THERAPEUTIC

BIOFEEDBACK
 INTRODUCTION
• Biofeedback may be defined as the technique
of using equipment (usually electronic) to
reveal to human beings some of their internal
physiological events ,normal & abnormal ,in
the form of visual & auditory signals in order
to teach them to manipulate these otherwise
involuntary or unfelt events by manipulating
the displayed signals.
THE BIOFEEDBACK METHOD
 ORIGIN OF BIOFEEDBACK
• A psychologist and neuroscientist who worked
and studied at Yale University during the
middle of the 20th century, is generally
considered the father of modern-day
biofeedback
• Origin of biofeedback- Neal Miller.
 Defination
• It is a process that enables an individual to learn
how to change physiological activity for the
purpose of improving health and performance.
• Use precise instruments measure physiological
activity such as, brainwaves, heart functions,
breathing, muscle activity and skin temp.
• This instruments rapidly and accurately give feed
back information to the user.
 Aim
• It can be used to inform the pt about
physiological events like, blood pressure, skin
temp, heart rate and other things like force,
joint displacement so, that by seeing the pt is
able to control these activities, in order to
understand biofeedback.
• The motor learning can be facilitated by
improving the motor performance. This is the
main aim of biofeedback in physiotherapy.
 Mechanism
• Pt’s motor behavior or physiological changes
can be detected by measuring device is called
feedback device.
• The following changes are displayed by
indicator and information ( audible & visual )
is perceived and develops
• so, exact movement can be achieved.
 Main use of biofeedback
• The use of biofeedback is classified for two
broad criteria
• 1. to improve the control over the defective
muscle or defective movement
• 2. for the control of stress related conditions
 Other uses
• 1) Essential hypertension- if the blood
pressure of the patient is monitored and
displayed, the pt can learn how to control the
blood pressure.
• By practicing, he can control up to 35 mm of
Hg.
• 2) cardiac arrhythmias- heart rate is
monitored and displayed to the pt by
biofeedback.
• He learns to control by slowing the heart rate.
• Simultaneously, pt can control blood pressure
also.

• 3) Reynaud's disease- the temp of finger is

monitored using a suitable skin thermometer
and pt learns voluntarily to increase the temp
• 4) Migraine- An attack of migraine is caused
by dilatation of blood vessels over the surface
of the brain.
• Pain is severe and unilateral
• So biofeedback in the treatment of migraine
has involved attempts to increase peripheral
blood flow usually to hands and fingers.
• 5) Tension headache- that tension in the
occipitofrontalis and postural neck muscles is
the cause of these headaches.
• So relaxation of these muscles with
biofeedback displays that the
electromyography of these muscles is done.
• 6) Epilepsy- it is possible for the pts to reduce
the frequency of epileptic fits by producing a
special rhythm in the electroencephalogram,
i.e., the sensory motor rhythm.
 Major biofeedback modalities and
its uses
• EMG
• NCV
• Feed back thermometer.
• Electrodermograph.
• Electroencephalograph.
• Photoplethysmograph.
• Pnuemograph.
• Capnometer.
• Haemoencephalography.
• ECG
• Rheoencephalograph
EMG
 EMG

• An electromyography, or EMG is the one of the most

commonly used modalities in biofeedback
treatment.
• An EMG in a biofeedback setting typically uses
electrodes in order to measure muscle action
potentials..
• EMG is used as a relaxation technique to
relieve tension in the muscles causing
backaches, neck pain, incontinence, and
tension, migraine, and cluster headaches.
• EMG is also used in the process of muscle
rehabilitation, such as in cases of paralysis
resulting from Cerebral Palsy, stroke, and
incomplete spinal cord lesions.
• Use surface electrode to detect muscle action
potentials from underlying skeletal muscles
that initiate muscle contraction.
• Surface electromyogram- using one or more
active electrodes that are placed over a target
muscle and a reference electrode that is
placed within in six inches of either active.
• It is measured in micro volts.
 uses
• Treating anxiety, chronic pain, computer
related disorder, essential hypertension,
headache, low back pain, physical
rehabilitation like CP, incomplete spinal cord
lesions and stroke, TM joint disorders,
torticollis and urinary incontinence and pelvic
pain
FEEDBACK THERMOMETER
 Feedback thermometer
• It detects skin temp with a thermistor, that is
usually attached to a finger or toe and
measured in degrees.
• Skin temp mainly reflects arteriole diameter
• Hand warming and Hand cooling are produced
by separate mechanism and their regulation
involves different skills.
• 1. hand warming- involves arteriole
vasodilatation produced by a beta-2
adrenergic hormonal mechanism.

• 2. hand cooling- involves arteriole

vasoconstriction produced by the increased
firing of sympathetic c- fibers
 uses
• when treating chronic pain, oedema,
headache, essential hypertension, anxiety
and stress
ELECTRODERMOGRAPH
 Electrodermograph
• Measures skin electrical activity directly ( skin
conductance and skin potential ) and
indirectly (skin resistance) using electrodes
placed over the digits or hand and wrist.
• 1. in skin conductance- an EDG imposes an
imperceptible current across the skin and
measures how easily it travels through the
skin.
• 2. in skin potential- a therapist places an
active electrode over an active site ( e.g the
Palmar surface of the hand ) and a reference
electrode over a relatively inactive site ( e.g
forearm )
• Skin potential is the voltage that develops
between sweat glands and internal tissues

• 3. in skin resistance-also called galvanic skin

response
 uses
• when treating anxiety disorders,
hyperhydrosis ( excessive sweating ) and
stress.
• It is also used as an adjacent to psychotherapy
to increase client awareness of their emotions
• EDG as one of the central tools in polygraphy
( lie detection) because they reflect changes in
anxiety or emotional activation.
EEG
 EEG
• Measures the electrical activation of the brain
from scalp sites located over the human
cortex.
• EEG shows the amplitude of electrical activity
at each cortical site, the amplitude and
relative power of various wave forms at each
site, and the degree to with each cortical site
fires in conjunction with other cortical sites
• EEG uses precious metal electrode to detect a
voltage between at least two electrodes located
on the scalp
• EEG records both excitatory postsynaptic
potentials and inhibitory postsynaptic potentials
that largely occur in dendrites in pyramidal cells
located in macro columns, several millimeters in
diameter in the upper cortical layers
• Main frequency range include- delta, theta,
alpha, sensori-motor rhythm, low beta, high
beta, gamma.
 uses

• When treating addiction, attention deficit

hyperactivity disorders ( ADHD), learning
disability, anxiety disorders (including worry,
obsessive- compulsive disorder and
posttraumatic stress disorder ), depression,
migraine and generalized seizures
PHOTOPLETHYSMOGRAPH
 PHOTOPLETHYSMOGRAPH
• Measures the relative blood flow through a
digit using a PPG sensor attached by a Velcro
band to the fingers or to the temple to
monitor the temporal artery
• An infrared light source is transmitted through
or reflected off the tissue, detected by a
phototransistors and quantified in orbiters
units
• Less light is absorbed when blood flow is
greater, increasing the intensity of light
reaching sensor.
• PPG can measure blood volume pulse, which
is the phasic changes in blood volume with
each heartbeat, heart rate and heart rate
variability (HRV), which consists of beat – to-
beat differences in intervals between
successive heart beats.
• A PPG can provide useful feedback when
temp feedback shows minimal change.
 uses
• When treating chronic pain, oedema,
headache, essential hypertension, anxiety and
stress
Pnuemograph
 Pnuemograph
• Use a flexible sensor band that is placed
around the chest, abdomen or both.
• The strain gauge method – can provide
feedback about the relative expansion or
contraction of the chest and abdomen and
can measure respiration rate.
• Clinicians can use a Pnuemograph to detect
and correct dysfunctional breathing patterns
and behavior.
• Dysfunctional breathing patterns include-
• 1. clavicle breathing- breathing that primarily
relies on the external intercostals and the
accessory muscles of respiration to inflate the
lungs.
• 2. Reverse breathing- breathing where the
abdomen expands during exhalation and
contracts during inhalation.
• 3. thoracic breathing- shallow breathing that
primarily relies on the external intercostals to
inflate the lungs.
 uses
• A Pnuemograph is often used in conjunction
with an ECG or PPG in heart-rate variability
(HRV) training.
• When treating anxiety disorders, asthma,
chronic pulmonary obstructive disorders
( COPD), essential hypertension and stress.
Capnometer
 Capnometer/ capnograph
• Use an infrared detector to measure end-tidal
CO2 ( the partial pressure of CO2 in expired air
at the end of expiration ) exhaled through the
nostrils into a latex tube.
 uses
• When treating anxiety disorders, asthma,
COPD, essential hypertension and stress.
Haemoencephalography
 Haemoencephalography
• It is a functional infrared imaging technique
• It measures the differences in the color of
light reflected back through the scalp based
on the relative amount of oxygenated and
unoxygeneted blood in the brain.
 uses
• To treat ADHD ( attention deficit hyperactivity
disorder) and migraine.
ECG
 ECG
• Uses electrodes placed on the torso, wrists or
legs to measure the electrical activity of the
heart and measures the interbeat interval.
• The heartbeat interval, divided into 60 sec,
determines the heart rate at the moment.
• ECG method is more accurate than the PPG
method in measuring heart rate variability.
 uses
• When treating asthma, COPD, depression,
heart diseases and unexplained abdominal
pain.
Rheoencephalograph
 Rheoencephalograph
• It is a biofeedback technique of a conscious
control of blood flow.
• An electrode device called a REG is utilized in
brain blood flow biofeedback.
• Electrodes are attached to the skin at certain
points on the head and permit the device to
measure continuously the electrical
conductivity of the tissues of structures
located between the electrodes.
 Treatment duration
• No specific criteria
• 10 to 30 min per day
 advantages
• 1. provides corrective information to the pt
immediately
• 2. pt gets involved actively in his own
treatment
• 3. it may not require sophisticated
understanding of the skill by pts
• 4. can be used during ongoing activities.
• 5. it may save physiotherapist’s time.
 disadvantages
• 1. treat symptoms and not the underlying cause
of symptoms
• 2. these device are not available commercially
at all the places
• 3. these are unacceptable to pts who won’t like
to put wires and electronic boxes, over their
body
• 4. sometimes physiotherapists may need
special training for the use of biofeedback.
 REFERENCES
• Gladdy
• Khokher- principles of EMG Biofeedback
Tha
nk
you