Biofeedback Research Articles

Efficacy of Traditional Acupuncture Compared to Biofeedback Therapy in Fecal Incontinence: A Randomized Controlled Trial.

Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy, including biofeedback therapy, improves mild symptoms with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity, resulting in low uptake and acceptability. Although acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well accepted as a treatment strategy. To determine the effectiveness of traditional Chinese medicine acupuncture, compared to biofeedback therapy, in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life after treatment. Randomized controlled trial. Prospective, single-institution study. Patients with 2 or more episodes of fecal incontinence per week or St. Mark's incontinence score of 5 or higher were recruited. Patients were randomly assigned into biofeedback therapy, which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks. Incontinence episodes, St. Mark's score, and fecal incontinence quality-of-life scale. Eighty-five patients were randomly assigned to biofeedback therapy (n = 46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different ( p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer episodes at week 15 ( p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 ( p < 0.05). Although the St. Mark's score was significantly reduced in both arms at week 15 ( p < 0.001), the acupuncture arm's score was significantly lower ( p = 0.002). Longer follow-up is required. Acupuncture is clinically effective and improves the quality of life in patients with fecal incontinence. See Video Abstract . Clinicaltrials.gov : NCT04276350. ANTECEDENTES:La incontinencia fecal tiene un impacto devastador en la calidad de vida e impone una carga socioeconómica sustancial. La mejor terapia médica, incluida la terapia de biorretroalimentación, mejora los síntomas leves, con un impacto mínimo sobre los síntomas moderados a graves. El tratamiento quirúrgico de la incontinencia conlleva un grado de morbilidad que resulta en una baja aceptación y aceptabilidad. Si bien la acupuntura es una práctica común en Singapur para numerosas afecciones médicas, su papel en la incontinencia fecal es relativamente novedoso. Sin embargo, en nuestro contexto local, la acupuntura es accesible, económica y potencialmente bien aceptada como estrategia de tratamiento.OBJETIVO:Determinar la efectividad de la acupuntura de la Medicina Tradicional China, en comparación con la terapia de biorretroalimentación en el tratamiento de la incontinencia fecal. El objetivo secundario es investigar las diferencias en la calidad de vida después del tratamiento.DISEÑO:Ensayo controlado aleatorio.AJUSTE:Estudio prospectivo de una sola institución.PACIENTES:Se reclutaron pacientes con >2 episodios de incontinencia fecal/semana o una puntuación de incontinencia de St. Mark's >5. Los pacientes fueron asignados aleatoriamente a una terapia de biorretroalimentación que incluyó 3 sesiones durante 10 semanas o 30 sesiones de acupuntura durante 10 semanas.PRINCIPALES MEDIDAS DE RESULTADO:Episodios de incontinencia, puntuación de St. Mark's y escala de calidad de vida de incontinencia fecal.RESULTADOS:Ochenta y cinco pacientes fueron asignados aleatoriamente a terapia de biorretroalimentación (n = 46) o acupuntura (n = 39). Las características demográficas y clínicas iniciales no fueron diferentes ( p > 0,05). La mediana general de episodios de incontinencia se redujo en ambos, y el grupo de acupuntura informó significativamente menos en la semana 15 ( p <0,001). La acupuntura también mejoró la calidad de vida, con mejoras en el estilo de vida, el afrontamiento, la depresión y la vergüenza en la semana 15 ( p <0,05). Mientras que la puntuación de St Mark se redujo significativamente en ambos brazos en la semana 15 ( p < 0,001), la puntuación del brazo de acupuntura fue significativamente menor (p = 0,002).LIMITACIONES:Se requiere un seguimiento más prolongado.CONCLUSIONES:La acupuntura es clínicamente efectiva y mejora la calidad de vida en pacientes con incontinencia fecal. (Traducción-Dr Yolanda Colorado ).

Biofeedback combined with percutaneous electrical pudendal nerve stimulation for the treatment of low anterior rectal resection syndrome: a study protocol for a randomized controlled trial

BackgroundLow anterior resection syndrome (LARS) is a distressing condition that affects approximately 25–80% of patients following surgery for rectal cancer. LARS is characterized by debilitating bowel dysfunction symptoms, including fecal incontinence, urgent bowel movements, and increased frequency of bowel movements. Although biofeedback therapy has demonstrated effectiveness in improving postoperative rectal control, the research results have not fulfilled expectations. Recent research has highlighted that stimulating the pudendal perineal nerves has a superior impact on enhancing pelvic floor muscle function than biofeedback alone. Hence, this study aims to evaluate the efficacy of a combined approach integrating biofeedback with percutaneous electrical pudendal nerve stimulation (B-PEPNS) in patients with LARS through a randomized controlled trial (RCT).Methods and analysisIn this two-armed multicenter RCT, 242 participants with LARS after rectal surgery will be randomly assigned to undergo B-PEPNS (intervention group) or biofeedback (control group). Over 4 weeks, each participant will undergo 20 treatment sessions. The primary outcome will be the LARS score. The secondary outcomes will be anorectal manometry and pelvic floor muscle electromyography findings and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 29 (EORTC QLQ-CR29) scores. Data will be collected at baseline, post-intervention (1 month), and follow-up (6 months).DiscussionWe anticipate that this study will contribute further evidence regarding the efficacy of B-PEPNS in alleviating LARS symptoms and enhancing the quality of life for patients following rectal cancer surgery.Trial registrationChinese Clincal Trials Register ChiCTR2300078101. Registered 28 November 2023.

Prospective Randomized Trial Comparing 2 Devices for Deep Inspiration Breath Hold Management in Breast Radiation Therapy: Results of the BRAVEHeart Trial

Aims: The BRAVEHeart trial prospectively randomized left-sided breast cancer patients to one of two deep inspiration breath hold (DIBH) biofeedback devices: a novel chest surface tracking system and an abdominal block tracking system. The primary hypothesis was that the accuracy of chest tracking would be higher than that of abdominal tracking as the chest is a more direct surrogate of the breast target.Methods: Left-sided breast cancer patients were treated in DIBH with IMRT delivery. Patients were randomized to either the novel chest surface system or abdominal block system for active management of breath hold with visual feedback. On both trial arms the unallocated system monitored passively.239,296 cine EPID images were analyzed retrospectively to extract the chest wall position. Treatment accuracy was quantified as the deviation of the internal chest wall during treatment relative to the planned position from the digitally reconstructed radiograph. The correlation between motion of the external surrogate and internal chest wall was calculated per breath hold. Ease of use was assessed with questionnaires for both radiation therapists and patients and appointment length recorded.Results: Data from 26 participants were available for analysis. No difference was found in delivered treatment accuracy between arms. Across all patients and fractions, the median correlation between internal chest wall movement and external surrogate was 0.69 for the chest surface and 0.17 for the abdominal block. Patients found it easy to follow visual feedback from both systems. No difference was found in appointment length between arms.Conclusions: No statistical evidence was found for superior treatment accuracy, satisfaction or appointment length for the novel chest surface tracking device compared to the abdominal block system. During DIBH, the median per-breath hold correlation of internal chest wall movement to the motion of the chest surface was higher than the median correlation of the abdominal block to the chest surface.

Fecal incontinence patients categorized based on anal pressure and electromyography: Anal sphincter damage and clinical symptoms.

Disruption of external anal sphincter muscle (EAS) is an important factor in the multifactorial etiology of fecal incontinence (FI). We categorize FI patients into four groups based on the location of lesion in neuromuscular circuitry of EAS to determine if there are differences with regards to fecal incontinence symptoms severity (FISI) score, age, BMI, obstetrical history, and anal sphincter muscle damage. Female patients (151) without any neurological symptoms, who had undergone high-resolution manometry, anal sphincter EMG, and 3D ultrasound imaging of the anal sphincter were assessed. Patients were categorized into four groups: Group 1 (normal)-normal cough EMG (>10 μV), normal squeeze EMG (>10 μV), and normal anal squeeze pressure (>124 mmHg); Group 2 (cortical apraxia, i.e., poor cortical activation)-normal cough EMG, low squeeze EMG, and low anal squeeze pressure; Group 3 (muscle damage)-normal cough EMG, normal squeeze EMG, and low anal squeeze pressure; and Group 4 (pudendal nerve damage)-low cough EMG, low squeeze EMG, and low anal squeeze pressure. The four patient groups were not different with regards to the patient's age, BMI, parity, and FISI scores. 3D ultrasound images of the anal sphincter complex revealed significant damage to the internal anal sphincter, external anal sphincter, and puborectalis muscles in all four groups. The FI patients are a heterogeneous group; majority of these patients have significant damage to the muscles of the anal sphincter complex. Whether biofeedback therapy response is different among different patient groups requires study.

Management of the child with refractory constipation.

Caring for children with constipation refractory to conventional treatment can be challenging and management practices vary widely. To review recent advances in the evaluation and treatment of children with refractory constipation and to propose an algorithm that incorporates the latest evidence and our institutional experience. We performed a literature review on diagnostic tests and treatment options for children with refractory constipation. Evaluation of a child with refractory constipation seeks to better understand factors contributing to an individual child's presentation. Anorectal manometry evaluating for a rectal evacuation disorder and colonic manometry evaluating for colonic dysmotility can guide subsequent treatment. For the child who has not responded to conventional treatment, a trial of newer medications like linaclotide can be helpful. Transanal irrigation offers a safe and effective alternative for families able to administer daily rectal treatment. Despite mixed evidence in children, pelvic floor biofeedback therapy can help some children with pelvic floor dyssynergia. For younger children unable to cooperate with pelvic floor therapy, or older children with refractory symptoms, internal anal sphincter botulinum toxin injection can be beneficial. Antegrade continence enema treatment can be effective for children with either normal colonic motility or segmental dysmotility. Sacral nerve stimulation is generally reserved for symptoms that persist despite antegrade continence enemas, particularly if faecal incontinence is prominent. In more severe cases, temporary or permanent colonic diversion and segmental colonic resection may be needed. Recent advances offer hope for children with refractory constipation.

Urotherapy and biofeedback resistant dysfunctional voiding: How to deal with?

To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV). Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted. Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%. Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.

Assessment of the Acute Effects of Wearable Sensor Derived Auditory Biofeedback on Gross Lumbar Proprioception

Lower back disorders (LBDs) affect a large proportion of the population, and treatment for LBDs have been shifting toward individualized, patient-centered approaches. LBDs are typically associated with poor proprioception. Therefore, there has been a recent uptake in the utilization of wearable sensors that can administer biofeedback in various industrial, clinical, and performance-based settings to improve lumbar proprioception. The aim of this study was to investigate whether wearable sensor-derived acute auditory biofeedback can be used to improve measures of gross lumbar proprioception. To assess this, healthy participants completed an active target repositioning protocol, followed by a training period where lumbar-spine posture referenced auditory feedback was provided for select targets. Target re-matching abilities were captured before and after acute auditory biofeedback training to extract measures related to accuracy and precision across spine flexion targets (i.e., 20%, 40%, 60%, 80% maximum). Results suggest a heterogenous response to proprioceptive training whereby certain individuals and spine flexion targets experienced positive effects (i.e., improved accuracy and precision). Specifically, results suggest that mid-range flexion targets (i.e., 40-60% maximum flexion) benefited most from the acute auditory feedback training. Further, individuals with poorer repositioning abilities in the pre-training assessment showed the greatest improvements from the auditory feedback training.

Commentary to does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

Commentary to does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

The Role of Secondary Conservative Management Strategies in Bladder and Bowel Dysfunction: A Systematic Review and Meta-analysis

We sought to determine the effect of secondary management strategies in addition to urotherapy on bowel bladder dysfunction outcomes. The review protocol was prospectively registered (CRD42023422168). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (database initiation until June 2023) were searched. Comparative studies of secondary management strategies vs conventional urotherapy alone were included. Two authors independently screened titles, abstracts, and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. In this systematic review and meta-analysis of 18 studies and 1228 children, secondary management strategies (home-based education, biofeedback, and physical therapy) were associated with reduced symptom burden, fewer recurrent urinary tract infections, and improved uroflowmetry findings than children treated solely with urotherapy for conservative management. Although there is significant reporting heterogeneity, secondary conservative management strategies such as home education, biofeedback or cognitive behavioral therapy, and physiotherapy-based education are associated with less urinary incontinence, fewer infections, and fewer abnormal uroflowmetry findings.

Effects of Heart Rate Variability Biofeedback Training on Anxiety Reduction and Brain Activity: a Randomized Active-Controlled Study Using EEG.

Heart rate variability biofeedback (HRVBF) is a promising anxiety-reducing intervention that increases vagally-mediated heart rate variability (vmHRV) through slow-paced breathing and feedback of heart rhythm. Several studies have reported the anxiety-reducing effects of HRVBF; however, some studies have reported such training as ineffective. Furthermore, the effects of training and underlying brain activity changes remain unclear. This study examined the anxiety-reducing effects of HRVBF training and related brain activity changes by randomly assigning participants, employing an active control group, and measuring anxiety-related attentional bias using the emotional Stroop task and electroencephalography (EEG). Fifty-five healthy students with anxiety were randomly assigned to the HRVBF or control groups, and 21 in the HRVBF group and 19 in the control group were included in the analysis. Both groups performed 10 training sessions of 20min each within 3 weeks. They were assessed using resting vmHRV, event-related potential (ERP), time-frequency EEG, attentional bias, and the State-Trait Anxiety Inventory-JYZ (STAI-JYZ) before and after training. The results demonstrated increased resting vmHRV in the HRVBF group compared to the control group after training. However, no differences were observed in ERP, time-frequency EEG, attentional bias, and STAI-JYZ. Participants with higher pre-training resting vmHRV achieved higher heart rhythm coherence in HRVBF training and had reduced attentional bias. This study suggests that individuals with higher resting vmHRV are more likely to be proficient in HRVBF training and benefit from its anxiety-reducing effects. The findings contribute to participant selection to benefit from HRVBF training and modification of the training protocols for non-responders.Clinical trial registrationOrganization: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), JapanRegistration number: UMIN000047096Registration date: March 6, 2022.

The use of biofeedback training in complex therapy of neurotic disorders and correction of negative psychological consequences of combat stress in combatants

The parameters and effectiveness of biofeedback training in the complex treatment of neurotic disorders at the hospital stage and psychological correction at the sanatorium stages of rehabilitation of military personnel were assessed. We examined 40 mentally healthy military personnel who participated in combat operations and 36 military personnel who participated in combat operations and suffered from stress-associated neurotic disorders and who were undergoing inpatient treatment in the S.M. Kirov Military Medical Academy clinics. In identifying possible negative psychological consequences of combat stress in a group of mentally healthy military personnel, a medical and psychological examination was performed using the military version of the Mississippi scale for assessing post-traumatic reactions, Neurotic Disorders-Symptomatic Questionnaire, and Quality of Life Questionnaire-12. The military personnel underwent stress testing according to a specially developed scenario using a biofeedback hardware software complex to assess individual changes in physiological parameters in response to emotionally significant stimuli. In the military personnel who participated in combat operations and suffered from neurotic disorders, a medical and psychological examination was performed using the Neurotic Disorders-Symptomatic Questionnaire and Quality of Life Questionnaire-12 upon admission to the hospital and on the eve of discharge, and stress testing was conducted upon admission to the hospital. The therapeutic effectiveness of biofeedback training in the treatment of neurotic disorders was evaluated by comparing the results of treatment between two groups of 18 individuals each. One group received only drug therapy, whereas the other group, in addition to drug therapy, underwent biofeedback training on the amplitude of the systolic wave. The level of stress-associated psychogenic damage was found to be correlated with the amplitude of the systolic wave according to the digital photoplethysmogram. Moreover, the physiological indicators of the circulatory and respiratory systems, used in foreign studies for psychophysiological training in the treatment of post-stress disorders, were not associated with the level of psychogenic damage, indicating their lack of involvement in pathogenesis and the ineffectiveness of their use. The addition of biofeedback training on the amplitude of the systolic wave to the complex therapy of neurotic disorders leveled astheno-neurotic symptoms and improved quality of life. Therefore, when treating astheno-neurotic disorders in military personnel participating in combat operations, it is critical to include biofeedback training on the amplitude of the systolic wave; this reduces severity of neurotic symptoms, improves quality of life, and forms preventive skill of conscious control of excessive physiological reactions of combat stress. Furthermore, the correlation between the magnitude of the decrease in the amplitude of the systolic wave and level of mental damage in combatants, revealed during stress testing, indicates the importance of biofeedback training on the amplitude of the systolic wave in sanatorium-resort organizations and military clinical hospitals of the Russian Ministry of Defense for the medical and psychological rehabilitation of military personnel exhibiting negative symptoms and those suffering from psychological consequences of combat stress.

Artificial Intelligence, Immersive Technologies, and Neurotechnologies in Breathing Interventions for Mental and Emotional Health: A Systematic Review

Breathing is one of the most vital functions for being mentally and emotionally healthy. A growing number of studies confirm that breathing, although unconscious, can be under voluntary control. However, it requires systematic practice to acquire relevant experience and skillfulness to consciously utilize breathing as a tool for self-regulation. After the COVID-19 pandemic, a global discussion has begun about the potential role of emerging technologies in breath-control interventions. Emerging technologies refer to a wide range of advanced technologies that have already entered the race for mental health training. Artificial intelligence, immersive technologies, biofeedback, non-invasive neurofeedback, and other wearable devices provide new, but yet underexplored, opportunities in breathing training. Thus, the current systematic review examines the synergy between emerging technologies and breathing techniques for improving mental and emotional health through the lens of skills development. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology is utilized to respond to the objectives and research questions. The potential benefits, possible risks, ethical concerns, future directions, and implications are also discussed. The results indicated that digitally assisted breathing can improve various aspects of mental health (i.e., attentional control, emotional regulation, mental flexibility, stress management, and self-regulation). A significant finding of this review indicated that the blending of different technologies may maximize training outcomes. Thus, future research should focus on the proper design and evaluation of different digital designs in breathing training to improve health in different populations. This study aspires to provide positive feedback in the discussion about the role of digital technologies in assisting mental and emotional health-promoting interventions among populations with different needs (i.e., employees, students, and people with disabilities).

Effect of percutaneous electrical stimulation at the Baliao point on preventing postpartum urinary retention after labor analgesia

BACKGROUND Anesthetic drugs used in labor analgesia also paralyze the bladder muscle by blocking the sacral plexus, thereby affecting maternal postpartum spontaneous urination and increasing the risk of postpartum urinary retention (PUR). AIM To analyze the effect of percutaneous electrical stimulation at the Baliao point combined with biofeedback therapy for PUR prevention. METHODS We selected 182 pregnant women who received labor analgesia in obstetrics between June 2022 and December 2023. They were divided into the combined therapy group (transcutaneous electrical stimulation of the Baliao point combined with biofeedback therapy) and the control group (biofeedback therapy alone). The first spontaneous urination time, first postpartum urine volume, bladder residual urine volume, postpartum hemorrhage volume, pre-urination waiting time, PUR incidence, adverse reactions, and the intervention’s clinical efficacy were compared between the two groups. RESULTS The first spontaneous urination time after delivery was more delayed (2.92 ± 1.04 h vs 3.61 ± 1.13 h, P &lt; 0.001), with fewer initial postpartum urine (163.54 ± 24.67 mL vs 143.72 ± 23.95 mL, P &lt; 0.001), more residual bladder urine (54.81 ± 10.78 mL vs 65.25 ± 13.52 mL, P &lt; 0.001), more postpartum bleeding (323.15 ± 46.95 mL vs 348.12 ± 45.03 mL, P = 0.001), and longer waiting time for urination (0.94 ± 0.31 min vs 1.29 ± 0.42 min, P &lt; 0.001), in the control group than in the combined therapy group. The control group also had higher PUR incidence (4.65% vs 15.85%, P = 0.016). Both groups had no adverse reactions, but the clinical total efficacy rate of the intervention was significantly higher in the combined therapy group than in the control group (95.35% vs 84.15%, P = 0.016). CONCLUSION Percutaneous electrical stimulation of the Baliao point combined with biofeedback can significantly promote postpartum micturition of parturients with labor analgesia, thereby effectively preventing PUR occurrence.

The Utility of Heartrate and Heartrate Variability Biofeedback for the Improvement of Interoception across Behavioural, Physiological and Neural Outcome Measures: A Systematic Review.

Interoceptive dysfunctions are increasingly implicated in a number of physical and mental health conditions. Accordingly, there is a pertinent need for therapeutic interventions which target interoceptive deficits. Heartrate and heartrate variability biofeedback therapy (HR(V)-BF), interventions which train individuals to regulate their cardiovascular signals and constrain these within optimal parameters through breathing, could enhance the functioning of interoceptive pathways via stimulation of the vagus nerve. Consequently, this narrative systematic review sought to synthesise the current state of the literature with regard to the potential of HR(V)-BF as an interoceptive intervention across behavioural, physiological and neural outcome measures related to interoception. In total, 77 papers were included in this review, with the majority using physiological outcome measures. Overall, findings were mixed with respect to improvements in the outcome measures after HR(V)-BF. However, trends suggested that effects on measures related to interoception were stronger when resonance frequency breathing and an intense treatment protocol were employed. Based on these findings, we propose a three-stage model by which HR(V)-BF may improve interoception which draws upon principles of interoceptive inference and predictive coding. Furthermore, we provide specific directions for future research, which will serve to advance the current knowledge state.

SPECIAL ISSUE: Improve Client Care by Dispelling HRV Myths

Heart rate variability (HRV) indexes how efficiently we mobilize and utilize limited self-regulatory resources to maintain homeostasis. HRV plays a vital role in regulatory capacity, executive functions, health, and performance. We address common misconceptions regarding cardiovascular health, HRV measurement, and HRV biofeedback training. This review highlights the importance of context and individual differences in interpreting HRV. We debunk common misconceptions to improve HRV biofeedback training for health and performance.

Study of electronic biofeedback combined with nursing intervention in the treatment of vascular cognitive impairment-no dementia.

To investigate the effects of electronic biofeedback combined with nursing intervention and conventional drug treatment on cognitive function in patients with vascular cognitive impairment-no dementia (VCIND). A total of 102 patients with VCIND treated in the Department of Neurology from January 2021 to May 2022 were enrolled and divided into the routine treatment group and biofeedback group according to different treatment methods. The routine treatment group was given conventional drug therapy and nursing intervention; for the biofeedback group, electronic biofeedback therapy was added, based on the routine treatment group. The Montreal Cognitive Assessment, (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale, (ADAS-cog), and Hamilton Depression Scale (HAMD) were checked before treatment, 2weeks after treatment, and 3months after treatment. At 3months of treatment, the scores of the MoCA and ADAS-cog scales in the biofeedback group were better than those in the routine treatment group, while no difference was detected in the HAMD scores before and after treatment and between the two groups. Electronic biofeedback therapy for VCIND can significantly improve the MoCA score, reduce the ADAS-cog score and improve the cognitive level of patients and can be used as a complementary treatment for VCIND.

The effect of duration between sessions on microperimetric biofeedback training in patients with maculopathies

Aim of this study was to explore the optimal training interval and times of microperimetric biofeedback training (MBFT) in maculopathies. Twenty-nine patients with maculopathies were divided into two groups: daily training (Group A) or alternate daily training (Group B). Both groups underwent 15 MBFT sessions. We compared the BCVA, reading speed, and fixation stability at baseline, after 5, 10, 15 sessions. After 15 sessions of MBFT, all visual parameters in both groups improved. There was a significant increase in BCVA after 5 sessions in both groups (P=0.016, and P<0.001 respectively), but Group A showed further improvement after 10 sessions (P<0.001). Regarding reading speed, Group A showed significant improvement from baseline after 15 sessions(P=0.020), Group B improved significantly after 5 sessions (P=0.047) and continued to improve after 10 sessions (P=0.030). Additionally, P1 and LgBCEA of Group A significantly improved after 10 sessions (P=0.001, and P=0.001 respectively), while Group B significantly improved after 5 sessions (P=0.002, and P<0.001 respectively). There was no significant difference in visual outcomes between the two groups (P>0.05) except LgBCEA (P=0.046) after 15 sessions. We concluded that the both MBFT frequencies are effective at improving vision and quality of life in patients with maculopathies. The alternate daily training group showed less time-dependent of improvement in all parameters and a greater benefit in fixation stability. Ten sessions are the optimal number of treatment sessions for alternate daily training.

Nonpharmacologic Treatment of Chronic Constipation.

Functional constipation is a common clinical diagnosis that affects approximately 14% of the world's population. Non-pharmacological therapies often represent the initial steps in management and may include lifestyle adjustments or changes such as physical activity and diet. Pharmacological options have been used when the non-pharmacological approach has been ineffective. Biofeedback therapy, surgery, sacral nerve stimulation, botulinum toxin injection, and vibrating capsules can be considered in scenarios where the laxatives are ineffective. Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. This paper overviews non-pharmacological therapies for functional constipation.

Short-term meditation training alters brain activity and sympathetic responses at rest, but not during meditation

Although more people are engaging in meditation practices that require specialized training, few studies address the issues associated with nervous activity pattern changes brought about by such training. For beginners, it remains unclear how much practice is needed before objective physiological changes can be detected, whether or not they are similar across the novices and what are the optimal strategies to track these changes. To clarify these questions we recruited individuals with no prior meditation experience. The experimental group underwent an eight-week Taoist meditation course administered by a professional, while the control group listened to audiobooks. Both groups participated in audio-guided, 34-min long meditation sessions before and after the 8-week long intervention. Their EEG, photoplethysmogram, respiration, and skin conductance were recorded during the mediation and resting state periods. Compared to the control group, the experimental group exhibited band-specific topically organized changes of the resting state brain activity and heart rate variability associated with sympathetic system activation. Importantly, no significant changes were found during the meditation process prior and post the 8-week training in either of the groups. The absence of notable changes in CNS and ANS activity indicators during meditation sessions, for both the experimental and control groups, casts doubt on the effectiveness of wearable biofeedback devices in meditation practice. This finding redirects focus to the importance of monitoring resting state activity to evaluate progress in beginner meditators. Also, 16 h of training is not enough for forming individual objectively different strategies manifested during the meditation sessions. Our results contributed to the development of tools to objectively monitor the progress in novice meditators and the choice of the relevant monitoring strategies. According to our findings, in order to track early changes brought about by the meditation practice it is preferable to monitor brain activity outside the actual meditation sessions.

SPECIAL ISSUE: Male-Female Differences in Psychophysiological Stress Profiles Before and After a Group Relaxation/Biofeedback Stress Management Program

This study used stress profiles to assess whether a biofeedback-assisted stress management program that previously documented decreased anxiety, stress symptoms, medication use, and increased well-being also had physiological effects. Psychophysiological stress profiles are used in quantifying an individual’s responses under stress and during recovery from stressors by looking at their degree of response, pattern of response, and degree of recovery. A stress profile measuring surface electromyography (sEMG), heart rate, and skin temperature was performed on 141 adults before and after their participation in a group relaxation and stress management program. After 10 sessions of skills training, the only significant change in physical parameters was warmer hand temperatures in both males and females. Temperature was also the only modality that was included as biofeedback training within the program. Trait anxiety (STAI) was significantly positively correlated with females’ sEMG before and after the program. Females had significantly colder hands, higher heart rate, and a pattern of higher sEMG than males did throughout all profiles. The responses and recovery from different stressors showed some significant male-female differences. Future psychophysiological and psychological studies should further investigate male-female differences.