1. BIOFEEDBACK

2. What is Biofeedback?
A clinical technique that involves recording electrical activity generated in body systems that are not generally felt to be under voluntary control.
Uses an instrument that measures, processes & provides feedback reinforcing information via visual or auditory signals
E.g. a tone gets lower when blood pressure goes down, etc..
Used for rehabilitation & research purposes
It has numerous legitimate clinical applications, but some of its practitioners have strayed far from science.

3. Biofeedback Units 4 types of Units:
Peripheral temperature,
Finger Phototransmission,
Electrical resistance units/ Skin Conductance Activity
Electromyography (EMG),
EMG - most typically used form of biofeedback
Scale on unit can be both visual and audio
Measured in microvolts, 0-10 scale, or some form of pitch

4. EMG & Other Units
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5. Biofeedback Units Peripheral temperature units
Indirect measure of the diameter of peripheral blood vessels
Easily seen in toes & fingers
Variations in body reactions change temperature
 temperature indicates relaxed state
 temperature indicates stress, fear, anxiety
Measured in degrees Fahrenheit

6. Biofeedback Units Finger Phototransmission
Measured indirectly using a Photoplethysmograph
Monitors amount of light reflected by subcutaneous tissues based on amount of blood flow
As blood volume increases the amount of light detected decreases
Monitor finger pulse

7. Biofeedback Units
Electrical resistance units/ Skin Conductance Activity
Measures amount of perspiration on the skin
Sweat contains salt which increases electrical conductivity
Passes a small current through the fingers (volar surface) and/or palm
Measures impedance of electrical current
Lie detector testing

8. Lie Detectors

9. Biofeedback Units Electromyographic (EMG)
Measures electrical activity in skeletal muscle
May be very simple to very complex
Take-home models
Electrodes – you will mostly see surface electrodes
Active electrodes:
Detects electrical activity from muscle contraction & converts into visual or auditory signals
Reference electrode (ground electrode):
Filters “noise” or unwanted electrical activity in the environment (other electromagnetic energy);
Point of reference to compare the electrical activity recorded by the active electrodes

10. EMG Units

11. Indications for EMG Use
Facilitation for muscle reeducation
Restoration of neuromuscular function
Increase muscular strength
Promotion of relaxation of spasm
Reduction of muscle guarding
Assistance with pain control
Neurological Conditions (following stroke, spinal cord injury, cerebral palsy, incontinence)

12. Advantages for using EMG
Provides feedback with a chance to make appropriate small changes in performance that are immediately noted & rewarded
Patient learns early in rehab to do something for him/herself instead of relying on the athletic trainer
Proven to reduce myofascial pain, migraine & tension headache pain and stress reduction
With neuromuscular effects, biofeedback helps with input that is lost from receptor

13. Contraindications
If movement of a joint or isometric contractions are contraindicated
Conditions in which muscle contractions might exacerbate the condition
Unhealed tendon grafts, avulsed tendons, 3rd degree tears of muscle fibers
Unstable fractures, injury to joint structure, ligaments, capsule or articulating surfaces
Generally, if your measurement or procedures might hurt your patient, don’t!

14. Patient Set-up & Application
Shave area if applicable
Clean skin to remove all dirt, oil, lotion, etc.
Area may have to be mildly abraded if unit is sensitive
Secure electrodes OVER the muscle belly. The active electrodes MUST be on target area. Reference electrode may be secured anywhere on the body, but is usually in between the two active electrodes
Distance between active electrodes is usually close

15. Patient Set-up & Application
Plug electrode lead(s) into unit
Turn unit on
Adjust output to desired mode
THE PATIENT SHOULD NOT BE DISTRACTED BY OUTSIDE NOISES DURING SESSION.
Various protocols