Breathing Biofeedback Research Articles

Virtual Reality for Subacute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study.

Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury. We enrolled 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping). The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients. The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.

"Brain-IT": Exergame training with biofeedback breathing in neurocognitive disorders.

The combination of exergame-based motor-cognitive training with resonance breathing guided by heart-rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in mild neurocognitive disorders (mNCD). This randomized controlled trial (RCT) investigated the effectiveness of adding this novel intervention approach to usual care in mNCD. The individualized intervention was delivered via the "Brain-IT" training concept, which was iteratively co-designed, tested, and refined with patient and public involvement. We observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. Fifty-five percent of participants showed a clinically relevant improvement in response to training. Confirmatory RCTs are warranted to investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia and test the implementation of the training in clinical practice. We proposed a novel intervention approach for mild neurocognitive disorders. It combines exergame-based training with biofeedback-guided resonance breathing. Our results confirm the effectiveness of this approach. Fifty-five percent of participants showed a clinically relevant improvement in response to training.

The use of a breathing biofeedback for stress management while driving: examining the influence of individual characteristics

The use of a breathing biofeedback for stress management while driving: examining the influence of individual characteristics

Development and Feasibility Test of a Mouth Contactless Breathing Exercise Solution Using Virtual Reality: A Randomized Crossover Trial

The purpose of this study was to develop a novel mouth contactless breathing exercise solution based on virtual reality (VR), and to test its feasibility. We developed the Virtual Reality-based Breathing Exercise System (VR-BRES), a self-regulating biofeedback breathing exercise with gaming characteristics and a soft stretch sensor. The feasibility and efficacy of the VR-BRES prototype were investigated through a randomized crossover trial. Fifty healthy adults participated in the trial, and their respiratory parameters and user evaluation of the VR-BRES were compared with conventional deep breathing (CDB) exercises. The respiratory parameters, forced vital capacity (Z=4.82, 4.95, p<.001), forced expiratory volume in one second (t=6.02, 6.26, p<.001), and peak expiratory flow (t=5.35, 5.68, p<.001) were significantly higher during breathing exercises using the VR-BRES. User evaluation was also significantly higher for the VR-BRES in terms of efficiency (Z=3.86, p<.001), entertainingness (Z=5.00, p<.001), and intention to use (Z=3.22, p=.001) compared to CDB. However, there was no difference in convenience between the two methods (Z=-0.90, p=.369). The VR-BRES has the potential to be an efficient breathing exercise solution. We recommend a clinical study that evaluates the effects of the VR-BRES for a certain period of time for people who need breathing exercises.

161 Sleep, Emotion, and Physical Activity in Older Adults Who Engage in Resonant Breathing Biofeedback

Abstract Introduction Resonant breathing (RB) biofeedback increases rhythmic heart-respiration coherence patterns and has been associated with improved emotional wellbeing, physiological health, and sleep quality (Lehrer et al, 2000). Sleep quality declines with age, which leads to emotion dysregulation, cognitive impairment, and poor physical health (Crowley, 2011). However, limited research has investigated the sleep characteristics of older adults who practice RB-biofeedback. Therefore, our study investigates this population’s sleep characteristics, emotional stability, and physical health. Methods Thirty-one healthy participants (24 Female; M=54.68 years, SD=9.74) who self-identified as RB-biofeedback experts completed a series of online questionnaires assessing history, frequency, and duration of practice, sleep (habits and quality), physical activity (frequency, duration, and intensity), and mood (depression symptoms). They also reported their typical coherence level achieved, which is a numerical composite value associated with the heart rhythm’s uniform sine-wave pattern at approximately .1HZ (McCraty et al., 2010). Results Using bivariate correlations, we found that poor sleep quality was positively correlated with stress (r = .954, p = .001), poor sleep hygiene (r = .591, p &amp;lt; .001), severe sleepiness (r = .518, p = .003), emotion dysregulation (r = .511, p = .004), depressive symptoms (r = .089, p &amp;lt; .001), and negatively correlated with subjective happiness (r = .511, p &amp;lt; .003). Severe sleepiness was negatively correlated with older adults’ enhanced physical fitness (r = .612, p &amp;lt; .001), and poor sleep hygiene was positively correlated with depressive symptoms (r = .503, p = .004). We found no significant correlations between coherence level, mood, physical activity, or sleep measures. Conclusion We found significant associations between healthy sleep habits and emotional wellbeing. Those with better sleep quality and more positive sleep habits also had fewer depression symptoms. Moreover, those categorized as more athletic reported lower levels of severe sleepiness, suggesting that physical activity may be a protective factor for sleep in older adults. We did not find a relation between coherence level and sleep, or physical activity. These null results may be due to the high expertise level of the subject sample. Future studies should compare results to older adults who do not practice RB-biofeedback. Support (if any) Undergraduate Research Opportunity Program

Effects of resonant breathing biofeedback training on athletes' heart rate variability and choice reaction time

Effects of resonant breathing biofeedback training on athletes' heart rate variability and choice reaction time

A Qualitative Descriptive Study: Young Adults' Experiences With Biofeedback.

This study explored the experiences of young adults who participated in biofeedback training and reported a family history of cardiovascular disease. A qualitative descriptive study design was used. Private semistructured interviews were conducted on a purposive sample. Young adults (N = 9) were interviewed about their experiences using paced breathing biofeedback training with continuous blood pressure monitoring. Codes were identified across the sample with common themes recorded. Data analysis yielded four themes: skeptical inquisition, tangible impression, positive health impact, and motivation. Prior to using biofeedback, participants were extremely skeptical of the training. However, all participants found it useful for health maintenance and stress reduction. Biofeedback therapy may be a promising alternative and holistic approach to managing blood pressure and psychological stress in young adults. This is a complementary approach that nurses can incorporate when caring for the holistic needs of young adults.

Implementation of Biofeedback Interventions for the Treatment of Adults With Post-Concussion Syndrome

Abstract Date Presented 03/28/20 Postconcussion syndrome can present with a variety of negative symptoms. Implementation of biofeedback breathing protocols have demonstrated positive outcomes for anxiety, perceived stress, and heart rate variability. OTs should consider implementing this technique to better serve those with postconcussion syndrome. Primary Author and Speaker: Kelsee Hove Additional Authors and Speakers: Mariah Roe, Emily Mock Contributing Authors: Mariah Roe, Emily Mock

EP-1980 Randomised trial investigating breathing regularity: Audiovisual biofeedback vs free breathing

EP-1980 Randomised trial investigating breathing regularity: Audiovisual biofeedback vs free breathing

Rumination syndrome after esophagectomy

Gastric conduit dysfunction after esophagectomy is a disabling condition that may require revisional surgery. Rumination syndrome is an uncommon and poorly recognized functional foregut disorder of unknown etiology characterized by effortless oral regurgitation of recently ingested food. Rumination is associated with increased intragastric pressure generated by an unconscious mechanism eliciting contraction of the abdominal wall and relaxation of the diaphragm. Rumination syndrome after esophagectomy has not been previously reported in the literature. Two female patients were referred for inability to eat and weight loss due to severe food regurgitation following esophagectomy and gastric conduit replacement. Their previous medical and psychiatric history was apparently unremarkable. Symptoms occurred within the first postoperative year and progressively worsened. High-dose proton pump inhibitors, erythromycin, metoclopramide, antidepressant medications, pneumatic pyloric dilatation, and laparoscopic pyloromyotomy failed to relieve symptoms, and both patients eventually required permanent tube jejunostomy for nutritional support. Subsequently, thoracoscopic implant of a neurostimulator and a laparoscopic Roux-en-Y gastrojejunostomy were performed and failed in both patients. All medical and surgical attempts to relieve symptoms were clinically unsuccessful in these patients in whom radiological and endoscopic investigations did not demonstrate trans-diaphragmatic hernia or mechanical obstruction of the gastric conduit. Eventually, the diagnosis of rumination syndrome was made based on the Rome IV criteria. In the absence of anatomical or other functional abnormalities of the gastric conduit, revisional surgery is contraindicated; rather, the diagnosis of rumination syndrome should be considered. The role of behavioral therapy integrated with diaphragmatic breathing training and biofeedback should be investigated in these patients.

Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study.

BackgroundThe speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery.ObjectiveThe aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor.MethodsA total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min).ResultsThere was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50 ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery.ConclusionsApp-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress.

Impact of audiovisual biofeedback on interfraction respiratory motion reproducibility in liver cancer stereotactic body radiotherapy.

Irregular breathing motion exacerbates uncertainties throughout a course of radiation therapy. Breathing guidance has demonstrated to improve breathing motion consistency. This was the first clinical implementation of audiovisual biofeedback (AVB) breathing guidance over a course of liver stereotactic body radiotherapy (SBRT) investigating interfraction reproducibility. Five liver cancer patients underwent a screening procedure prior to CT sim during which patients underwent breathing conditions (i) AVB, or (ii) free breathing (FB). Whichever breathing condition was more regular was utilised for the patient's subsequent course of SBRT. Respiratory motion was obtained from the Varian respiratory position monitoring (RPM) system (Varian Medical Systems). Breathing motion reproducibility was assessed by the variance of displacement across 10 phase-based respiratory bins over each patient's course of SBRT. The screening procedure yielded the decision to utilise AVB for three patients and FB for two patients. Over the course of SBRT, AVB significantly improved the relative interfraction motion by 32%, from 22% displacement difference for FB patients to 15% difference for AVB patients. Further to this, AVB facilitated sub-millimetre interfraction reproducibility for two AVB patients. There was significantly less interfraction motion with AVB than FB. These findings demonstrate that AVB is potentially a valuable tool in ensuring reproducible interfraction motion.

Effects of Biofeedback Training on Stress, Stress Response and Academic Resilience of Nursing Students

Purpose: The purpose of this study was to observe the effects of biofeedback training on the perceived stress, stress response, and academic resilience of nursing students. Methods: The research used a randomly assigned control group pretest-posttest design. The study participants were 34 senior students from the College of Nursing of S University. The study was conducted from March to April 2012. The biofeedback training conducted in this study consisted of eight sessions, each divided into two stages: 15 minutes each for breathing biofeedback training and electromyography (EMG) biofeedback training. The collected data were analyzed using SPSS version 19.0. Results: We found statistically significant decreases in perceived stress and EMG levels and an increase in academic resilience in the experimental group. Conclusion: The results showed that the biofeedback training for the nursing students was extremely effective in reducing their levels of perceived stress and EMG while increasing academic resilience. To clarify the effects of biofeedback training on the biological stress response, participants with a higher level of stress response should be recruited in future studies.

MO-FG-CAMPUS-JeP2-02: Audiovisual Biofeedback Guided Respiratory-Gated MRI: An Investigation of Tumor Definition and Scan Time for Lung Cancer

Purpose: Breathing consistency variations can cause respiratory-related motion blurring and artifacts and increase in MRI scan time due to inadequate respiratory-gating and discarding of breathing cycles. In a previous study the concept of audiovisual biofeedback (AV) guided respiratory-gated MRI was tested with healthy volunteers and it demonstrated image quality improvement on anatomical structures and scan time reduction. This study tests the applicability of AV-guided respiratorygated MRI for lung cancer in a prospective patient study. Methods: Image quality and scan time were investigated in thirteen lung cancer patients who underwent two 3T MRI sessions. In the first MRI session (pre-treatment), respiratory-gated MR images with free breathing (FB) and AV were acquired at inhalation and exhalation. An RF navigator placed on the liver dome was employed for the respiratory-gated MRI. This was repeated in the second MRI session (mid-treatment). Lung tumors were delineated on each dataset. FB and AV were compared in terms of (1) tumor definition assessed by lung tumor contours and (2) intra-patient scan time variation using the total image acquisition time of inhalation and exhalation datasets from the first and second MRI sessions across 13 lung cancer patients. Results: Compared to FB AV-guided respiratory-gated MRI improved image quality for contouring tumors with sharper boundaries and less blurring resulted in the improvement of tumor definition. Compared to FB the variation of intra-patient scan time with AV was reduced by 48% (p<0.001) from 54 s to 28 s. Conclusion: This study demonstrated that AV-guided respiratorygated MRI improved the quality of tumor images and fixed tumor definition for lung cancer. These results suggest that audiovisual biofeedback breathing guidance has the potential to control breathing for adequate respiratory-gating for lung cancer imaging and radiotherapy.

Vulvodynia Treated Successfully with Breathing Biofeedback and Integrated Stress Reduction: A Case Report

Millions of women experience substantial pain and suffering from vulvodynia, which is pain around the entrance to the vagina (vulva). A common treatment is surgical removal of the tissue (vestibulectomy). This case report describes the detailed process of a holistic biofeedback-based intervention that successfully resolved the vulvodynia in a 23-year-old woman. The four-session treatment interventions included teaching diaphragmatic breathing to transform shallow thoracic breathing into slower diaphragmatic breathing. Treatment transformed her feeling of powerlessness, a belief that there was nothing she could do, into empowerment and a hope that she could reduce her symptoms and optimize her health. She also practiced self-healing imagery and learned to change her posture from collapsed to erect/empowered. Each time she felt discomfort or was fearful, her lower abdomen tended to tighten. After treatment, she used this sensation as a reminder to breathe lower and slower and sit or stand erect. After 6 weeks, she once again could initiate and enjoy intercourse and has been symptom free during the 8 month follow-up.

SU‐E‐J‐185: A Systematic Review of Breathing Guidance in Radiation Oncology and Radiology

Purpose:The advent of image‐guided radiation therapy (IGRT) has led to dramatic improvements in the accuracy of treatment delivery in radiotherapy. Such advancements have highlighted the deleterious impact tumor motion can have on both image quality and radiation treatment delivery. One approach to reducing tumor motion is the use of breathing guidance systems during imaging and treatment. A review of such research had not yet been performed, it was therefore our aim to perform a systematic review of breathing guidance interventions within the fields of radiation oncology and radiology.Methods:Results of online database searches were filtered in accordance to a set of eligibility criteria. The search, filtration, and analysis of articles were conducted in accordance with the PRISMAStatement reporting standard (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) utilizing the PICOS approach (Participants, Intervention, Comparison, Outcome, Study design).Participants:Cancer patients, healthy volunteers.Intervention:Biofeedback breathing guidance systems.Comparison:No breathing guidance of the same breathing type.Outcome:Regularity of breathing signal and anatomic/tumor motion, medical image quality, radiation treatment margins and coverage, medical imaging and radiation treatment times.Study design:Quantitative and controlled prospective or retrospective trials.Results:The systematic search yielded a total of 479 articles, which were filtered down to 27 relevant articles in accordance to the eligibility criteria. The vast majority of investigated outcomes were significantly positively impacted by the use of breathing guidance; however, this was dependent upon the nature of the breathing guidance system and study design. In 25/27 studies significant improvements from the use of breathing guidance were observed.Conclusion:The results found here indicate that further clinical studies are warranted which quantify more comprehensively the clinical impact of The results found here indicate that further clinical studies are warranted which quantify more comprehensively the clinical impact of breathing guidance interventions.

PO-0966: Audiovisual biofeedback breathing training during thoracic 4DCT imaging: a digital phantom study

PO-0966: Audiovisual biofeedback breathing training during thoracic 4DCT imaging: a digital phantom study

Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study.

Although trauma-focused cognitive behavioral therapy (TF-CBT) with exposure is an effective treatment for posttraumatic stress disorder (PTSD), not all patients recover. Addition of breathing biofeedback to exposure in TF-CBT is suggested as a promising complementary technique to improve recovery of PTSD symptoms. Patients (n = 8) with chronic PTSD were randomized to regular TF-CBT or TF-CBT with complementary breathing biofeedback to exposure. PTSD symptoms were measured before, during and after TF-CBT with the Impact of Event Scale-Revised. The results show that breathing biofeedback is feasible and can easily be complemented to TF-CBT. Although PTSD symptoms significantly decreased from pre to post treatment in both conditions, there was a clear trend towards a significantly faster (p = .051) symptom reduction in biofeedback compared to regular TF-CBT. The most important limitation was the small sample size. The hastened clinical improvement in the biofeedback condition supports the idea that breathing biofeedback may be an effective complementary component to exposure in PTSD patients. The mechanism of action of breathing biofeedback may relate to competing working memory resources decreasing vividness and emotionality, similar to eye movement desensitization and reprocessing. Future research is needed to examine this.

Motion management within two respiratory-gating windows: feasibility study of dual quasi-breath-hold technique in gated medical procedures

A dual quasi-breath-hold (DQBH) technique is proposed for respiratory motion management (a hybrid technique combining breathing-guidance with breath-hold task in the middle). The aim of this study is to test a hypothesis that the DQBH biofeedback system improves both the capability of motion management and delivery efficiency. Fifteen healthy human subjects were recruited for two respiratory motion measurements (free breathing and DQBH biofeedback breathing for 15 min). In this study, the DQBH biofeedback system utilized the abdominal position obtained using an real-time position management (RPM) system (Varian Medical Systems, Palo Alto, USA) to audio-visually guide a human subject for 4 s breath-hold at EOI and 90% EOE (EOE90%) to improve delivery efficiency. We investigated the residual respiratory motion and the delivery efficiency (duty-cycle) of abdominal displacement within the gating window. The improvement of the abdominal motion reproducibility was evaluated in terms of cycle-to-cycle displacement variability, respiratory period and baseline drift. The DQBH biofeedback system improved the abdominal motion management capability compared to that with free breathing. With a phase based gating (mean ± std: 55 ± 5%), the averaged root mean square error (RMSE) of the abdominal displacement in the dual-gating windows decreased from 2.26 mm of free breathing to 1.16 mm of DQBH biofeedback (p-value = 0.007). The averaged RMSE of abdominal displacement over the entire respiratory cycles reduced from 2.23 mm of free breathing to 1.39 mm of DQBH biofeedback breathing in the dual-gating windows (p-value = 0.028). The averaged baseline drift dropped from 0.9 mm min−1 with free breathing to 0.09 mm min−1 with DQBH biofeedback (p-value = 0.048). The averaged duty-cycle with an 1 mm width of displacement bound increased from 15% of free breathing to 26% of DQBH biofeedback (p-value = 0.003). The study demonstrated that the DQBH biofeedback system has the potential to significantly reduce the residual respiratory motion with the improved duty cycle during the respiratory gating procedure.

SU-D-17A-04: The Impact of Audiovisual Biofeedback On Image Quality During 4D Functional and Anatomic Imaging: Results of a Prospective Clinical Trial

Purpose: The ability of audiovisual (AV) biofeedback to improve breathing regularity has not previously been investigated for functional imaging studies. The purpose of this study was to investigate the impact of AV biofeedback on 4D-PET and 4D-CT image quality in a prospective clinical trial. We hypothesized that motion blurring in 4D-PET images and the number of artifacts in 4D-CT images are reduced using AV biofeedback. Methods: AV biofeedback is a real-time, interactive and personalized system designed to help a patient self-regulate his/her breathing using a patient-specific representative waveform and musical guides. In an IRB-approved prospective clinical trial, 4D-PET and 4D-CT images of 10 lung cancer patients were acquired with AV biofeedback (AV) and free breathing (FB). The 4D-PET images in 6 respiratory bins were analyzed for motion blurring by: (1) decrease of GTVPET and (2) increase of SUVmax in 4-DPET compared to 3D-PET. The 4D-CT images were analyzed for artifacts by: (1) comparing normalized cross correlation-based scores (NCCS); and (2) quantifying a visual assessment score (VAS). A two-tailed paired t-test was used to test the hypotheses. Results: The impact of AV biofeedback on 4D-PET and 4D-CT images varied widely between patients, suggesting inconsistent patient comprehension and capability. Overall, the 4D-PETmore » decrease of GTVPET was 2.0±3.0cm3 with AV and 2.3±3.9cm{sup 3} for FB (p=0.61). The 4D-PET increase of SUVmax was 1.6±1.0 with AV and 1.1±0.8 with FB (p=0.002). The 4D-CT NCCS were 0.65±0.27 with AV and 0.60±0.32 for FB (p=0.32). The 4D-CT VAS was 0.0±2.7 (p=ns). Conclusion: A 10-patient study demonstrated a statistically significant reduction of motion blurring of AV over FB for 1/2 functional 4D-PET imaging metrics. No difference between AV and FB was found for 2 anatomic 4D-CT imaging metrics. Future studies will focus on optimizing the human-computer interface and including patient training sessions for improved comprehension and capability. Supported by NIH/NCI R01 CA 093626, Stanford BioX Interdisciplinary Initiatives Program, NHMRC Australia Fellowship, and Kwanjeong Educational Foundation. GE Healthcare provided the Respiratory Gating Toolbox for 4D-PET image reconstruction. Stanford University owns US patent #E7955270 which is unlicensed to any commercial entity.« less