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.

1

 Knowledge of results (KR)- It is feedback given
after performance of a task.
 Knowledge of performance (KP)- It is feedback
given during and after performance of a task and
is related to how the task was performed.
 The closed loop mechanism:
When attempting to learn a new skill or modify a learnt
motor skill, constant error correction is necessary in
order to complete the intended task without error. The
CNS constantly needs input from the various feedback
mechanisms before issuing each motor command and
modifying the command by analyzing the feedback
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
 Defination:
- EMG Biofeedback is the use of amplified electric
voltage generated by the muscles as visual,
auditory or sensory feedback to initiate, inhibit or
train a muscle contraction.
6/9/2018
Natural feedback process
 The mode of execution of movement may be classified
into open and closed loop mechanisms, though normal
motor behaviour is a combination of both.
 The open loop mechanism:
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
When using biofeedback the patient should,
 Understand the relationship of the electronic signal
to the desired functional task
 Practice controlling biofeedback signal
 Perform the functional task until it is mastered and
patient no longer needs biofeedback.
EMG Biofeedback equipment
Consists of:
 Surface electrodes (10mm diameter)
 Electrode paste
 Amplifier
 Signal processor
 Audiospeaker
 Video display
2
 6/9/2018

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

3

POSITIONAL BF
 Positional BF is especially used in the training of balance and
coordination.
 Positional BF is used to expose the convenient timing and coordination
needed to control a movement.
 There are several examples where positional BF was used such as head
control training in cerebral palsy and postural trunk control training in
hemiplegic patients.
 In our trunk control training study, the BF system depends on a
multidimensional, round on-off mercury switch placed on the midline of
the upper back portion of the body.
 When the patient tilts from the erect position in any direction, shifting
of the mercury causes a short circuit, and the loudspeaker and the
warning lamp give feedback to the patient.
 In this study, angular BF intervention provided earlier postural trunk
control compared to controls.
ELECTROGONIOMETRIC BF
 This BF system gives knowledge to patients about range
of motion of their joints that are monitorized during gait
training.
 By comparing their own goniometric traces with the
normals, patients try to normalize their gait patterns.
 Or the goniometer can be set up to give signals on
determined angles.
 For example regarding genu recurvatum in hemiplegic
patients, the device can be adjusted to give feedback
if the knee of the patient hyperextends (genu
recurvatum)
EEG BF
 On EEG, alpha waves are commonly observed when
a person relaxes.
 It is presumed that patients can relief from anxiety,
insomnia and perhaps epilepsy by learning to
increase their alpha wave activity.
 This alpha training is only useful if it is combined
with other therapies.
6/9/2018
PRESSURE/FORCE BF
 Force monitoring can be used when information
about force being transmitted through a body
segment is needed.
 In balance deficits, patients can be informed by
providing feedback from a force platform while
balance activities are performed.
 The feedback can take visual and/or auditory form.
 For training of symmetrical standing or gait, a limb
load monitor can be used to monitor the force
transmitted through an extremity.
Temperature BF
 Temp BF device monitors skin temp and can be helpful
in certain circulatory disorders.
 Raynaud’s disease is an example that can be benefited
by this technique.
 Usually, a sensor is attached to the foot or to the middle
or small finger of dominant hand.
 It is based on the assumption that when a person is
tense or anxious, his skin temperature drops as blood is
redirected inward to muscles and internal organs.
 It is a useful tool in learning how to manage stress.
 This method may also reduce the frequency of migrane
headaches, and is also used to promote relaxation.
Galvanic skin response
 Also known as electrodermal response.
 GSR measures electrical conductance in the skin, which
is associated with the activity of sweat glands.
 A very slight electrical current is run through the patients
skin.
 Then a machine measures changes in the salt and water
in the person’s sweat gland ducts.
 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.
4
 6/9/2018

THANK U