Biofeedback Treatment Research Articles

A Randomized Controlled Trial of Treatment Distribution and Biofeedback Effects on Speech Production in School-Age Children With Apraxia of Speech.

This study examines how ultrasound biofeedback and intensive treatment distribution affect speech sound generalization during an evidence-based treatment, Speech Motor Chaining, for children with persisting speech errors associated with childhood apraxia of speech (CAS). In a 2 × 2 factorial randomized controlled trial, children ages 9-17 years meeting CAS criteria were randomized to receive (a) a distributed treatment (20 sessions twice weekly over 10 weeks) or intensive treatment (20 hr in 5 weeks, with 10 hr in Week 1) and (b) treatment with or without biofeedback. Due to the COVID pandemic, some participants were randomized to distributed/intensive telepractice treatment only. The primary outcome was percent target sounds correct on untreated phrases (i.e., generalization) at the 10-week time point. More than 50,000 narrow phonetic transcriptions were analyzed. Forty-eight participants completed treatment. Intensive treatment significantly increased generalization at all time points. The effect of biofeedback was significant at 5 weeks from the start of treatment but not significant at the primary 10-week time point. However, when comparing each group immediately after their 20 hr of treatment finished, generalization was significantly greater in intensive over distributed treatment and greater in ultrasound over no-ultrasound treatment (with a significant interaction favoring intensive treatment with ultrasound). Only the advantage of intensive treatment remained significant 5 weeks after groups finished treatment. There was no significant difference between face-to-face and telepractice modalities. When the number of treatment hours is fixed, an intensive schedule of Speech Motor Chaining facilitated greater improvement than a distributed schedule. Ultrasound biofeedback initially accelerated learning, but the benefits may dissipate as treatment continues or after it ends.

The use of biofeedback techniques in clinical practice

In the past decades, biofeedback has become a widely adopted non-pharmacological option in the management of a variety of somatic, neurological, and psychiatric conditions. The biofeedback method is based on the associations between one’s vegetative and mental functions; during a session with the device, information about the change in his/her condition over time is “returned” to the patient as accessible audial or visual stimuli. The efficacy of biofeedback treatment may primarily be attributed to improvements in the state of the patients based on establishing an individual model of his/her best psychophysiological state, enabling effective rehabilitation activities at a rate suitable for each patient along with ensuring better awareness of the patient of his/her body functions; such an intervention is stepwise and helps sustain the patient’s motivation for success, thus affecting the pathological condition. This review describes the historical prerequisites for the development of biofeedback techniques and the principal mechanisms of their action; a brief summary of studies looking at the efficacy of this method in various somatic, neurological, and psychiatric conditions is also provided. The presented data clearly indicate that the use of biofeedback results in a decreased medication load in patients suffering from conditions such as arterial hypertension, epilepsy, ADHD, chronic pain, anxiety disorders, autism etc. while there are practically no contraindications for this method, except for acute psychosis, photosensitive epilepsy, and severe cognitive impairment. In this connection, clinical implementation of biofeedback techniques should be intensified in a variety of conditions.

A sensitive LC-MS/MS methotrexate assay capable of assessing adherence to methotrexate therapy in rheumatoid arthritis.

To develop a sensitive liquid chromatography-tandem mass spectrometry method capable of measuring serum methotrexate in patients with rheumatoid arthritis to assess adherence to drug treatment. Isotopically labelled internal standard and deionised water were added to sample prior to solid phase extraction using a Waters Oasis Max ion-exchange 96-well plate. Following extraction, samples were analysed by LC-MS/MS on a TQS-micro mass spectrometer. Mean recovery was 107 % for four different concentrations of methotrexate spiked into seven patient samples, whilst post extraction spiking gave a mean recovery of 100 %. Between-batch and within-batch CVs were≤6 % at three different concentrations of methotrexate in fresh frozen plasma. Mean bias was <5 % for between-batch and within batch analysis at three different weighed in concentrations of methotrexate certified reference material. The lower limit of quantification of the assay was 0.1 nmol/L with linearity up to approximately 100 nmol/L. Dilution linearity studies were used to validate the dilution of patient samples prior to analysis. There was no significant interference in the method from lipaemia, haemolysis or icterus. A sensitive LC-MS/MS assay for methotrexate has been developed and validated. The method has been used to measure methotrexate adherence in patient samples from clinical trials and could be used in future research to assess the ability of the assay as a biofeedback intervention to improve adherence to methotrexate therapy.

A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia.

The purpose of this study is to investigate the efficacy of bilateral upper-limb training (BULT) in helping people with upper-limb impairments due to stroke or brain illness regain their previous level of function. Patients recuperating from a stroke or cerebral disease were given the option of undergoing BULT or conventional training to enhance their upper-limb function. Participants were randomly allocated to one of the several different fitness programs. Results from the action research arm test, Box and block test, Wolf motor function test, Fugal-Meyer evaluation, and any other tests administered were taken into account. Some researchers have found that exercising with BULT for just 30 min per day for 6 weeks yields significant results. There were a total of 1,411 individuals from 10 randomized controlled trials included in this meta-analysis. Meta-analysis findings revealed that biofeedback treatment outperformed conventional rehabilitation therapy in reducing lower leg muscular strain, complete spasm scale score, electromyography score, and inactive ankle joint range of motion. An analysis of the literature found that BULT improved limb use in people who had suffered a stroke and hemiplegia but it did not provide any additional benefit over unilateral training.

The Evaluation of Electromyography Biofeedback on Proprioception and Balance in Healthy Young Athletes

Introduction: We evaluated the effect of electromyography biofeedback on proprioception and functional balance in healthy young athletes.&#x0D; Materials and Methods: In this clinical trial, 24 athletes were randomly divided into two study (n=12) and control (n=12) groups. The study group received rehabilitation exercises, including one-foot standing, squatted standing, and isometric contraction of quadriceps muscle at different knee angles, including 30, 45, and 90 degrees of knee flexion along with electromyography biofeedback. The control group received only rehabilitation exercises without electromyography biofeedback. Exercises were performed by both groups for a 4-week period in three sessions per week. Functional balance and proprioception before and after exercises were measured using the star excursion balance test and a system consisting of digital photography non-reflective markers, respectively. The data of the center of pressure and time of vertical ground reaction force using a force plate was also collected to evaluate static balance and dynamic balance, respectively.&#x0D; Results: The absolute error in knee joint reconstruction for 30° (P=0.005), 45° (P=0.001), and 90° (P=0.033) angles significantly decreased after the intervention in the study group compared to the control group. Star excursion balance test scores in all directions did not show any significant differences between the two groups (P&gt;0.05), except for the anterior-lateral direction (P=0.03). Moreover, all variables related to static and dynamic balance did not show a significant difference between two the groups after the interventions (P&gt;0.05).&#x0D; Conclusion: The electromyography biofeedback intervention can probably be used as a rehabilitation protocol in recovering and healing proprioception injuries resulting from sports injuries.

Runners’ responses to a biofeedback intervention aimed to reduce tibial acceleration differ within and between individuals

An increment in peak tibial acceleration (PTA) may be related to an increased risk of running-rated injury. Many authors believe that reducing PTA through improved shock-absorption could, therefore, help prevent injury. The aim of the current study was, therefore, to investigate the individual responses of participants to a biofeedback intervention aimed at reducing PTA.11 participants (two females, nine males; 43 ± 10 years; stature: 1.74 ± 0.07 m; body mass: 74 ± 11 kg; distance running a week: 19 ± 14 km; 5 km time: 24 ± 3 min) received an intervention of six sessions of multisensory biofeedback aimed at reducing PTA. Mean PTA and kinematic patterns were measured at baseline, directly after the feedback intervention and a month after the end of the intervention. Group as well as single-subject analyses were performed to quantify differences between the sessions. A significant decrease of 26 per cent (effect size: Hedges’ g = 0.94) in mean PTA was found a month after the intervention. No significant changes or large effect sizes were found for any group differences in the kinematic variables. However, on an individual level, shock-absorbing solutions differed both within and between participants. The data suggest participants did not learn a specific solution to reduce PTA but rather learned the concept of reducing PTA. These results suggest future research in gait retraining should investigate individual learning responses and focus on the different strategies participants use both between and within sessions. For training purposes, participants should not focus on learning one running strategy, but they should explore several strategies.

MANAGING ANXIETY AND STRESS IN HYPERTENSION: DEVELOPMENT OF HEART RATE VARIABILITY BIOFEEDBACK WITH PSYCHOLOGICAL SUPPORT

Objective: How can digital wearable Heart Rate Variability (HRV) biofeedback and psychological support be used to improve the management of anxiety and stress in hypertension? Design and method: A mixed methods study was used to develop and evaluate initial outcomes from a HRV biofeedback intervention for the management of anxiety and stress in hypertension. We used systematic review evidence to guide a series of patient and stakeholder consultations to co-design a HRV biofeedback intervention to assess and treat anxiety and cardiovascular stress reactivity in a hypertension specialist outpatient's service. We evaluated initial outcomes from case studies of 15 patients who attended 2-5 x 1 hour face to face sessions with a Health Psychologist. Sessions involved: 1) assessment of anxiety and stress responses; 2) resonance frequency breathing training with HRV biofeedback with a respiration rate (between 6.5 and 4.5 breaths/minute) to produce optimal baroreflex stimulation and blood pressure regulation; 3) psychological skills development for dealing with anxiety and stress. Results: At 8 weeks follow up, 45% patients reported a 5-10 mmHg systolic reduction in blood pressure and 55% reported a reduction of 10-20 mmHg. 85% of patients reported increased morning HRV readiness scores and improvements in patient reported psychological outcomes (e.g. improvements in BP, anxiety reduction and increase in valued activities). 11 patients reported improved health behaviour change (increased physical activity, improved diet, reduction in alcohol intake). Whitecoat hypertension was improved in 70% of patients. Conclusions: Biofeedback with psychological support can help improve anxiety and stress symptoms, as well as improvements in systolic blood pressure within an integrated specialist hypertension team.

Implementing biofeedback treatment in a psychosomatic-psychotherapeutic inpatient unit: a mixed methods evaluation of acceptance, satisfaction, and feasibility.

Feedback-based therapies such as biofeedback have a benefit in patients with mental health disorders. While biofeedback is heavily researched in outpatient settings, it has been rarely investigated in psychosomatic inpatient settings. The implementation of an additional treatment option in inpatient settings holds special requirements. The aim of this pilot study is the evaluation of additional biofeedback treatment in an inpatient psychosomatic-psychotherapeutic unit to derive clinical implications and recommendations for the future implementation of biofeedback offers. The evaluation of the implementation process was investigated using a convergent parallel mixed methods approach (following MMARS guidelines). Quantitative questionnaires measured patients' acceptance and satisfaction with biofeedback treatment after receiving 10 sessions in addition to treatment as usual. After 6 months during implementation, qualitative interviews were conducted with biofeedback practitioners, i.e., staff nurses, examining acceptance and feasibility. Data analysis was conducted using either descriptive statistics or Mayring's qualitative content analysis. In total, 40 patients and 10 biofeedback practitioners were included. Quantitative questionnaires revealed high satisfaction and acceptance in patients regarding biofeedback treatment. Qualitative interviews showed high acceptance in biofeedback practitioners but revealed several challenges that were encountered during the implementation process, e.g., increased workload due to additional tasks, organizational and structural difficulties. However, biofeedback practitioners were enabled to expand their own competencies and take over a therapeutic part of the inpatient treatment. Even though patient satisfaction and staff motivation are high, the implementation of biofeedback in an inpatient unit requires special actions to be taken. Not only should personnel resources be planned and available in advance of implementation but also be the workflow for biofeedback practitioners as easy and quality of biofeedback treatment as high as possible. Consequently, the implementation of a manualized biofeedback treatment should be considered. Nevertheless, more research needs to be done about suitable biofeedback protocols for this patient clientele.

A systematic review of heart rate variability (HRV) biofeedback treatment following traumatic brain injury (TBI)

ABSTRACT Objective Autonomic nervous system dysregulation is a common consequence of traumatic brain injury (TBI). Heart rate variability (HRV) is a cost-effective measure of autonomic nervous system functioning, with studies suggesting decreased HRV following moderate-to-severe TBI. HRV biofeedback treatment may improve post-TBI autonomic nervous system functioning and post-injury emotional and cognitive functioning. We provide a systematic evidence-based review of the state of the literature and effectiveness of HRV biofeedback following TBI. Method We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two coders coded each article and provided quality ratings. Seven papers met inclusion criteria. All studies included a measure of emotional functioning and 5 studies (63%) included neuropsychological outcomes. Results Participants completed 11 sessions of HRV biofeedback on average (range = 1 to 40). HRV biofeedback was associated with improved HRV following TBI. There was a positive relationship between increased HRV and TBI recovery following biofeedback, including improvements in cognitive and emotional functioning, and physical symptoms such as headaches, dizziness, and sleep problems. Conclusion The literature on HRV biofeedback for TBI is promising, but in its infancy; effectiveness is unclear due to poor-to-fair study quality, and potential publication bias (all studies reported positive results).

A combined heart rate variability biofeedback and progressive aerobic exercise intervention for remediating persistent post-concussive symptoms. (P7-1.006)

<h3>Objective:</h3> Evaluate the combined benefit of heart-rate variability biofeedback (HRVB) and progressive aerobic exercise (PAE) for remediating persistent post-concussive symptoms (PPCS). <h3>Background:</h3> Cardio-autonomic dysfunction is a key patho-physiological process underlying PPCS. Therefore, any interventions targeting cardioautonomic dysfunction should help ameliorate PPCS. Preliminary research suggests PAE and HRVB can improve cardio-autonomic dysfunction and clinical symptoms. However, none have evaluated whether there is a combined benefit. <h3>Design/Methods:</h3> Participants were randomized into a six-week intervention consisting of either HRVB, PAE or HRVB+PAE. Concussion symptoms, HRV, cognition, and mood states were assessed pre- and post-intervention. The HRVB group practiced resonant-frequency breathing for 20 minutes, four nights a week. The PAE group completed a three-day-a-week aerobic exercise protocol that gradually increased in intensity and duration. The HRVB+PAE group completed HRVB training four nights a week and PAE three days a week. <h3>Results:</h3> Each intervention resulted in significant improvement in concussion symptoms, HRV, cognition, and mood states (ps≤.05). PAE resulted in greater reductions in sleep disturbance, depressive symptoms, and total mood disturbance than HRVB (ps≤.05). HRVB+PAE resulted in the largest improvements in cognition, depressive symptoms, and mood disturbance (ps≤.05), but had no additional benefit beyond HRVB or PAE for concussion symptoms, or PAE for sleep disturbance. Each intervention improved cardio-autonomic function as indexed by changes in both time and frequency domain measures of HRV (ps≤.05). Surprisingly, HRVB did not result in greater changes on any HRV metric than PAE (ps≥.19). However, HRVB+PAE resulted in greater changes in the time domain (RMSDD) and frequency domain (HF, coherence ratio) metrics beyond HRVB or PAE. <h3>Conclusions:</h3> Both HRVB and PAE can help ameliorate cardio-autonomic dysfunction but HRVB+PAE resulted in additive benefits in cardio-autonomic function, cognition, and psycho-affective health beyond HRVB or PAE alone. These interventions are low-cost, easy to implement, and may be a feasible non-pharmacological treatment for PPCS. <b>Disclosure:</b> Dr. Moore has nothing to disclose. Mr. Gunn has nothing to disclose. Mr. Kay has nothing to disclose.

Effect of electromyography biofeedback treatment on reaction time, pain, hand grip strength, and upper extremity functional status in patients with carpal tunnel syndrome.

Purpose: The aim of the study was to investigate the effect of electromyography biofeedback (EMG-BF), which in addition to conventional electrophysical therapy (EPT) commonly used in the symptomatic treatment of carpal tunnel syndrome (CTS), on motor parameters such as strength and reaction time and symptomatic functional parameters such as pain and function of the upper extremity.&#x0D; Materials and Methods: Patients diagnosed with CTS were divided into two groups. The first group was the conventional EPT group only (control group, n=46 hands), and the second group was the group that received EMG-BF in addition to the conventional EPT treatment (research group, n=42 hands). The pain (VAS), hand grip strength (HGS), audio-visual reaction time (ART-VRT), and upper extremity disability (Quick DASH) of patients in both groups were assessed before and after the treatment program.&#x0D; Results: After treatment, VRT, ART, HGS, and Quick DASH were significantly better in favor of the EPT +EMG- BF group. Before treatment, resting state (VASr), mobile state (VASm), and night state (VASn) VAS values were similar between the two groups. After training, the VAS -values were better in favor of the EPT +EMG- BF –group.&#x0D; Conclusion: Although EPT applications provide effective results in the rehabilitation of CTS, EMG-BF applications together with EPT applications provide more meaningful results in the rehabilitation process.

Modulating heart rate oscillation affects plasma amyloid beta and tau levels in younger and older adults

Slow paced breathing via heart rate variability (HRV) biofeedback stimulates vagus-nerve pathways that counter noradrenergic stress and arousal pathways that can influence production and clearance of Alzheimer's disease (AD)-related proteins. Thus, we examined whether HRV biofeedback intervention affects plasma Αβ40, Αβ42, total tau (tTau), and phosphorylated tau-181 (pTau-181) levels. We randomized healthy adults (N = 108) to use slow-paced breathing with HRV biofeedback to increase heart rate oscillations (Osc+) or to use personalized strategies with HRV biofeedback to decrease heart rate oscillations (Osc−). They practiced 20–40 min daily. Four weeks of practicing the Osc+ and Osc− conditions produced large effect size differences in change in plasma Aβ40 and Aβ42 levels. The Osc+ condition decreased plasma Αβ while the Osc− condition increased Αβ. Decreases in Αβ were associated with decreases in gene transcription indicators of β-adrenergic signaling, linking effects to the noradrenergic system. There were also opposing effects of the Osc+ and Osc− interventions on tTau for younger adults and pTau-181 for older adults. These results provide novel data supporting a causal role of autonomic activity in modulating plasma AD-related biomarkers.Trial registration: NCT03458910 (ClinicalTrials.gov); first posted on 03/08/2018.

Efficacy of an Audio-Based Biofeedback Intervention to Modify Running Gait in Female Runners.

A variety of gait retraining interventions are available to modify running mechanics associated with musculoskeletal injuries. These often require specialized equipment and/or personnel to prompt the runner toward specific strategies. To determine whether instructing female recreational runners to "run quietly" could decrease impact force characteristics. Cohort. Research laboratory. Fifteen healthy female recreational runners (24 [7]y) volunteered. Baseline testing occurred on day 1 (baseline), a posttraining assessment occurred on day 2 (training), and a final assessment occurred 1week after training on day 3 (follow-up). A smartphone decibel measuring app was used to provide biofeedback on the decibel level of foot strike on day 2 (training). Peak vertical force, impact transient, peak and average vertical loading rate, ground contact time, and running economy were collected on each day and compared via repeated-measures analyses of variance. Vertical ground reaction force was lower at follow-up (2.30bodyweights [BW]) versus baseline (2.39BW, P = .023) and training (2.34BW, P = .047). Maximal loading rate decreased from baseline (69.70BW·s-1) to training (62.24BW·s-1, P = .021) and follow-up (60.35BW·s-1, P = .031). There was no change in running economy. Our findings demonstrate that simple instructions to "run quietly" can yield immediate and sustained reductions in impact force profiles, which do not influence running economy.

Quantification of swallowing movements by ultrasound imaging in normal and disordered subjects

Ultrasound imaging may be useful for tracking oral-pharyngeal structures of the vocal tract critical for effective swallowing, but use of this technology has been hampered by a lack of validation against standard clinical measures derived from x-ray video fluoroscopy (Modified Barium Swallow Studies or MBSS). Here, we compare quantitative tracking of hyoid bone and tongue motion from ultrasound imaging and simultaneously measured MBSS from a range of participants with disordered and healthy swallowing behavior. The proximal edge of the hyoid bone in MBSS and ultrasound recordings is tracked using CASM (Computational Analysis of Swallowing Mechanics) software, while tongue motion is tracked using TonguePART software, originally developed for analysis of speech. Hyoid trajectories and velocities measured from synchronized ultrasound and MBSS recordings are compared and standard deviations of differences between the two measurements are evaluated. Tongue motion during swallowing is characterized by analysis of root, dorsum, and blade displacement, velocity, and timingas well as tongue base retraction in the pharynx. Preliminary findings show quantitatively similar patterns in ultrasound and MBSS, suggesting that ultrasound has potential utility as an accessible tool for bedside diagnosis and biofeedback. Characteristic patterns separating normal from healthy swallowing, as well as potential therapeutic targets for biofeedback treatment of dysphagia, will be discussed.

Biofeedback Has Therapeutic Effects on Asthma, Although Additional Research Is Needed to Document Specificity

Asthma is a common disorder leading to significant disability and healthcare cost throughout the world. Although medical treatment is usually highly effective in controlling it, asthma medicines often have high costs and attendant side effects. Biofeedback is an inexpensive noninvasive alternative with minimal side effects. This paper reviews evidence for two validated biofeedback treatments for treating asthma, heart rate variability biofeedback (HRVB), and muscle relaxation with surface electromyographic biofeedback. In multiple studies, although most of them are of modest size, both methods have clinically meaningful results, often allowing decreases in the use of steroid medication. Further research is needed to prove which specific components of HRVB are responsible for clinical effects, and to determine asthma populations that can best benefit from these methods. Despite demonstrated effectiveness, few insurance schemes reimburse for biofeedback, and national guidelines consider it only as worthy of further investigation. Funding for the requisite large-scale clinical trials remains lacking, creating a limbo-like status quo for these useful methods.

Acceptability of a Telerehabilitation Biofeedback System Among Stroke Survivors: A Qualitative Analysis.

Electromyography (EMG) biofeedback delivered via telerehabilitation can increase access to occupational therapy services for stroke survivors with severe impairment, but there is limited research on its acceptability. This study identified factors influencing the acceptability of a complex, muscle biofeedback system (Tele-REINVENT) for upper extremity sensorimotor stroke telerehabilitation among stroke survivors. We conducted interviews with stroke survivors (n = 4) who used Tele-REINVENT at home for 6 weeks and analyzed the data with reflexive thematic analysis. Biofeedback, customization, gamification, and predictability affected the acceptability of Tele-REINVENT among stroke survivors. Across themes, features and experiences that gave participants agency and control were more acceptable. Our findings contribute to the design and development of at-home EMG biofeedback interventions, which can improve access to advanced occupational therapy treatment options for those who need it most.

Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study.

Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.

Effect of a slow-paced breathing with heart rate variability biofeedback intervention on pro-inflammatory cytokines in individuals with panic disorder - A randomized controlled trial

A generalized proinflammatory state has been observed in individuals with panic disorder (PD). There is evidence that slow-paced breathing (SPB) with heart rate variability-biofeedback (HRV-BF) strengthens the nervus vagus with its anti-inflammatory pathway. Therefore, with this randomized controlled trial we aimed to investigate the effect of a four-week SPB with HRV-BF intervention on pro-inflammatory cytokines in people with PD. Fifty-five individuals with PD (mean age: 37.22 ± 15.13 years) were randomly allocated either to SPB-HRV-BF (intervention group) or to HRV-Sham-BF (active control group). SPB-HRV-BF was performed over four weeks while cytokine concentration and HRV during a short-term resting condition were measured before and after intervention. SPB-HRV-BF decreased concentration of Tumor Necrosis Factor alpha (TNF-alpha) (F(1, 53) = 4.396, p ≤ .05, η2 = 0.077) in individuals with PD. In addition, SPB-HRV-BF demonstrated an increase in the HRV-time and frequency domain parameters SDNN, Total Power and LF during short-term resting condition. There was no intervention effect in HRV-Sham-BF group. In conclusion, SBP-HRV-BF as a non-pharmacological treatment may reduce pro-inflammatory cytokine TNF-alpha via the cholinergic anti-inflammatory pathway in individuals with PD. Based on the generalized proinflammatory state in PD, decreasing TNF-alpha is highly beneficial to reduce risk of cardiovascular diseases and metabolic syndrome.

Tutorial: Using Visual-Acoustic Biofeedback for Speech Sound Training.

This tutorial summarizes current practices using visual-acoustic biofeedback (VAB) treatment to improve speech outcomes for individuals with speech sound difficulties. Clinical strategies will focus on residual distortions of /ɹ/. Summary evidence related to the characteristics of VAB and the populations that may benefit from this treatment are reviewed. Guidelines are provided for clinicians on how to use VAB with clients to identify and modify their productions to match an acoustic representation. The clinical application of a linear predictive coding spectrum is emphasized. Successful use of VAB requires several key factors including clinician and client comprehension of the acoustic representation, appropriate acoustic target and template selection, as well as appropriate selection of articulatory strategies, practice schedules, and feedback models to scaffold acquisition of new speech sounds. Integrating a VAB component in clinical practice offers additional intervention options for individuals with speech sound difficulties and often facilitates improved speech sound acquisition and generalization outcomes. https://doi.org/10.23641/asha.21817722.

A meta analysis of TCM syndrome differentiation and treatment combined with biofeedback in the treatment of functional constipation

Objective: To systematically evaluate the efficacy of TCM syndrome differentiation and treatment combined with biofeedback in the treatment of functional constipation. Methods: All the clinical randomized controlled trials (RCTs) of TCM syndrome differentiation and treatment combined with biofeedback in the treatment of functional constipation, which were published in September 2022, were retrieved by computer from CNKI, VIP, Wanfang, The Cochrane Library, Pubmed and Embase and other databases. Use RevMan5.3 software for meta analysis. Results: Totally 937 patients were included in 16 clinical randomized controlled trials. Meta analysis showed that traditional Chinese medicine based on syndrome differentiation and treatment combined with biofeedback treatment for functional constipation had more advantages than conventional biofeedback treatment in terms of effective rate (RR=1.21, 95% CI (1.13, 1.30), Z=5.61, P<0.0001) and improvement of constipation symptom score (SMD=-0.31, 95% CI (-0.53, -0.10), Z=2.82, P=0.005), and the negative rate was higher in balloon ejection test (RR=1.26, 95% CI (1.05, 1.50), Z=2.48, P=0.01), It plays a role in reducing anal systolic pressure (MD=15.56, 95% CI (8.59, 22.53), Z=4.38, P<0.0001), but it has no statistical significance in reducing anal resting pressure (MD=-1.25, 95% CI (-15.75, 13.25), Z=0.17, P=0.87), It also played a very good role in reducing anxiety score (MD=-5.04, 95% CI (-7.16, -2.92), Z=4.66, P<0.00001) and depression score (MD=-5.85, 95% CI (-7.93, -3.77), Z=5.52, P<0.00001), and had a greater advantage in reducing follow-up recurrence rate (RR=0.39, 95% CI (0.25, 0.60), Z=4.27, P<0.0001). In terms of adverse reactions, there was no significant difference between the treatment group and the observation group (P=1.00). Conclusion: TCM syndrome differentiation and treatment combined with biofeedback has more advantages than conventional biofeedback treatment.