6/9/2018

Biofeedback

 A therapeutic procedure which uses electronic

or electromechanical instruments to accurately
BIOFEEDBACK measure, process, and feedback reinforcing
information via auditory or visual signals

 Used to help patient develop greater voluntary

control of either neuromuscular relaxation or
muscle re-education following injury.

Dr. Khyati Parekh

Outline of the biofeedback process

 Feedback is ongoing, in a temporal sense, occuring
before, during, and after any motor or movement Visual or Auditory
task. Biofeedback device input

 Feedback from some measuring instrument which

Information to
provides moment to moment information about a
the patient
biologic function is referred to as biofeedback
Patient’s
monitor Desired
behaviour movement
attempt

Types of feedback
 2 types:  Intrinsic feedback- It is the body’s internal feedback
1. Intrinsic feedback mechanism which uses visual, auditory, vestibular
2. Extrinsic feedback- 2 types: and proprioceptive mechanism.
- Knowledge of results
- Knowledge of performance  Extrinsic feedback- It is derived from external
source.e.g., biofeedback signal, external therapists
command.

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Natural feedback process

 Knowledge of results (KR)- It is feedback given  The mode of execution of movement may be classified
after performance of a task. into open and closed loop mechanisms, though normal
motor behaviour is a combination of both.

 Knowledge of performance (KP)- It is feedback

given during and after performance of a task and  The open loop mechanism:
is related to how the task was performed. When a well learnt skill is executed in a fast fashion
there is no sufficient time to rely on feedback
mechanisms for error correction or in other words it is
just an execution of a preplanned motor program. Eg-
walking, running, playing a piano,etc.

Biofeedback in rehabilitation
 The closed loop mechanism: When using biofeedback the patient should,
When attempting to learn a new skill or modify a learnt  Understand the relationship of the electronic signal
motor skill, constant error correction is necessary in to the desired functional task
order to complete the intended task without error. The
 Practice controlling biofeedback signal
CNS constantly needs input from the various feedback
mechanisms before issuing each motor command and  Perform the functional task until it is mastered and

modifying the command by analyzing the feedback patient no longer needs biofeedback.
obtained constantly. Since there is no open execution,
the mechanism is said to be closed one. Eg- learning to
walk or trying to balance on a cycle.

EMG Biofeedback EMG Biofeedback equipment

 Defination: Consists of:
- EMG Biofeedback is the use of amplified electric  Surface electrodes (10mm diameter)
voltage generated by the muscles as visual,  Electrode paste
auditory or sensory feedback to initiate, inhibit or  Amplifier
train a muscle contraction.
 Signal processor

 Audiospeaker

 Video display

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Uses of EMG biofeedback

 Surface electrodes:  Neuromuscular reeducation
- They are usually silver chloride electrodes. They may  Relaxation
require electrode gel or they may be pregelled  Tension recognition training
adhesive electrodes. Some electrodes come with pre-  Training to use myoelectric appliances
amplifiers attached to the electrode leads.
 The display:
- The output of the feedback machine may be an
auditory response or a visual response
- Auditory- beeps or music
- Visual- graphs, LEDs, numbers, animations, etc

Uses of EMG biofeedback in Limitations of EMG biofeedback in

reeducation reeducation
 Smaller prognosis can be monitered  It is not perfect substitute for proprioception deficiency
 Easier to focus the patient’s attention on the effort  Pick up irrelevant contractions
 Provides a clear goal  Successful contraction does not reflect actual outcome
 Reinforces appropriate motor behaviour  Delay in feedback is unnatural
 Patient knows that the machine does not give false  Blind reliance on output is sometimes deceiving
encouragement  Not useful in complete lesions
 It is the only way to communicate which motor unit to  Dependency if not progressed properly
activate.
 Intact special senses required
 Used as a treatment tool (not a treatment)
 In skin lesions
 Sensitive and accurate
 Localized to an area
 Creates interest

Clinical application of EMG

biofeedback
 Relaxation training
 Stroke rehabilitation OTHER BIOFEEDBACK
Spasticity control


 Training in peripheral nerve injuries INSTRUMENTS

 For treatment of spasmodic conditions like spasmodic torticollis,
hemi facial spasm
 For treatment of disorders of voluntary movements like chorea,
tremors, etc.
 For muscle reeducation following surgeries
 For pain management
 For cerebral palsy
 SCI management
 Treatment for gait training

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POSITIONAL BF
 Positional BF is especially used in the training of balance and
PRESSURE/FORCE BF
coordination.
 Positional BF is used to expose the convenient timing and coordination  Force monitoring can be used when information
needed to control a movement. about force being transmitted through a body
 There are several examples where positional BF was used such as head segment is needed.
control training in cerebral palsy and postural trunk control training in  In balance deficits, patients can be informed by
hemiplegic patients. providing feedback from a force platform while
 In our trunk control training study, the BF system depends on a balance activities are performed.
multidimensional, round on-off mercury switch placed on the midline of  The feedback can take visual and/or auditory form.
the upper back portion of the body.
 When the patient tilts from the erect position in any direction, shifting
 For training of symmetrical standing or gait, a limb
of the mercury causes a short circuit, and the loudspeaker and the load monitor can be used to monitor the force
warning lamp give feedback to the patient. transmitted through an extremity.
 In this study, angular BF intervention provided earlier postural trunk
control compared to controls.

ELECTROGONIOMETRIC BF Temperature BF
 This BF system gives knowledge to patients about range  Temp BF device monitors skin temp and can be helpful
of motion of their joints that are monitorized during gait in certain circulatory disorders.
training.  Raynaud’s disease is an example that can be benefited
 By comparing their own goniometric traces with the by this technique.
normals, patients try to normalize their gait patterns.  Usually, a sensor is attached to the foot or to the middle
 Or the goniometer can be set up to give signals on or small finger of dominant hand.
determined angles.  It is based on the assumption that when a person is
 For example regarding genu recurvatum in hemiplegic tense or anxious, his skin temperature drops as blood is
patients, the device can be adjusted to give feedback redirected inward to muscles and internal organs.
if the knee of the patient hyperextends (genu  It is a useful tool in learning how to manage stress.
recurvatum)
 This method may also reduce the frequency of migrane
headaches, and is also used to promote relaxation.

EEG BF Galvanic skin response

 On EEG, alpha waves are commonly observed when  Also known as electrodermal response.
a person relaxes.  GSR measures electrical conductance in the skin, which
is associated with the activity of sweat glands.
 It is presumed that patients can relief from anxiety,
 A very slight electrical current is run through the patients
insomnia and perhaps epilepsy by learning to skin.
increase their alpha wave activity.
 Then a machine measures changes in the salt and water
 This alpha training is only useful if it is combined in the person’s sweat gland ducts.
with other therapies.  The more emotionally aroused the patient is, the more
active will be the sweat glands, and the greater the
electrical conductivity of the skin.
 GSR is effective in treating phobias, anxiety, excessive
sweating, etc.

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THANK U