional ultrasound is an effective, simple and non-invasive method for the determination of levator ani muscle fissure in female patients with pelvic floor relaxation syndrome.

Contingent electrical stimulation inhibits jaw muscle activity during sleep but not pain intensity or masticatory muscle pressure pain threshold in self-reported bruxers: a pilot study

This study investigated the effect of contingent electrical stimulation (CES) on present pain intensity (PI), pressure pain threshold (PPT), and electromyographic events per hour of sleep (EMG/h) on probable bruxers with masticatory myofascial pain. The study enrolled 15 probable bruxers with masticatory myofascial pain in 3 phases: (1) baseline EMG/h recording, (2) biofeedback treatment using a CES paradigm (active group, n = 7) or inactive device (control group, n = 8), and (3) posttreatment EMG/h recording. PI and PPT were assessed after each phase. Analysis of variance models were used to compare results at a 5% significance level. Patients in the active group had 35% lower EMG/h in P2 and 38.4% lower EMG/h in P3, when compared with baseline. There were no differences in PI or PPT levels at any phase. CES could reduce EMG activity associated with sleep bruxism in patients with masticatory myofascial pain but did not influence perceived pain.

Long-term effects of electrodermal biofeedback training on seizure control in patients with drug-resistant epilepsy: Two case reports

We report data from two patients, followed over 3 years after electrodermal biofeedback treatment. Patients were trained three times each week for four weeks to increase their sympathetic arousal using electrodermal biofeedback. This treatment was directed at enabling the patients to change their psychophysiological state as a countermeasure to prevent seizures. Both patients voluntarily kept a record of seizure frequency over the year preceding the treatment and continued to record their seizures for up to 3 years after the termination of biofeedback treatment. Both patients showed a marked reduction in seizure frequency (54.9% and 59.8%) during the month of biofeedback treatment. This improvement was maintained over the subsequent years. We highlight the therapeutic potential of biofeedback interventions that enable patients to volitionally control their state of physiological arousal in the management of drug-resistant epilepsy.

Effect of Emotional Regulation on Performance of Soccer Skills

Abstract Present study was aimed at determining efficacy of differential biofeedback training on performance of soccer skills. Forty two young adult male soccer performers, selected for this experiment were assessed on the basis of physiological and psychophysiological parameters and were randomly assigned into three different groups (control group, i.e. - Gr. A, and two experimental groups, Gr. B, who received heart-rate biofeedback training and Gr. C, received skin-conductance biofeedback treatment for 20 sessions). Post-intervention assessment of physiological and psychophysiological parameters however indicated improvement in juggling performance followed by biofeedback treatment, while no such improvement was observed in control group participants.

The value of anorectal investigations in predicting patient outcome after biofeedback treatment for management of faecal incontinence

The value of anorectal investigations in predicting patient outcome after biofeedback treatment for management of faecal incontinence

Ultrasound Biofeedback Treatment for Persisting Childhood Apraxia of Speech

The purpose of this study was to evaluate the efficacy of a treatment program that includes ultrasound biofeedback for children with persisting speech sound errors associated with childhood apraxia of speech (CAS). Six children ages 9-15 years participated in a multiple baseline experiment for 18 treatment sessions during which treatment focused on producing sequences involving lingual sounds. Children were cued to modify their tongue movements using visual feedback from real-time ultrasound images. Probe data were collected before, during, and after treatment to assess word-level accuracy for treated and untreated sound sequences. As participants reached preestablished performance criteria, new sequences were introduced into treatment. All participants met the performance criterion (80% accuracy for 2 consecutive sessions) on at least 2 treated sound sequences. Across the 6 participants, performance criterion was met for 23 of 31 treated sequences in an average of 5 sessions. Some participants showed no improvement in untreated sequences, whereas others showed generalization to untreated sequences that were phonetically similar to the treated sequences. Most gains were maintained 2 months after the end of treatment. The percentage of phonemes correct increased significantly from pretreatment to the 2-month follow-up. A treatment program including ultrasound biofeedback is a viable option for improving speech sound accuracy in children with persisting speech sound errors associated with CAS.