Effects Of Biofeedback Training Research Articles

Effects of electromyographic biofeedback training on psychological and motor functioning in patients with spinal cord injury

Objective To investigate the therapeutic effects of electromyography biofeedback (EMGBF) on motor and psychological function in patients with spinal cord injury (SCI).Methods Seventy SCI patients were randomly divided into research and control groups with 35 patients in each.In addition to conventional rehabilitation,the patients in the research group received EMGBF training while those in the control group were treated with medium frequency electrotherapy.To evaluate the patients' self confidence and motor function of their paralyzed limbs,Rosenberg's self-esteem scale (RSES) and American Spinal Injury Association (ASIA) locomotor function scoring were performed before and six weeks after the interventions in both groups of patients.The changes of EMG of the quadriceps,hamstring and anterior tibial muscles of both groups in maximum contraction were also observed before and six weeks after the interventions.Results There were no significant differences in the RSES scores or ASIA locomotor function results between the groups before the interventions.ASIA locomotor function evaluation scores increased significantly in both groups after the interventions,with significantly better results in the research group.The RSES scores in the research group also improved significantly after the interventions,and RSES scoring and ASIA scoring were positively correlated in those patients.But no significant improvement in average RSES scores was found in the control group.The muscle contraction EMG amplitudes also increased significantly in patients of the research group after the interventions.Conclusions EMGBF training can enhance patients' self-confidence,which helps patients with SCI improve their motor functions. Key words: Spinal cord injury; Electromyographic biofeedback training; Rosenberg self-esteem scale; Medium frequency electrotherapy

UP-03.167 Effectiveness of Biofeedback Training with EXTT-101TM in Female Stress Urinary Incontinence

UP-03.167 Effectiveness of Biofeedback Training with EXTT-101TM in Female Stress Urinary Incontinence

The effect of biofeedback on tennis service accuracy

This paper presents a study which seeks to extend the ‘Five-step approach to mental training incorporating biofeedback (BFB)’ later renamed the ‘Wingate five-step approach for mental training incorporating BFB’. In particular, this study investigated the effectiveness of BFB training, through each of the five phases, on the accuracy of tennis serving. The participants were six male junior national elite tennis athletes. The results showed that the biofeedback training was effective in improving tennis serve accuracy. Social validation results indicated that the participants' mental skills adherence was improved and that the athletes were content with their serving accuracy results. Manipulation checks, throughout the five phases, gave some insight into the inner workings of the Wingate five-step approach to mental training. These findings extend the Wingate five-step model. Practical implications are that phase 2 needs to be considered with caution and that there appears to be a positive stabilization of performance after the cessation of the Wingate five-step protocol.

The effect of BFB training on the efficiency of voluntary relaxation in junior schoolchildren

Psychophysiological features of schoolchildren seven to eight and nine to ten years of age (their autonomic balance and brain functional state) were studied; the effect of biofeedback (BFB) training on the regulatory influence of relaxation was evaluated (BFB signal—electrical skin resistance). Before and after BFB training, the electrophysiological experiment, i.e., relaxation testing, was performed without BFB in three situations: background, relaxation, and the state after relaxation. The EEG of various cortical areas was recorded, and the electrical skin resistance was determined. The short-term memory test was used to determine changes in the functional state at the behavioral level. Short-term training (five sessions) often enhanced the efficiency of voluntary relaxation and improved the postrelaxation mnestic function only in the group of 9- to 10-year-old children. The effect of training on the relaxation of the regulation depended on the individual psychophysiological features of children.

Biofeedback in the treatment of heart failure

Biofeedback training can be used to reduce activation of the sympathetic nervous system (SNS) and increase activation of the parasympathetic nervous system (PNS). It is well established that hyperactivation of the SNS contributes to disease progression in chronic heart failure. It has been postulated that underactivation of the PNS may also play a role in heart failure pathophysiology. In addition to autonomic imbalance, a chronic inflammatory process is now recognized as being involved in heart failure progression, and recent work has established that activation of the inflammatory process may be attenuated by vagal nerve stimulation. By interfering with both autonomic imbalance and the inflammatory process, biofeedback-assisted stress management may be an effective treatment for patients with heart failure by improving clinical status and quality of life. Recent studies have suggested that biofeedback and stress management have a positive impact in patients with chronic heart failure, and patients with higher perceived control over their disease have been shown to have better quality of life. Our ongoing study of biofeedback-assisted stress management in the treatment of end-stage heart failure will also examine biologic end points in treated patients at the time of heart transplant, in order to assess the effects of biofeedback training on the cellular and molecular components of the failing heart. We hypothesize that the effects of biofeedback training will extend to remodeling the failing human heart, in addition to improving quality of life.

The effects of biofeedback training of pelvic floor muscles on fecal incontinence

Objective The purpose of this study is to discuss the effect of pelvic floor muscle training on fecal incontinence. Methods A retrospective study was performed on patients who received pelvic floor muscle training from March 2002 to April 2007. There were 55 patients with fecal incontinence (male, 32 cases; female, 23 cases; mean age, 9.4 years old from 6 to 14), including 39 cases of anorectal malformation and 16 cases of Hirschsprung's disease. Pelvic floor muscle training was performed using biofeedback for 2 weeks in hospital, 2 times each day, and 30 minutes each time. The patients were then instructed to carry out self-training at home without the biofeedback device daily and received training evaluations in the hospital outpatient department monthly. All patients completed the training regimen and were followed up for 1 year. Anal manometry and clinical score were evaluated before and after training. Results Anal continence of 30 patients had satisfactory improvement, but not for the other 25 cases after training. The mean anal squeeze pressures of the group that had good results and the group that had poor results were 98.4 ± 7.3 and 47.4 ± 13.6 mm Hg, respectively, before training. There were 31 patients whose anal squeeze pressures were above 80 mm Hg, and 26 of these had satisfactory anal continence improvement, including all patients with Hirschsprung's disease. On the contrary, only 4 of 24 cases whose anal squeeze pressure was below 80 mm Hg acquired satisfactory anal continence improvement. Conclusions Pelvic floor muscle training could achieve good results in some patients with fecal incontinence. Baseline measurements during anorectal manometry appear to provide good prediction of prognosis and effective management.

Model analyses of visual biofeedback training for EEG-based brain-computer interface

The primary goal of this study was to construct a simulation model of a biofeedback brain-computer interface (BCI) system to analyze the effect of biofeedback training on BCI users. A mathematical model of a man-machine visual-biofeedback BCI system was constructed to simulate a subject using a BCI system to control cursor movements. The model consisted of a visual tracking system, a thalamo-cortical model for EEG generation, and a BCI system. The BCI system in the model was realized for real experiments of visual biofeedback training. Ten sessions of visual biofeedback training were performed in eight normal subjects during a 3-week period. The task was to move a cursor horizontally across a screen, or to hold it at the screen's center. Experimental conditions and EEG data obtained from real experiments were then simulated with the model. Three model parameters, representing the adaptation rate of gain in the visual tracking system and the relative synaptic strength between the thalamic reticular and thalamo-cortical cells in the Rolandic areas, were estimated by optimization techniques so that the performance of the model best fitted the experimental results. The serial changes of these parameters over the ten sessions, reflecting the effects of biofeedback training, were analyzed. The model simulation could reproduce results similar to the experimental data. The group mean success rate and information transfer rate improved significantly after training (56.6 to 81.1% and 0.19 to 0.76 bits/trial, respectively). All three model parameters displayed similar and statistically significant increasing trends with time. Extensive simulation with systematic changes of these parameters also demonstrated that assigning larger values to the parameters improved the BCI performance. We constructed a model of a biofeedback BCI system that could simulate experimental data and the effect of training. The simulation results implied that the improvement was achieved through a quicker adaptation rate in visual tracking gain and a larger synaptic gain from the visual tracking system to the thalamic reticular cells. In addition to the purpose of this study, the constructed biofeedback BCI model can also be used both to investigate the effects of different biofeedback paradigms and to test, estimate, or predict the performances of other newly developed BCI signal processing algorithms.

The influence of biofeedback training on trapezius activity and rest during occupational computer work: a randomized controlled trial

The aim of this study was to investigate effects of biofeedback training on trapezius activity and rest (gaps) during occupational computer work. A randomized controlled trial with 164 computer workers was performed. Two groups working with computer mouse more than 50% (n = 64) and less than 25% (n = 49) of their work time performed five sessions with unilateral electromyographical (EMG) biofeedback from the dominant trapezius during computer work. A third group working with computer mouse more than 50% of their work time (n = 51) served as controls. Bipolar EMG from the bilateral upper trapezius muscles during normal computer work was recorded. Changes in discomfort/pain were not recorded. The biofeedback training reduced activity (P < 0.05), and increased the frequency of short (P < 0.05) and long (P < 0.05) gaps, and the relative rest time (P < 0.05) of the trapezius during computer work. By improving trapezius inactivity during computer work, biofeedback training may have the potential to prevent trapezius myalgia in computer workers.

The effect of biofeedback training on affective regulation and simulated car-racing performance: A multiple case study analysis

The foundation of this study was based on an idiosyncratic concept, which uses probabilistic determinations (Kamata, Tenenbaum, & Hanin, 2002) to verify the utility and effectiveness of a biofeedback intervention by manipulating affective performance states in a race-car simulator. Nine males completed five separate time-trials of a simulated racing task and were then randomly assigned to one of three arousal regulation treatment conditions: (1) optimal, (2) poor, and (3) attention control. Following the biofeedback intervention, participants underwent another series of race trials to determine the effectiveness of the arousal regulation intervention. The results indicated that there were relative similarities in the strength and direction of the perceived and physiological states between the participants; however, the subtle details of the participants' unique performance zones and the probability of achieving each zone were revealed to be unique among the participants. The results also indicated that: (a) the biofeedback manipulation resulted in the expected changes for each participant, and (b) there were some large individual differences among the participants, necessitating the idiosyncratic approach. Limitations and future directions are also addressed.

Effect of Biofeedback Training on Paradoxical Pelvic Floor Movement in Children with Dysfunctional Voiding

Dynamic perineal ultrasonography to assess the function of the pelvic floor muscles in children with micturition complaints shows that many children with daytime incontinence or recurrent urinary tract infections use their pelvic floor paradoxically. They strain when asked to withhold urine, or they have no voluntary control of the pelvic floor muscles at all. The aim of this study was to record the pelvic floor function and evaluate the physical therapy regimens for children with dysfunctional voiding (DV) and paradoxical pelvic floor function. A total of 65 patients with DV, many who also had constipation, were diagnosed with paradoxical movement of the pelvic floor. The patients were asked to contract their pelvic floor muscles during a perineal dynamic ultrasound investigation. Of the 52 patients treated by physical therapists, 32 had a single 1-hour biofeedback session with rectal examination and anal balloon expulsion. In the remaining 20 patients, this was followed by 2 weeks of biofeedback balloon expulsion training at home. Forty control patients were observed. In 13 of the 65 patients, the diagnosis could not be confirmed by the physical therapists. At 6 to 10 months after training, 50 of the 52 other patients had normal voluntary pelvic floor muscle control. Of the 40 control patients, 39 had normal pelvic floor control. The results of this study have demonstrated that pelvic floor dysfunction occurs frequently in children with DV and can be cured by dedicated physical therapy. The clinical importance of this phenomenon is not yet clear. Prospective studies will teach us more about the true incidence and therapeutic effect of pelvic floor dysfunction on DV.

P32.8 Evaluation of effect of biofeedback training for prevention against stress urinary incontinence using mathematical index of surface electromyography

P32.8 Evaluation of effect of biofeedback training for prevention against stress urinary incontinence using mathematical index of surface electromyography

Longitudinal Follow-up of Children With Functional Nonretentive Fecal Incontinence

Functional nonretentive fecal incontinence (FNRFI), incontinence in the absence of signs of fecal retention, is a frustrating phenomenon in children. No data on long-term outcome are available. The aim was to investigate the long-term outcome of FNRFI patients after intensive medical treatment. Between 1990 and 1999, 119 patients (96 boys) with FNRFI were enrolled in 2 prospective, randomized trials investigating the effect of biofeedback training and/or laxative treatment. Follow-up (FU) was performed at 6 months, 1 year, and thereafter annually until September 2004. A standardized questionnaire was used to evaluate symptoms. Success was defined as a fecal incontinence frequency <1 per 2 weeks. Median age (25th-75th percentiles) was 9.2 years (range, 7.9-11.6 years). A 90% FU was achieved at all stages of the study. After 2 years of intensive therapy, 33 of 112 (29.5%) patients were successfully treated. The cumulative success percentage after 7 years of FU was 80%. At the biologic ages of 12 and 18 years, 49.4% (40/81) and 15.5% (9/58), respectively, of the patients still had fecal incontinence. Duration of fecal incontinence, with 4 years of age as the starting age for fecal incontinence (when a child should be toilet trained), was not related to successful outcome or relapse. Relapse occurred in 37% of patients. Only 29% of the patients with FNRFI were successfully treated after 2 years of intensive treatment. Despite recovery in the majority of patients beyond puberty, at age 18 years, 15% continued to have fecal incontinence.

FUNCTIONAL NON-RETENTIVE FAECAL SOILING IN CHILDREN: 12 YEARS OF LONGITUDINAL FOLLOW-UP

Background: Functional non-retentive faecal soiling (FNRFS), encopresis in the absence of signs of faecal retention, is a frustrating phenomenon in children and difficult to treat. It is assumed that FNRFS will resolve spontaneously beyond puberty, however no data on long-term outcome are available. Aim: To investigate the very long-term outcome of FNRFS patients after intensive medical treatment. Methods: Between 1990 and 1999, 119 patients (96 boys) with FNRFS were enrolled in 2 prospective, randomised trials investigating the effect of biofeedback training and/or laxative treatment. Thereafter, follow-up (FU) was performed at 6 months, 1 year and thereafter annually until the end of data collection in September 2004. A standardised questionnaire was used, either during clinical visit or by telephone, to evaluate symptoms. Success was defined as having less than 1 encopresis episode in 2 weeks while not using medication for more than 1 month. Results: Median age at entry (25th-75th percentiles) was 9.2 (7.9-11.6) years and the median duration of symptoms before intake (25th-75th percentiles) was 4.4 (3.0-6.7) years. A 90% follow-up was achieved at all stages of the study. After 2 years of intensive behavioural and medical therapy, 33 out of 112 (29.5%) patients were successfully treated. The cumulative success percentage after 7 years of FU was 80%. At the biological ages of 12 and 18 years, 49.4% (40/81) and 15.5% (9/58) of the patients still had encopresis, respectively. Age at intake younger than 6 years in combination with secondary encopresis was associated with a lower chance of achieving success (HR: 0.51 (95% CI: 0.27-0.98), P = 0.04). Relapse occurred in 37% of patients (cumulative percentage after 7 years), and occurred most likely in the first two years after an initial success. Conclusions: Only 29% of the patients with FNRFS are successfully treated after two years of intensive treatment. Thereafter, a steady increase in success is observed. Nevertheless, at the age of 18 years, 15% still have encopresis.

Outlet obstruction due to anismus and rectal hyposensation: effect of biofeedback training.

Outlet obstruction due to anismus and rectal hyposensation: effect of biofeedback training.

Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence

Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75% of fecally incontinent patients. However, previous studies have not ruled out nonspecific treatment effects. It is also unknown whether biofeedback works primarily by improving the strength of the striated pelvic floor muscles or by improving the rectal perception. We aimed to 1) evaluate the efficacy of biofeedback in formed-stool fecal incontinence, 2) assess the relative contribution of sensory and strength retraining to biofeedback outcomes, and 3) identify patient characteristics that predict a good response to treatment. Twenty-four patients with frequent (at least once a week) solid-stool incontinence were provided with three to four biofeedback sessions. They were taught to squeeze in response to progressively weaker rectal distentions. Patients were re-evaluated by anorectal manometry and symptom diary 3 months after completing training and by diary and interview 6-12 months after training. Seventeen (71%) were classified responders; 13 became continent and four reduced incontinence frequency by at least 75%. Clinical improvements were maintained at 12-month follow-up. At 3-month follow-up, responders had significantly lower thresholds for perception of rectal distention and for sphincter contraction, but squeeze pressures did not significantly differ from those of nonresponders. Baseline measures that predicted a favorable response were sensory threshold (50 ml or less), urge threshold (100 ml or less), lower threshold for sphincter contraction, and lower threshold for the rectoanal inhibitory reflex; neither anal squeeze pressure nor severity of incontinence predicted treatment outcome. In solid-stool fecal incontinence biofeedback training effects are robust and seem not to be explained by expectancy or nonspecific treatment effect. Sensory retraining appears to be more relevant than strength training to the success of biofeedback.

Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence

OBJECTIVES: Biofeedback is a nonsurgical treatment that reportedly produces good results in 65–75% of fecally incontinent patients. However, previous studies have not ruled out nonspecific treatment effects. It is also unknown whether biofeedback works primarily by improving the strength of the striated pelvic floor muscles or by improving the rectal perception. We aimed to 1) evaluate the efficacy of biofeedback in formed-stool fecal incontinence, 2) assess the relative contribution of sensory and strength retraining to biofeedback outcomes, and 3) identify patient characteristics that predict a good response to treatment. METHODS: Twenty-four patients with frequent (at least once a week) solid-stool incontinence were provided with three to four biofeedback sessions. They were taught to squeeze in response to progressively weaker rectal distentions. Patients were re-evaluated by anorectal manometry and symptom diary 3 months after completing training and by diary and interview 6–12 months after training. RESULTS: Seventeen (71%) were classified responders: 13 became continent and four reduced incontinence frequency by at least 75%. Clinical improvements were maintained at 12-month follow-up. At 3-month follow-up, responders had significantly lower thresholds for perception of rectal distention and for sphincter contraction, but squeeze pressures did not significantly differ from those of nonresponders. Baseline measures that predicted a favorable response were sensory threshold (50 ml or less), urge threshold (100 ml or less), lower threshold for sphincter contraction, and lower threshold for the rectoanal inhibitory reflex; neither anal squeeze pressure nor severity of incontinence predicted treatment outcome. CONCLUSIONS: In solid-stool fecal incontinence biofeedback training effects are robust and seem not to be explained by expectancy or nonspecific treatment effect. Sensory retraining appears to be more relevant than strength training to the success of biofeedback.

Effects of biofeedback training on voluntary heart rate control during dynamic exercise.

The aims of this study were to (1) compare the effect of biofeedback with that of verbal instructions on the control of heart rate during exercise on a treadmill, (2) test the possible effect of workload on this control, and (3) examine the effect of workload on baseline heart rate at rest and during exercise. The study involved 35 participants who were randomly assigned to each of 4 experimental conditions generated by combining the 2 independent variables: training strategy for heart rate control (heart rate biofeedback or verbal control instructions) and work level (30 or 50% of maximal heart rate). By the end of 5 experimental sessions, participants trained with heart rate biofeedback showed a greater attenuation of the increase in heart rate produced by exercise than participants trained with verbal control instructions. The workload did not influence the voluntary control of heart rate, nor did it affect resting baseline heart rate, but it did affect exercise baseline heart rate.

Improved ankle function in children with cerebral palsy after computer-assisted motor learning.

The effect of biofeedback training on ankle function was studied in young children with cerebral palsy (CP) during a pilot study and a 6-week follow-up study. Patients underwent range of motion (ROM) and ankle dorsiflexor (DF) strength training in a laboratory 3 days per week, receiving auditory and visual feedback. An at-home programme used portable EMG units to help train DF muscle recruitment on the remaining days. Independent outcome measures included DF strength, active ROM, and tapping ability pretraining and 6 weeks and 14 months posttraining. Tapping ability increased significantly in the trained leg posttraining. It then fell significantly at the 6-weeks posttraining test, but remained significantly higher than pretest levels, and returned to pretraining levels by 14 months. Passive ROM was unchanged, but active ROM increased significantly in the trained leg. DF strength increased in most children posttraining in both the pilot and main study. Increased motor-unit recruitment is believed to explain the increases in DF strength and active ROM. These results suggest that biofeedback training can improve ankle function, and the implications for gait are discussed.

Rectocele is associated with paradoxical anal sphincter reaction.

Rectocele is a frequent finding in constipated patients. However, constipation is not always relieved by rectocele repair, which may be due to other overlooked reasons for constipation. The study was designed to investigate patients with rectocele, in order to elucidate concomitant colorectal disorders and their association with rectocele. One hundred and twelve female patients suffering from severe constipation and rectal emptying difficulties were investigated using defecography, electrophysiology, anorectal manometry and colon transit time. Fifty-six patients with rectocele demonstrated by defecography were compared with 56 patients without rectocele, but with other abnormal findings at defecography. The frequency of paradoxical anal sphincter reaction (PSR) was higher in patients with rectocele (60%) than in patients without rectocele (24%). The present study supports an association between rectocele and PSR. We suggest that constipated patients with a rectocele should be investigated thoroughly before rectocele repair is considered. Further studies on the effect of biofeedback training in patients with rectocele and PSR are indicated.

Clinical Management of Intractable Constipation

To review current management of intractable constipation. Original articles and reviews published in the English-language literature between 1965 and 1993 identified by MEDLINE search. Verbal feedback from attendees after presentation of the document as a clinical symposium at the 14th International Symposium on Gastrointestinal Motility in September 1993. Key words included constipation, epidemiology, colonic inertia, pseudo-obstruction, pelvic floor dysfunction, and results of therapeutic interventions, particularly the effects of biofeedback training and subtotal colectomy. In most patients, constipation is usually due to lack of dietary fiber and responds to simple measures to correct these factors, often without consulting a physician. In some, probably fewer than 10% of patients who consult their physicians, structural diseases of the colon and rectum, systemic disease, or medications that slow gut transit should be excluded, and regular exercise, dietary fiber, and an osmotic laxative prescribed. In a series of 277 highly selected patients from a tertiary referral center who had intractable constipation, only 29% had a definable abnormality; identification of abnormal transit facilitates selection of patients for further investigations identifying colonic inertia or pelvic floor dysfunction. An algorithmic approach can carefully select patients with intractable constipation for behavioral modification and biofeedback; the long-term outcome is excellent, with at least 75% success in several series. In a minority of patients with slow transit constipation unresponsive to medical treatment, subtotal colectomy with ileorectostomy is indicated and effective.