Multimodal Biofeedback Research Articles

Biofeedback therapy using Cerebri for the prevention of migraine attacks in adults with episodic migraine (BioCer): a randomized, wait-list controlled trial – the study protocol

Introduction Biofeedback is a non-pharmacological treatment option valued for its minimal risk of adverse events and offers a safe alternative for individuals seeking preventive care for migraine. Despite level A evidence for migraine prevention, biofeedback treatment is still unavailable to most patients. We developed a novel medical device (Cerebri) for multimodal biofeedback treatment that omits the need for healthcare personnel involvement. Cerebri consists of a smartphone application (app) and two wireless sensors. Unique in its approach, the Cerebri app seamlessly integrates three biofeedback modalities – heart rate variability, temperature, and electromyography – making it a comprehensive, therapist-independent solution for non-pharmacological migraine management. Methods Biofeedback therapy using Cerebri for the prevention of migraine attacks in adults with episodic migraine (The BioCer study) was an open-label, randomized, waitlist-controlled, multicenter trial. This study investigated the safety and efficacy of daily home-based biofeedback sessions using the Cerebri device. A total of 286 participants will be randomized to either a 12-week intervention arm or waitlist control arm. The primary outcome was the change in the mean number of migraine days from baseline to the last 28-day period during the treatment phase in the treatment group compared with the control group. The primary outcome variable was prospectively collected through daily eDiary entries. Ethics and Dissemination Approval from the ethics committee and competent authorities was obtained prior to study initiation. Participation was voluntary and informed and written consent was obtained prior to inclusion. The results of this trial will be published in peer-reviewed international medical journals and communicated to patients and healthcare personnel through the relevant channels. Trial registration numbers EUDAMED: CIV-NO-22-08-040446 REK (Regional Committees for Medical and Health Research Ethics): 502734 Date of approval 2022-10-14 Trial registration: NCT05616741, 2022-11-15, https://clinicaltrials.gov/study/NCT05616741

Multimodal biofeedback for Parkinson’s disease motor and nonmotor symptoms

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor retardation, myotonia, quiescent tremor, and postural gait abnormality, as well as nonmotor symptoms such as anxiety and depression. Biofeedback improves motor and nonmotor functions of patients by regulating abnormal electroencephalogram (EEG), electrocardiogram (ECG), photoplethysmography (PPG), electromyography (EMG), respiration (RSP), or other physiological signals. Given that multimodal signals are closely related to PD states, the clinical effect of multimodal biofeedback on patients with PD is worth exploring. Twenty-one patients with PD in Beijing Rehabilitation Hospital were enrolled and divided into three groups: multimodal (EEG, ECG, PPG, and RSP feedback signal), EEG (EEG feedback signal), and sham (random feedback signal), and they received biofeedback training five times in two weeks. The combined clinical scale and multimodal signal analysis results revealed that the EEG group significantly improved motor symptoms and increased Berg balance scale scores by regulating β band activity; the multimodal group significantly improved nonmotor symptoms and reduced Hamilton rating scale for depression scores by improving θ band activity. Our preliminary results revealed that multimodal biofeedback can improve the clinical symptoms of PD, but the regulation effect on motor symptoms is weaker than that of EEG biofeedback.

Performing Dynamic Weight-Shifting Balance Exercises With a Smartphone-Based Wearable Telerehabilitation System for Home Use by Individuals With Parkinson's Disease: A Proof-of-Concept Study.

Telerehabilitation technology often helps individuals with Parkinson's disease (PD) to control their balance and improve postural stability. This proof-of-concept study describes the redesign of a smartphone-based wearable balance rehabilitation system, or Smarter Balance System (SBS) intended for in-home use, and determines the number of exercise sessions required to achieve steady-state balance exercise performance by people with PD who performed 6 weeks of in-home dynamic weight-shifting balance exercises. The redesigned SBS supplied real-time multimodal (visual and vibrotactile) biofeedback during dynamic weight-shifting balance exercises (WSBEs). A Technology Acceptance Model (TAM) questionnaire completed by participants validated its acceptability and use. The results of regression analyses of participants' balance exercise performance, based on the average cross-correlations and absolute position errors between the target motion and the exerciser's motion, showed exponential trends, a performance plateau after 3 weeks, and a quasi-steady state performance by the end of 6 consecutive weeks.

MATLAB-Based Real-Time Data Acquisition Tool for Multimodal Biofeedback and Arduino-Based Instruments

AfDaq is an open-source, plug and play, MATLAB based tool that offers the capabilities of multi-channel real-time data acquisition, visualization, manipulation, and local saving of data for offline analysis. The MATLAB Arduino package suffers from serious timing jitter during real-time data acquisition. This timing jitter associated with four main commands (Analog Read, Digital Read, Digital Write and PWM Set) available in MATLAB Arduino package is statistically analyzed and a simple post-hoc timing jitter correction mechanism is proposed to acquire data points with high timing accuracy. The benchmark of the final program is conducted at various sampling rates for multichannel acquisition with 10 Hz comes as the maximum sampling rate for 5 channel recording. In the end, a use case of the developed tool for physiological data acquisition in multimodal biofeedback is presented. The software tool, data, and analysis scripts that support the findings of this study are released as an open-source project to support the replicability and reproducibility of the research.

Efficacy of Using Retro Games in Multimodal Biofeedback Systems for Mental Relaxation

Video games are used to increase the engagement of biofeedback systems. For cost-effectiveness, the original Nintendo Entertainment System (NES) games can be used. Therefore, a multimodal biofeedback system was developed to leverage the NES games for biofeedback. This study aims to test the efficacy of the developed system, the motivation of participants, and the usability of the system. A within-group design study was conducted with 16 participants followed through four interventions: deep breathing, stress-test, non-biofeedback game (control), and biofeedback game (experiment), where their HRV was recorded. Participants showed significantly different HRV during interventions (F(1.60, 23.93) = 11.94, p < 0.001) and reported higher HRV when using biofeedback game than the non-biofeedback game (t(15) = 9.14, p < 0.0001). The motivation was reported to be the same with biofeedback and non-biofeedback version of the game, and the overall system was reported as usable. The results of this study support the efficacy of using original NES games in biofeedback for mental relaxation.

Slow Breathing Exercise with Multimodal Virtual Reality: A Feasibility Study.

Many studies have shown that slow breathing training is beneficial for human health. However, several factors might discourage beginners from continuing their training. For example, a long training period is generally required for benefit realization, and there is no real-time feedback to trainees to adjust their breathing control strategy. To raise the user’s interest in breathing exercise training, a virtual reality system with multimodal biofeedback is proposed in this work. In our system, a realistic human model of the trainee is provided in virtual reality (VR). At the same time, abdominal movements are sensed, and the breathing rate can be visualized. Being aware of the breathing rate, the trainee can regulate his or her breathing to achieve a slower breathing rate. An additional source of tactile feedback is combined with visual feedback to provide a more immersive experience for the trainees. Finally, the user’s satisfaction with the proposed system is reported through questionnaires. Most of the users find it enjoyable to use such a system for mediation training.

Ming Shan Digital Experience

The Ming Shan Digital Experience is an immersive installation designed to support meditation in the context of a new Taoist center. Its creation confronted current academic literature on digital technology for meditation with the practical and cultural requirements of Taoist practice. Quantitative and qualitative learnings show the effectiveness of multimodal biofeedback on individual and collective meditative experience. Now instated in the Taoist center, the installation opens new perspectives for combining digital technology with ancient practice.

A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial.

Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke. The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery. Randomized controlled trial (NCT02439515). Inpatient rehabilitation facility. Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old. Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale. Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008). The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training. The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.

Self-Compassion and Psycho-Physiological Recovery From Recalled Sport Failure.

Failure inherent to high-performance sport can precipitate emotional distress that can impair athletes’ performance and physical and mental health. Identifying factors that allow athletes to manage failure to sustain their health is critical. Self-compassion, treating oneself kindly in response to failure, may help athletes manage failure; it buffers against negative affective psychological responses, yet athletes often fear self-compassion. It is unknown whether the benefits of self-compassion extend to athletes’ physiological responses to failure and whether fear of self-compassion has an influence on psychological and physiological responses to failure, beyond self-compassion. The purpose of this study was to examine the influence of self-compassion on athletes’ psychological and physiological responses when recalling a sport failure and determine if fear of self-compassion exerted unique effects, beyond self-compassion. Participants (n = 91; M age = 21) were university or national-level athletes. In this laboratory-based, observational study, athletes were connected to a multi-modal biofeedback system to measure physiological responding at baseline, during a stress induction (imagining a past performance failure), and during a recovery period. Physiological responding was assessed according to athletes’ high-frequency heart rate variability (HRV), indexing parasympathetic nervous system activity, during the stress induction and recovery phase. Next, to assess psychological reactivity, athletes completed a series of scales (behavioral reactions, thoughts, and emotions). Regression analyses revealed that self-compassion predicted athletes’ HRV reactivity to the stress induction (β = 0.30, p < 0.05). There was no relationship between self-compassion and HRV recovery. Further, self-compassion predicted adaptive behavioral reactions (β = 0.46, p < 0.01), and negatively predicted maladaptive thoughts (β = −0.34, p < 0.01) and negative affect (β = −0.39, p < 0.01). Fear of self-compassion explained additional variance in some maladaptive thoughts and behavioral reactions. Results suggest that self-compassion promotes adaptive physiological and psychological responses in athletes relative to a recalled sport failure and may have implications for performance enhancement, recovery and health outcomes. Further, addressing athletes’ fears of self-compassion may also be important in promoting optimal psychological recovery.

A multi-modal biofeedback protocol to demonstrate physiological manifestations of psychological stress and introduce heart rate variability biofeedback stress management

Physiological monitoring solutions and biofeedback technologies allow sport psychology practitioners to demonstrate physiological changes due to psychological stress, and provide their clients with an enhanced awareness of their stress response. These technologies can also provide evidence for the efficacy of stress management techniques, whether cognitive or physiological in nature. In this article, we present a protocol that uses multiple physiological signals to demonstrate how psychological stress can manifest in the body, and then evidence heart rate variability biofeedback as a stress management technique. Using insights from applied consultations, we focus on the delivery of the protocol through phases of baseline resting measures, stressor tasks, and post-stressor recovery. This article provides an accessible use of physiological monitoring and biofeedback technologies in sport psychology practice, so that practitioners may adopt and adapt this protocol for their purposes and available equipment.

Biofeedback for Everyday Stress Management: A Systematic Review

Background Mainly due to an increase in stress-related health problems and driven by recent technological advances in biosensors, microelectronics, computing platform, and human-computer interaction, ubiquitous physiological information will potentially transform the role of biofeedback in clinical treatment. Such technology is also likely to provide a useful tool for stress management in everyday life. The aim of this systematic review is to: 1) Classify biofeedback systems for stress management, with a special focus on biosensing techniques, bio-data computing approaches, biofeedback protocol, and feedback modality. 2) Review ways of evaluating approaches to biofeedback applications in terms of their effectiveness in stress management. Method A systematic literature search was conducted using keywords for “Biofeedback” and “Stress” within the following databases: PubMed, IEEE Xplore, ACM, and Scopus. Two independent reviewers were involved in selecting articles. Results We identified 103 studies published between 1990 and 2016, 46 of which met our inclusion criteria and were further analyzed. Based on the evidence reviewed, HRV, multimodal biofeedback, RSP, HR, and GSR appear to be the most common techniques for alleviating stress. Traditional screen-based visual displays remain the most common devices used for biofeedback display. Biofeedback applications are usually assessed by making both physiological and psychological measurements. Conclusions This review reveals several challenges related to biofeedback for everyday stress management, such as the facilitating user’s perception and interpretating the biofeedback information, the demand of ubiquitous biosensing and display technologies, and field evaluation in order to understand the use of biofeedback in everyday environments. We expect that various emerging HCI technologies could be used to address these challenges. New interaction designs as well as biofeedback paradigms can be further explored in order to for improve the accessibility, usability, comfort, engagement with, and user experience of biofeedback in everyday use.

Usability and Validation of the Smarter Balance System: An Unsupervised Dynamic Balance Exercises System for Individuals With Parkinson's Disease.

Conventional physical and balance rehabilitation programs to improve balance performance and increase postural stability are often limited due to cost, availability of physical therapists, and accessibility to rehabilitation facilities. Exercise compliance is also affected by a loss of memory and decline in motivation in prescribed home-based balance training. We have developed the smarter balance system (SBS) incorporating multimodal biofeedback (visual plus vibrotactile) intended for clinical and home-based balance rehabilitation and assessed its efficacy on physical therapists' recommended dynamic weight-shifting balance exercises (dynamic WSBE) in individuals with Parkinson's disease (PD). The SBS consists of a smartphone and custom belt housing a processing unit, miniaturized sensors, and vibrating actuators (tactors). Visual and vibrotactile biofeedback guidance during dynamic WSBE is generated by the SBS's custom app based on 90% of the user's limits of stability (LOS). Ten individuals with idiopathic PD having impaired postural stability participated in one unsupervised session comprising 24 trials of the dynamic WSBE in a laboratory setting. Participants' limits of stability (LOS) in the anterior-posterior (A/P) and medial-lateral (M/L) direction were measured at the pre- and post-session. To assess the efficacy of SBS to provide guidance during balance rehabilitation using dynamic WSBE, cross-correlation (XCOR), position error (PE), and percent of tactor activation (PTA) were measured. There was a significant increase in LOS between the pre- and post-training session in both A/P and M/L directions. The average XCOR across all participants were 0.87 (SD = 0.11) and 0.76 (SD = 0.11) for the A/P and M/L direction respectively. The average PE and PTA for the A/P direction was 1.17 deg (SD = 0.60) and 65.35% (SD = 15.1) respectively and 0.74 deg (SD = 0.28) and 31.3% (SD = 16.42) in the M/L direction respectively. There was no significant effect of trials for XCOR, PE, and PTA. Participants' LOS significantly increased after one session of the dynamic WSBE. Individuals with PD could accurately follow the target movements during the dynamic WSBE using the SBS. Future studies will assess the efficacy and acceptability of the SBS during long-term in-home rehabilitative training for balance-impaired individuals.

A novel balance training system using multimodal biofeedback.

BackgroundA biofeedback-based balance training system can be used to provide the compromised sensory information to subjects in order to retrain their sensorimotor function. In this study, the design and evaluation of the low-cost, intuitive biofeedback system developed at Gyeongsang National University is extended to provide multimodal biofeedback for balance training by utilization of visual and haptic modalities.MethodsThe system consists of a smartphone attached to the waist of the subject to provide information about tilt of the torso, a personal computer running a purpose built software to process the smartphone data and provide visual biofeedback to the subject by means of a dedicated monitor and a dedicated Phantom Omni® device for haptic biofeedback. For experimental verification of the system, eleven healthy young participants performed balance tasks assuming two distinct postures for 30 s each while acquiring torso tilt. The postures used were the one foot stance and the tandem Romberg stance. For both the postures, the subjects stood on a foam platform which provided a certain amount of ground instability.ResultsPost-experiment data analysis was performed using MATLAB® to analyze reduction in body sway. Analysis parameters based on the projection of trunk tilt information were calculated in order to ascertain the reduction in body sway and improvements in postural control. Two-way analysis of variance (ANOVA) showed no statistically significant interactions between postures and biofeedback. Post-hoc analysis revealed statistically significant reduction in body sway on provision of biofeedback. Subjects exhibited maximum body sway during no biofeedback trial, followed by either haptic or visual biofeedback and in most of the trials the multimodal biofeedback of visual and haptic together resulted in minimization of body sway, thus indicating that the multimodal biofeedback system worked well to provide significant (p < 0.05) assistance in postural control.ConclusionsA multimodal biofeedback system can offer more customized training methods and hence provide therapists with a comprehensive solution for a diverse array of patients. It is necessary to identify the long-term effects of this novel biofeedback system. In the future, the balance training schemes for individuals with upright balance issues will be studied.

Benefits of multi-session balance and gait training with multi-modal biofeedback in healthy older adults

Real-time balance-relevant biofeedback from a wearable sensor can improve balance in many patient populations, however, it is unknown if balance training with biofeedback has lasting benefits for healthy older adults once training is completed and biofeedback removed. This study was designed to determine if multi-session balance training with and without biofeedback leads to changes in balance performance in healthy older adults; and if changes persist after training. 36 participants (age 60–88) were randomly divided into two groups. Both groups trained on seven stance and gait tasks for 2 consecutive weeks (3×/week) while trunk angular sway and task duration were monitored. One group received real-time multi-modal biofeedback of trunk sway and a control group trained without biofeedback. Training effects were assessed at the last training session, with biofeedback available to the feedback group. Post-training effects (without biofeedback) were assessed immediately after, 1-week, and 1-month post-training. Both groups demonstrated training effects; participants swayed less when standing on foam with eyes closed (EC), maintained tandem-stance EC longer, and completed 8 tandem-steps EC faster and with less sway at the last training session. Changes in sway and duration, indicative of faster walking, were also observed after training for other gait tasks. While changes in walking speed persisted post-training, few other post-training effects were observed. These data suggest there is little added benefit to balance training with biofeedback, beyond training without, in healthy older adults. However, transient use of wearable balance biofeedback systems as balance aides remains beneficial for challenging balance situations and some clinical populations.

Biofeedback for psychiatric disorders: a systematic review.

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

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

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

THU0474-HPR Correction of anxiety and depression in systemic sclerosis patients by biofeedback therapy

BackgroundPatients with systemic sclerosis (SS) report about significant emotional problems that influence negatively on psychological well-being and quality of their life.ObjectivesOur aim was to improve the complex therapy of SS...

AB1398 Biofeedback therapy in complex treatment of systemic sclerosis

BackgroundVarious methods of non-medicinal therapy of systemic sclerosis (SS) were offered, but any of them does not allow achieving desirable success. It is known that active participation of patient in...

Interface computacional 3D para biofeedback multimodal em tempo real

Este artigo descreve o projeto de um sistema computacional em tempo real para biofeedback multimodal. As informacoes biologicas ou psico-fisiologicas do paciente sao detectadas por sensores especificos e processadas para prover feedback visual, por meio de ambientes virtuais tridimensionais e feedback auditivo. O dispositivo foi projetado para coleta e tratamento de seis sinais distintos: EMG, EEG, GSR, temperatura, frequencia cardiaca e frequencia respiratoria. O aplicativo de software foi projetado em linguagem Visual C++ e utiliza tecnicas de programacao concorrente para permitir o tratamento adequado de todas as acoes em tempo real. Os ambientes virtuais foram criados no software 3D Studio Max® e renderizados utilizando os recursos da biblioteca grafica DirectX® da Microsoft Corp. O sistema desenvolvido resultou, conforme relatos dos voluntarios, em sessoes agradaveis e interessantes, que permitiam a escolha de diferentes tipos de ambientes virtuais capazes de se adequar as necessidades individuais. Todos os dados coletados durante as sessoes de biofeedback sao armazenados em um banco de dados especifico, possibilitando a geracao de relatorios para o terapeuta e permitindo o acompanhamento da evolucao dos pacientes ao longo do tratamento. O sistema possui potencialidade para utilizacao como apoio ao tratamento de diversas patologias e disfuncoes, como demonstrado pelos experimentos realizados nas diferentes modalidades de biofeedback. Com este trabalho, os autores esperam ainda contribuir para o desenvolvimento de know-how nacional na area, a medida que disponibilizam tecnicas avancadas para producao de hardware e software aplicaveis a tratamentos em biofeedback multimodal.

Optimal Performance Field: The Exceptional Performance Training System

The author, an Argentine physician, describes an integrative program for optimal performance, combining multi-modal biofeedback and neurofeedback with “wisdom practices,” acupuncture, and such therapeutic activities as journaling, movement, art, and bibliographic therapy.