Standard Biofeedback Research Articles

Anorectal biofeedback: an effective therapy, but can we shorten the course to improve access to treatment?

Background:Instrumented anorectal biofeedback (BF) improves symptoms and quality of life in patients with faecal incontinence and defecation disorder-associated chronic constipation. However, demand for BF greatly outweighs availability, so refinement of the BF protocol, in terms of the time and resources required, is of importance. Our aim was to evaluate the outcomes of an abbreviated BF protocol in patients with defecation disorder-associated chronic constipation and/or faecal incontinence compared to standard BF.Methods:Data were collected from consecutive patients (n = 31; age 54 ± 15; 29 females; 61% functional constipation) undergoing an intentionally abbreviated BF protocol, and compared in a 1:2 ratio with 62 age, gender and functional anorectal disorder-matched control patients undergoing a standard BF. Outcomes included change in symptoms, physiology, patient satisfaction and quality of life.Results:On intention to treat, patients in both protocols showed significant improvement in symptom scores and the magnitude did not differ between groups. Impact on quality of life, satisfaction and control over bowel movements improved in both protocols, but satisfaction improved to a greater extent in the standard BF protocol (p = 0.009). Physiological parameters were unchanged after BF apart from improvement in rectal sensation in the standard BF group compared to abbreviated BF (p ⩽ 0.002).Conclusions:Abbreviated anorectal BF offered to patients travelling from far away was not different to a standard BF in providing substantial, at least short term, improvements in symptoms of constipation and faecal incontinence, quality of life and feeling of control over bowel movements. Refinement of the standard BF protocol according to individual patient phenotypes and desired outcomes warrants further study in order to maximize efficacy and improve access for patients.

Augmented reality system for muscle activity biofeedback

Augmented Reality (AR) has been proved successful in several applications from surgical training to balance rehabilitation. This work aims to develop an AR system for real-time visualization of an index of muscle activity superimposed to the investigated muscle. The system includes: (1) a video camera, (2) one or more surface EMG (sEMG) detection/acquisition systems, (3) one processing and visualization unit ( Fig. 1 ). The system integrates the information from the video camera and from the sEMG systems (the ARV of the sEMG signal epoch corresponding to the current video frame) and creates an “augmented video frame” by coloring the detection systems, identified within the video frame, with a color representative of the muscle activity (blue for low and red for high sEMG activity). The patient or the clinical operator can see the real-time augmented video on a display. The software can run (1) on a PC using a webcam for video capture and showing the augmented video on a monitor, (2) on a tablet using the integrated camera or (3) on the Epson Moverio BT-300 smartglasses using the see-through modality. Fig. 2 shows the AR feedback during a leg extension exercise; vastus medialis, vastus lateralis and rectus femoralis muscles are monitored using a sEMG bipolar system (Due, OTBioelettronica and LISiN). Fig. 3 shows the AR system used for the monitoring of sEMG activity distribution in the lumbar muscles using a multi-channel sEMG systems (32 channel amplifier by LISiN). An AR system for the visualization of sEMG activity over the muscles has been developed. The system is currently under validation for augmented biofeedback in sport and rehabilitation in order to verify advantages with respect to standard biofeedback.

Generalization of skills between operant control and discrimination of EEG alpha.

While biofeedback is often said to increase self-control of physiological states by increasing awareness of their subjective correlates, relatively few studies have analyzed the relationship between control (standard biofeedback) and awareness (a discrimination paradigm). We hypothesized that the two skills would generalize and facilitate each other for 8-12Hz EEG amplitude (alpha). Participants were given 7 sessions of training to either control or discriminate Pz alpha followed by 3 sessions of the other paradigm. Another group was given 7 sessions with time divided equally between the two types of training. The control-training first group showed significant generalization of skills to the discrimination task. However, the reverse was not true, and the combined task group did no better in either task than the other two groups. These results provide ambivalent support for the role of awareness in biofeedback, and suggest possible improvements in the discrimination paradigm.

Supplementary home biofeedback improves quality of life in younger patients with fecal incontinence.

Biofeedback is a scarce, resource-intensive clinical therapy. It is used to treat patients with bowel problems, including fecal incontinence (FI), who fail to respond to simple dietary advice, medication, or pelvic floor exercises. Populations are aging and younger cohorts use technology in managing their health, affording FI self-management opportunities. Does supplementary home-based biofeedback improve FI and quality of life (QOL)? Seventy-five incontinent participants (12 male), mean age 61.1 years, consented to participate. Thirty-nine patients (5 male) were randomized to the standard biofeedback protocol plus daily home use of a Peritron perineometer (intervention) and 36 patients (7 male) to the standard biofeedback protocol (control). On completion of the study each perineometer exercise session was rated for technique by 2 raters, blinded to the patient and order of sessions. With the exception of Fecal Incontinence Quality of Life Scale lifestyle improvement (intervention--9.1% vs. controls--0.3%, P=0.026) and embarrassment improvement (intervention--50.0% vs. controls--18.3%, P=0.026), supplementary home biofeedback did not result in greater clinical improvement for the intervention group as a whole. However, on stratification around the mean age, continence and QOL of younger people in the intervention group were significantly better than those of their control counterparts. Graphed perineometer sessions demonstrated high compliance and improvement in exercise technique. Perineometers provided reassurance, motivation, and an exercise reminder ensuring that confidence was achieved quickly. Home biofeedback was acceptable and well tolerated by all users. Younger participants significantly benefited from using this technology.

Home electrical stimulation for women with fecal incontinence: a preliminary randomized controlled trial.

The purpose of this study is to compare the effectiveness and cost of home electrical stimulation and standardized biofeedback training in females with fecal incontinence Thirty-six females suffering from fecal incontinence were randomized into two groups, matched for mean age (67.45 ± 7.2 years), mean body mass index (kg/m2) (26.2 ± 3.9), mean disease duration (4.1 ± 0.8 years), mean number of births (2.7 ± 1.3), and reports of obstetric trauma (25%). Questionnaires were used to evaluate their demographics, medical, and childbearing history. Subjects were randomized to home electrical stimulation or standardized biofeedback training for a period of 6 weeks. Subjective outcome measures included the frequency of fecal, urine, and gas incontinence by visual analog scale, Vaizey incontinence score, and subjects' levels of fecal incontinence related anxiety. Objective outcome measures included pelvic floor muscle strength assessed by surface electromyography. We also compared the cost of each treatment modality. Only females who received home electrical stimulation (HES) reported a significant improvement in Vaizey incontinence score (p = 0.001), anxiety (p = 0.046), and in frequency of leaked solid stool (p = 0.013). A significant improvement in pelvic floor muscle strength was achieved by both groups. HES was much cheaper compared to the cost of standardized biofeedback training (SBT) (US $100 vs. US $220, respectively). Our study comprised a small female population, and the study endpoints did not include objective measures of anorectal function test, such as anorectal manometry, before and after treatment. Home electrical stimulation may offer an alternative to standardized biofeedback training as it is effective and generally well-tolerated therapy for females with fecal incontinence.

Sa2043 The Impact of Lower Gastrointestinal Symptoms on Quality of Life in Women With Systemic Sclerosis

G A A b st ra ct s assessed by surface electromyography (EMG). Results: A total of 36 women with FI were randomized to HES or SBT (18 in each treatment group). Groups were matched by mean age: 65.5±13.5 years, mean BMI (kg/m2): 26.2±3.9, mean disease duration: 1.42±0.8 yrs, mean number of births: 2.7±1.3 and reports of obstetric trauma (25%). Only patients that received HES reported a significant improvement of FIGS (p=0.0015) and a significant drop in the number of leaked solid and liquid stool (p=0.012, p= 0.07, respectively). SF-36 scores were not affected significantly by treatment in both groups. A significant improvement of PEM contraction was achieved in 89 % of patients from both groups. Conclusions: Home electric stimulation only was found to be more efficient than standardized biofeedback training only if assessed by both subjective and objective measures.

Sa2045 25-G Is Better Than 50-G Lactose for Hydrogen Breath Test to Diagnose and Predict Symptom Resolution Following Milk Withdrawal in Adult Type Hypolactasia

G A A b st ra ct s assessed by surface electromyography (EMG). Results: A total of 36 women with FI were randomized to HES or SBT (18 in each treatment group). Groups were matched by mean age: 65.5±13.5 years, mean BMI (kg/m2): 26.2±3.9, mean disease duration: 1.42±0.8 yrs, mean number of births: 2.7±1.3 and reports of obstetric trauma (25%). Only patients that received HES reported a significant improvement of FIGS (p=0.0015) and a significant drop in the number of leaked solid and liquid stool (p=0.012, p= 0.07, respectively). SF-36 scores were not affected significantly by treatment in both groups. A significant improvement of PEM contraction was achieved in 89 % of patients from both groups. Conclusions: Home electric stimulation only was found to be more efficient than standardized biofeedback training only if assessed by both subjective and objective measures.

Sa2047 Effectiveness of a Therapeutic Algorithm for Functional Anorectal Pain: Experience in a Private Ambulatory Coloproctology Center in Buenos Aires, Argentina

G A A b st ra ct s assessed by surface electromyography (EMG). Results: A total of 36 women with FI were randomized to HES or SBT (18 in each treatment group). Groups were matched by mean age: 65.5±13.5 years, mean BMI (kg/m2): 26.2±3.9, mean disease duration: 1.42±0.8 yrs, mean number of births: 2.7±1.3 and reports of obstetric trauma (25%). Only patients that received HES reported a significant improvement of FIGS (p=0.0015) and a significant drop in the number of leaked solid and liquid stool (p=0.012, p= 0.07, respectively). SF-36 scores were not affected significantly by treatment in both groups. A significant improvement of PEM contraction was achieved in 89 % of patients from both groups. Conclusions: Home electric stimulation only was found to be more efficient than standardized biofeedback training only if assessed by both subjective and objective measures.

Peristeen rectal irrigation for functional bowel disorders: Which patients benefit?

Functional bowel disorders (FBD) are distressing for patients and pose a treatment dilemma for clinicians. Management is usually conservative, with rectal irrigation one of the available treatments. This study aimed to determine the acceptability and efficacy of rectal irrigation in a group of patients with FBD who had not responded to standard biofeedback treatment. All patients had previously been appropriately investigated and undergone standard biofeedback treatment with psychological assessment. Patients were taught to irrigate by a specialist nurse and followed up regularly. A visual analogue score was used to quantify symptoms. Over an 8-year period 113 patients were treated with rectal irrigation.

Skin temperature biofeedback: Evaluation of non-clinical children's responses

The present study evaluated the extent to which children are able to learn to increase skin temperature with biofeedback training. Forty-nine children (ages 7–16) were randomly assigned to either standard biofeedback, novel biofeedback or control groups, which met for 16, 16, and 5 sessions, respectively. Results indicated children in the novel biofeedback group significantly increased their skin temperature as compared with the control group. The biofeedback groups exhibited significant skin temperature control during feedback. Results provide normative data on what to expect from children receiving skin temperature biofeedback.

Altered skin temperature and electromyographic activity in the irritable bowel syndrome

A prospective study to determine the presence or absence of any difference in skin temperature and electromyographic (EMG) activity in 20 patients with irritable bowel syndrome (IBS) compared with 20 age- and sex-matched controls was conducted. A representative digital temperature and EMG activity during 4 phases, baseline, mental activity (arithmetic), unpleasant thoughts and audio biofeedback relaxation, were recorded using standard biofeedback equipment. Results showed the IBS group to have a significantly lower digital temperature and significantly higher EMG activity during the baseline and arithmetic phases. No difference was found in EMG activity for the unpleasant thought or audio biofeedback relaxation phases. Indeed, the IBS group were able to achieve a level of EMG activity during the audio feedback relaxation phase that approximated very closely that of the control group. These results provide further evidence suggestive of altered autonomie nervous system function in IBS patients and indicate that further studies should be undertaken to determine whether the reduction achieved in EMG activity post-relaxation is sustained, and if so, if it is associated with a corresponding improvement in symptoms.

Biofeedback and effects of set and sex with type A and type B college students: an exploratory study.

From a subject pool, Type A and B subjects, 13 women and 12 men, were chosen to participate in EMG biofeedback training for two sessions. In Session 1 subjects were given standard biofeedback training instructions without any set except to use the biofeedback signals to relax. In Session 2 a mildly competitive set was introduced with potential monetary reward. Subjects showed relaxation over and within sessions with no significant type or set differences or interactions. Men showed more increased relaxation within sessions than did women regardless of type and set.

Self-Control Procedures in Biofeedback Treatment of Tension Headache: The Effects of “Generalization Training”

Abstract EMG-biofeedback assisted relaxation training was used in the treatment of tension headache. Two groups of subjects were treated with either a “standard biofeedback” method, or a “biofeedback with generalization training” method. The latter included procedures which were aimed at maximizing voluntary control of frontal muscle activity in the absence of external feedback, as well as the ability to use the self-regulation skills in every-day life. The results indicated that only the “standard biofeedback” group showed evidence of increased relaxation abilities. However, these greater achievements were not accompanied by comparable superiority regarding headache decreases. These results are discussed and some hypothetical explanations are put forward.

A simple EMG--reward system for biofeedback training of children.

An automated reward system to be used with standard electromyographic (EMG) biofeedback instrumentation is described. The on-line reward system, when coupled with standard biofeedback instrumentation and procedures, constitutes instrumental conditioning. In addition to describing the EMG--reward interface circuitry, a study demonstrating the efficacy of the instrumental conditioning approach with cerebral-palsied children is presented.