Biofeedback Mastery

Biofeedback Mastery

Have you ever wondered what Biofeedback is all about? Uncover these unique information on Biofeedback! Are you in constant pain? Do you wish you could ever just find some relief? If so, you are not alone. Relieving chronic pain can be difficult and frustrating.

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Biofeedback or Meditation

Biofeedback is a relatively modern mind-body technique that uses computers to show body functions such as heart rate. Monitoring these activities enables you to observe how and why they change and eventually to control them. The ability to gain control over what had been considered to be involuntary or autonomic physiologic functions was documented in biofeedback studies in the I970s. However, since ancient times practitioners of yoga and Zen Buddhism have achieved similar control using meditation without the benefit of modern monitoring equipment. In a typical biofeedback session, electrodes leading from a monitoring machine are attached to the part of the body to be monitored, such as A biofeedback therapist helps interpret these signals while leading the patient through physical and mental exercises. The changes in monitor readings indicate that the desired related change has occurred in the body function being measured.

Biofeedback

In biofeedback, a computer is paired with controlled breathing, relaxation, or hypnotic techniques. The computer generates a visual or auditory indicator of the child's muscle tension, peripheral skin temperature, or anal control, allowing the child to have external validation of the physiological changes he or she has produced using the techniques. Biofeedback also enhances the child's sense of mastery and control. It has been successfully used with children as young as age 6 years.

Learning from the past

Images produced by a variety of drugs, focusing on such varied dimensions of these images as color, movement, action, and form. Siegel's subjects were trained to use an image classification system prior to the drug sessions. There were baseline and placebo sessions for comparative purposes. With regard to reported images, the amphetamine (a stimulant) and pheno-barbitol (a sedative) sessions did not differ from placebo sessions. However, the sessions with mescaline, LSD, psilocybin, and a synthetic compound based on the active ingredients in marijuana produced similar images. In the psychedelic drug sessions, for example, complex images did not appear until well after there was a shift to lattice tunnel forms memory images emerged in the later stages of the appearance of complex imagery. Noting that hypnagogic and hypnopompic images were accompanied by theta and low-frequency alpha brain waves, other researchers used biofeedback to teach subjects how to enter these states. There was...

Psychotic Syndromes

In patients with chronic mild or moderately severe anxiety, benzodiazepines, used sparingly for a few weeks to several months, can be helpful. When chronic treatment is necessary, buspirone, tricyclic antidepressants, and MAO inhibitors may be utilized in selected patients, particularly those with concomitant depression. Beta-blockers may also be useful in certain cases. Referral to a neuropsychologist or psychotherapist for training in self-reliance and relaxation techniques including biofeedback, meditation, and self-hypnosis should also be considered. The treatment of obsessive compulsive disorders should involve both pharmacological and psychological measures. Medications can significantly reduce the symptoms in over 50 percent of patients. Clomipramine is generally considered the drug of first choice, but other drugs with serotonergic properties such as fluoxetine, paroxetine, and clonazepam can be used.

Communicating Findings to the Medical Team and Family

Chaplaincy for spiritual and religious support. Occupational therapy for activities of daily living including feeding issues. Physical therapy for rehabilitation and biofeedback. Speech and language for evaluation and assistance with communication needs.

What Are The Other Elements Of Treatment Besides Medical Therapy

The psychosocial aspects of epilepsy are an important component of the disorder. Patients often have major concerns about health, independence, personal growth, relationships, well-being, and security. These issues are discussed more fully in Chapter 5 and can be appreciated and addressed only if the physician attempts to uncover the psychologic and social problems that adversely affect the patient's quality of life. This process begins with taking a complete psychosocial history, including information about any previous psychiatric illnesses or treatments, education, employment, driving, insurance, interpersonal relationships, and attitude toward having epilepsy. A number of questionnaires developed for this purpose supplement the psychosocial history and provide a quantifiable means of assessing and following patients as pharmacotherapeutic and psychosocial interventions are implemented.3 Uncovering a source of psychosocial stress may lead to an effective strategy for reducing the...

Condition Assessment Instruments

The Doppler scanner may be used to map arterial flow through audible ultrasonic response to arterial pulsing and because of its direct relationship to digital vessel patency, skin temperature may be used to assess tissue viability of the extremity. Temperature biofeedback may also be used to compare cutaneous temperature between the involved and noninvolved extremity.

Nonpharmacologic Therapy

Nonpharmacologic therapies (psychological interventions and physical therapy) might be used in both acute and chronic pain. Psychological interventions can reduce pain as well as the anxiety, depression, fear, and anger associated with pain. Psychological interventions helpful in management of acute pain are imagery (picturing oneself in a safe, peaceful place) and distraction (listening to music or focusing on breathing). Chronic pain patients might benefit from relaxation, biofeedback, cognitive behavioral therapy, psychotherapy, support groups, and spiritual counseling. Biofeedback teaches patients to control physiological responses to pain and has been effective in headache and chronic low back pain. Cognitive therapy encourages patients to monitor their perceptions of pain, reducing stress and negativism. Psychotherapy is very useful for patients with chronic pain it can also assist in treatment of psychiatric comorbidities and help patients to deal with terminal illness.38 The...

What Practitioners Say It Does

Biofeedback therapies were developed to treat a wide range of symptoms and problems, including stress, urinary incontinence, sleep disorders, Raynaud's disease, migraine headache, hypertension, addictions, vascular disorders, and many others. The procedure involves focusing the mind on a biological function and mentally visualizing or picturing the desired change. This might be warming the temperature of one's hands, tightening blood vessels to eliminate headaches, or inducing other physiological events to help relieve the particular disorder. According to practitioners, biofeedback creates a greater awareness of specific body parts and their functions. With training, increased awareness of physiologic functions enables the patient to regulate these functions. Biofeedback provides a logical approach to resolving many medical problems. When patients are properly trained, they can relieve or eliminate symptoms, replace feelings of helplessness with a sense of renewed control over...

Research Evidence to Date

It is clear that the use of monitoring devices to provide feedback about internal events is beneficial for many people. There is strong evidence that biofeedback is effective in treating alcoholism, drug abuse, and anxiety. It can Well-controlled studies report positive effects of biofeedback in treating Raynaud's disease. Biofeedback can also help people overcome urinary incontinence by developing more effective control of their bladder muscles. It can assist the retraining of body muscles after an accident or surgery, and help train new muscles to take over the function of those that are irreparably damaged. Not everyone is drawn to biofeedback or comfortable with using equipment. Researchers say that at least half of those who do use biofeedback for headache relief realize 50 to 80 improvement. It should be noted, however, that approximately the same proportion of patients show improvement when treated by relaxation without feedback. Biofeedback is useful also to prevent and reduce...

Cognitive Behavioral Approaches

Sometimes such techniques allow children to avoid medications and their possible side effects completely. Strategies include parent training, family interventions, psychotherapy, cognitive-behavioral therapy, relaxation, distraction, guided imagery and hypnotherapy, and biofeedback. Expertise with the techniques requires training and practice. Randomized trials provide evidence of efficacy for children and adolescents with functional abdominal pain, irritable bowel syndrome, headaches, procedural pain, and burn pain (Damen et al. 2006 Duarte et al. 2006 Hicks et al. 2006 Hoffman et al. 2008 Humphreys and Gevirtz 2000 Robins et al. 2005 Sanders et al. 1994 Stinson et al. 2008 Trautmann et al. 2006 Uman et al. 2006 Vlieger et al. 2007 Weydert et al. 2006). Preliminary research results are promising for children and adolescents with pain related to cancer, sickle cell anemia, complex regional pain syndrome, and arthritis (Lee et al. 2002 Walco et al. 1999 Wilder 2006)....

Gastrointestinal Dysmotility

Idiopathic fecal incontinence may be associated with delayed conduction in the pudendal nerves and denervation changes in the sphincter muscles. High-fiber bulking agents may be beneficial because semi-formed stools are easier to control than liquid feces. Fecal disimpaction is indicated in some patients. Daily tap water enemas aid in clearing the residue from the rectum between evacuations and may improve continence. Biofeedback may be successful in some cases. Patients who undergo surgical sphincter repair may gain some continence for solid stool, although the presence of pudendal neuropathy is associated with a poor outcome. Other surgical treatments include colostomy, artificial anal sphincters, and creation of a neosphincter with muscle grafts.

Therapeutic Interventions

Using progressive relaxation, biofeedback, or hypnosis, teach the client how to relax assign him her to relax twice a day for 10 to 20 minutes. 12. Using progressive relaxation, biofeedback, or hypnosis, teach the client how to relax assign him her to relax twice a day for 10 to 20 minutes.

Clinical challenges

Neuromodulation, sympathectomy (sympathetic blocks), TENS and electrotherapy, nighttime resting splints (not recommended for daytime), counselling, biofeedback, relaxation techniques, group therapy and psychotherapy. Exercise and a graded desensitisation programme within perceived pain thresholds may be helpful to gradually habituate patients to stimuli perceived as noxious. However, there is little evidence to support the efficacy of these interventions (Pertoldi and di Benedetto, 2005) and referral to specialised pain clinics is recommended.

Additional Resources

Breathing and hand temperature training are two basic meditation techniques. Regulating breathing is the first skill learned by beginning students of meditation. The goal is to replace shallow thoracic breathing with deeper diaphragmatic breathing, a calming practice. Hand temperature training, in which clients learn to adjust the warmth and blood flow in their hands, is an example of biofeedback which also integrates the mind body connection.

Relaxation Based Treatments

Table 13.9 Relaxation training and biofeedback basics Biofeedback provides patients with real-time information regarding surface EMG tension, peripheral temperature, skin conductance, the ratio of chest wall to diaphragmatic breathing, heart rate reactivity, and other physiological indices of stress. This is most effective when coupled with relaxation training.

Stress Reduction Programs and Psychosocial Intervention

Psychophysiological treatment interventions, including relaxation training and biofeedback, have promise, but little research to date has evaluated their use with children (McQuaid and Nassau 1999). These treatments are based on targeting psychobiological mechanisms, such as autonomic dys-regulation, that contribute to airway constriction through vagal cholinergic pathways (Lehrer et al. 2004). More research is needed on interventions targeting specific asthma-relevant psychobiological stress responses.

Vocal Cord Dysfunction

Treatment recommendations for VCD are varied. Speech therapy has been helpful for some patients, often in combination with some form of psychological counseling or psychotherapy. Hypnosis and biofeedback have been used with varying success rates. Some authors have reported benefits from sedative anxiolytic medications, and inhaled helium has been used to abort symptoms in acute attacks of laryngeal obstruction. In a report by Do-shi and Weinberger (2006), ipratropium bromide was prescribed and used successfully to prevent symptoms of exercise-induced VCD. Although many types of treatment have been recommended and attempted in pediatric patients with VCD, none has been found to be uniformly and reliably effective. However, the consensus of nearly all experts is that some form of psychotherapeutic modality, along with speech therapy and or pharmacotherapy, is most likely to be beneficial. The natural course of this syndrome and the prognosis are not known.

Evidence Based Treatments

Limited studies have been reported on psychiatric interventions in children and adolescents with cystic fibrosis. Glasscoe and Quittner (2008) compiled a meta-analysis of all available psychological treatments for children with cystic fibrosis. Their review was based on findings from eight studies. The interventions fell into four conceptually similar categories 1) gene pretest education counseling 2) biofeedback, massage, and music therapy to assist physiotherapy 3) behavioral interventions to improve dietary intake in children and 4) education regarding self-administration of treatment to promote independence and improve quality of life. These interventions were found to be largely educational. The investigators concluded that not enough

Trials of Schools of Therapy

Mine whether a particular technique improves functional performance. Small randomized trials during inpatient or outpatient therapy revealed no significant differences between conventional therapy and proprioceptive neu-romuscular facilitation (PNF),204 conventional exercise and Bobath's technique,205 conventional exercise versus Bobath and Rood,206 conventional versus PNF versus Bobath,207 electromyographic biofeedback (EMG BFB) versus Bobath technique,208 sensorimotor integration versus functional treatment in occupational therapy,209 and, in an alternating treatment design, Bobath compared to the Brunnstrom method.210 One of Johnstone's neurophysiologic techniques applies an air splint to the extended upper extremity and aims for the subject to push back with the affected proximal arm as a rocking chair leans the subject forward. A half-hour treatment for 30 days was compared to passive rocking in a well-designed trial with 100 subjects who had an acute stroke.211 The Fugl-Meyer...

The Cancer Counselling Center of Ohio

In the situation of life-threatening illness, anticipatory grief is compounded by uncertainty. At the Center, many clients have a disease which is potentially lethal. They face, as if this threat were not bad enough, the incursions and perhaps the worsening of bodily illness, the difficult treatments and their often debilitating side-effects, and the loss of many aspects of their customary daily life. The possibility of dying is just one facet of a much greater complex of issues. Treatment in these cases often calls for unique methods. We routinely use tools which can access the internal states - the subliminal message systems - that lie beneath the surface of conscious awareness. It is our belief that where denial, doubt, and ambivalence prevail, clearer messages can often be obtained from the 'inner self'. We begin with relaxation, brainwave biofeedback, or other calming techniques to create a disposition of openness. Then, mental imagery, searching for internal direction (i.e.,...

Traumatic Trigeminal Neuralgia

Pharmacotherapy options include antidepressants (such as tricyclic antidepressants TCAs , serotonin norepinephrine uptake inhibitors SNRIs , or trazodone), clonazepam, and membrane stabilizers or antiepilepsy drugs (see Table 17.1). Start low and gradually increase. Side effects of these medications have been discussed in previous treatment chapters. Behavioral strategies include cognitive behavioral therapy, relaxation techniques, and biofeedback.

Upper Extremity Function

Electromyographic biofeedback for upper extremity muscles within or near the zone of partial preservation, perhaps combined with other physical therapies and electrical stimulation, may improve strength and function. In one study of patients with quadriparesis, biofeedback increased the peak EMG of several intrinsic hand muscles by 2-5 times.183 The mechanism postulated from the investigators' single unit recordings and measures of twitch tensions was an increase in the firing rates of motor units that were already active. The increase may be caused by the recruitment of previously unavailable units, the synchronization of additional units, a greater safety factor in neuromuscular transmission so that fibers fire longer or at higher rates, a sprouting of nerve terminals, or muscle fiber reinnervation. The subjects had large numbers of motor units that were activated or deactivated only after a latency of 10 seconds. A synergis-tic movement often elicited them. The findings suggest...

Sexual Pain Disorders Vaginismus

Uncontrolled reports suggest that sex therapy may be helpful (McGuire and Hawton, 2005). Vaginismus is not under the patient's conscious control. Therapy must be directed at restoring conscious control under conditions that respect the patient's autonomy and maintain the patient's safety from further trauma. If the patient expresses fear or anxiety, pelvic examination may be deferred, and in severe cases, sedation may be necessary. Any physical abnormalities detected on pelvic examination, such as infections, should first be treated. After this, the patient may begin self-treatment with size-graded plastic or silicone vaginal dilators, gradually teaching her vagina to remain relaxed and receive nonpainful, self-controlled penetration (see Web Resources). Specialized physical therapists teach patients to use biofeedback to relax the pelvic floor musculature this can be more effective than treatment with dilators and is often preferred by patients....

Unclassified Interventions

There is a growing literature on the effects of psychotherapy on the pediatric immune system (Nassau et al. 2008). In addition to the Castes et al. (1999) study cited earlier, Kern-Buell et al. (2000) found that biofeedback-assisted relaxation reduced asthma severity and improved pulmonary function and inflammation in 16 adolescents and young adults ages 13-30 years old with asthma compared to a wait-list control group. Another study examined the effects of disclosure of their disease status to friends in 64 children with HIV (ages 8-18 years) (Sherman et al. 2000). Those children who disclosed their HIV status demonstrated a greater increase in CD4+ T cells, suggesting a slowing of disease progression. It was noted that most participants in this study contracted their HIV from transfusion and thus may not have had the same degree of stigma in disclosure as those who contracted the disease from their mother during pregnancy.

Micro and Nanotechnology and the Aging Spine

With respect to the aging spine, the ability to sense adverse changes in vivo and manipulate cells and molecules presents the possibility of promising treatments for debilitating diseases and musculoskeletal disorders. Smart materials that have the ability to repair and reorganize human tissue and eventually allow for an engineered material and scaffold to be substituted by newly regenerated tissue provide an attractive solution for implant and tissue longevity. Such novel materials should be capable of nonlinear responses to imitate the mechanics of living tissue. Smart biosensors and tooling can lend to improved surgical techniques and patient outcomes. The incorporation of micro- or nanotechnology into spinal implants and surgical tooling can enhance surgical accuracy provide precision cutting techniques for microsurgery with minuscule tissue damage manipulate cellular and subcellular structures develop genetic engineering clinical strategies monitor and respond to tissue-targeting...

Complementary Therapies for Some Common Ailments

Attention deficit disorder Biofeedback, yoga, massage therapy, cognitive behavioral therapy, music therapy. headache Press acupoints between eyebrows or in hollows at base of skull on both sides of the spine massage, progressive relaxation, biofeedback feverfew butterbur. pain, chronic Acupuncture, massage and other body work, biofeedback, hypnotherapy.

Classifications of Complementary and Alternative Medicine

Mind-body interventions entail a wide variety of techniques to improve the mind's capacity to affect bodily function and symptoms. Cognitive therapies, biofeedback, meditation, hypnosis, prayer, and creative outlets such as dance, music, and art are common examples of mind-body interventions.

Pregnancy and Migraine

Natural supplements such as magnesium oxide and vitamin B2 have demonstrated benefit in double-blind studies for migraine prophylaxis, and can be used when needed (see Chap. 9). Other non-medication options include biofeedback and other pain and stress management techniques. Yoga may also be of benefit in some women.

Provide a brief description of the types of mindbody therapy that have been used to treat patients with LBP

Cognitive-behavioral programs are a component of many established pain treatment centers. These programs focus on educating patients and teaching coping skills in a highly structured group setting under the guidance of a clinical psychologist. They frequently incorporate hypnosis, meditation, and biofeedback techniques 8. Biofeedback is a technique that utilizes vital sign monitoring to provide information about a patient's own physiologic state during a pain crisis (i.e. heart rate, blood pressure, muscle activity). Patients are taught to use this information to increase self-awareness and achieve subsequent relaxation, thereby minimizing pain

Headache Due to Head or Neck Trauma

Treatment of this condition focuses on the commonly reported symptoms of mood changes, memory loss, dizziness, and insomnia, in conjunction with management of the headache pain. Neuropsychologic testing may be useful in documenting the degree of neurocognitive impairment and to monitor success of treatment. Significant recovery can occur but may require a multidisciplinary approach with use of medications, physical therapy, and behavioral therapy including biofeedback and relaxation techniques. Although the majority of individuals have significant improvement over time, as many as 25 will experience long-term disability despite treatment (See Table 14.2).

Extremity Spasticity1

Spasticity is defined by Lance as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes ('muscle tone') with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome.33 Commonly encountered problems in the upper extremity secondary to spasticity include increased muscle tone, lack of smooth coordination, joint contractures, hygiene problems, decreased functional ability, pain, and potential nerve compression.23,43,52 Splinting, especially for prevention and correction of contractures, along with other treatment methods including facilitation and inhibition techniques, conventional rehabilitation techniques, biofeedback, electrical stimulation, and other physical modalities traditionally have been used in the management of these secondary problems.7,54,55

Refeeding and Nutrition

Malnutrition can cause delayed gastrointestinal transit, leading patients to experience abdominal pain, bloating, and constipation during the refeed-ing process. A warm pack to the abdomen can be helpful, as can relaxation techniques such as deep breathing, guided imagery, biofeedback, or hypnosis. If necessary, stool softeners, promotility agents, and or mild laxatives can also be used (American Psychiatric Association 2006).

A naturopathic first

Counseling or behavioral medicine is an important component of natur-opathy, and practitioners emphasize the role played by mental and emotional health in disease. Naturopathic physicians are trained in counseling, biofeedback, stress reduction, and other means of helping improve mental and therefore overall health.

Definition Of Terms

This healthcare facility offers a specific type of treatment and does not provide comprehensive assessment or management. Examples include nerve block clinic, transcutaneous nerve stimulation clinic, acupuncture clinic, and biofeedback clinic. Such a facility may have one or more healthcare providers with different professional training because of its limited treatment options and the lack of an integrated, comprehensive approach, it does not qualify for the term multidisciplinary.

Spinal Reflexes

Using electromyographic biofeedback, the stretch reflex of the human biceps brachii muscle was successfully conditioned to increase or decrease in amplitude, but also required considerable training, approximately 400 trials per session.153 Evidence for the effects of physical activity and training on the strength of spinal reflexes has also been found in active compared to sedentary people. The H-reflex and disynap-tic reciprocal inhibition responses were small in sedentary subjects, larger in moderately active subjects, and largest in very active ones.154 The reflexes were lowest, however, in professional ballerinas. The greater need for corticospinal input to the cord to stand en pointe and the sustained cocontractions involving the gastrocne-mius and soleus complex probably lead to a decrease in synaptic transmission at Ia synapses, reducing the reflex amplitude. Thus, activity-dependent plasticity in the spinal motor pools contributes to the long-term acquisition of motor skills....

Vascular Status

In addition to vascular studies, volumetric measurements, circumferential measurements, thermal imaging, and biofeedback may be used to assist in monitoring upper extremity vascular status. Skin temperature and color and composite mass of the extremity provide essential clues to understanding the vascular status of a diseased or injured hand or arm. Areas with questionable tissue viability should be

Part Three Overview

In the last few decades, modern scientific methods have been applied to old mind-body questions in efforts to understand how thoughts, expectations, and emotions influence health. This is the field of mind-body medicine, sometimes called behavioral medicine. Mind-body medicine programs have been established at the most prestigious medical centers in the United States and elsewhere. Researchers study meditation, hypnosis, biofeedback and other previously esoteric activities. They seek evidence about how the ancient wisdom linking mind and body can be documented, explained and applied within the framework of scientific knowledge and modern health care. Theoretically, any method that could alleviate or counteract the effects of stress should improve our health. What are the mind-body approaches, and can they accomplish this goal The predominant approaches involve efforts to train either the mind, through activities like meditation and biofeedback, or the body, through programs such as...

Lower Extremity

Generated by the patient and gives the patient a biofeedback display regarding exerted forces. These systems aim to lessen the physical efforts that therapists make when they assist the legs during treadmill training and, perhaps, allow more consistent kinematics and timing of assistance in relation to a patient's residual motor control than all but the most experienced hands-on therapist can provide.

Part Four Overview

The therapies in this section may be perceived as body-mind, as opposed to mind-body, medicine. In Part Three we saw that mind-body therapies such as hypnosis, biofeedback, and meditation claim to improve physiologic and psychological well-being through manipulating or training the mind. In contrast, the therapies described in this part share the belief that health problems can be alleviated or prevented, and well-being improved, by manipulating all or parts of the body. This is accomplished through specific exercises or manual manipulation by others.

Physical Modalities

Muscle cooling with an ice pack for 20 minutes will decrease spasticity for approximately an hour,161 so cryotherapy is commonly used to prepare for other modalities such as stretching, range of motion, and gait. Tendon vibration, reflex-inhibiting postures when seated and especially in bed, and EMG biofeedback can complement a stretching program, but formal studies of their use are too limited to judge any added benefit. Patients with spastic paraplegia from MS and SCI often report that standing in a support frame for as little as a Vg hour a day reduces spasms. The effect may be related to modulation by afferent inputs from prolonged stretching and from loading the joints. Formal studies of standing in nonam-bulatory patients, however, have not clearly demonstrated efficacy on clinical measures of hypertonicity or on limiting contractures and osteoporosis.162

Epilepsy

ERP research has dealt with three topics in epilepsy (1) whether a history of epileptic seizures (in combination with anti-epileptic drugs) leads to cognitive slowing and to other deficits of cognitive functions, (2) whether intracranial recordings from the hippocampi can predict memory performance after surgical removal of the epileptic focus, and (3) whether seizures can be reduced by biofeedback of event-related slow waves. Biofeedback movement of a target object on the screen during a 6-sec period. The object was in fact controlled by the amount of Cz-recorded negativity (with EOG transmission being rejected), with more or less negativity moving the object to one or the other goal. Patients had to learn this game in many training sessions and were expected to be able to use this skill to control excess amount of cortical excitation. In fact, patients needed many more sessions compared to healthy people to learn this skill, probably related to their problems in maintaining control...

Saliva

Drool do not have an increase in the amount of saliva they produce. Patients with Parkinson's disease with a reduced saliva production can often suffer from drooling. Drooling is the result of a lack of coordinated swallowing with pooling of saliva in the anterior floor of the mouth with subsequent drooling as exemplified in conditions such as cerebral palsy and amyotrophic lateral sclerosis. This condition can have a severe impact on the patient's quality of life. Many different methods of managing this condition have been proposed and were summarized in an excellent review by Meningaud et al. in 2006. These patients benefit from a multidisci-plinary team approach and both medical and surgical treatments are used in their management. Medical therapy includes oral motor therapy, orofacial regulation therapy, and behavioral modification via biofeedback. In an analysis of studies from 1970 to 2005 of behavioral treatments of drooling only 17 articles with 57 patients met the inclusion...

Cerebral Palsy

In older children and adults, EMG biofeedback,143 fitness training,144 and a short pulse of therapy for specific limb and trunk impairments and singular disabilities can benefit persons with well-defined problems. Few trials have applied motor learning principles or a task-oriented approach. A pilot study of BWSTT (see Chapter 6) found modest, but statistically significant gains in the ability to walk or to perform transfers in most of the 6 nonambulators and for 4 who walked with help who had had 3 sessions

Resistive Exercise

Splint Wearing Schedule Form

The purpose of resistive exercise is to produce sufficient muscle strength to allow maximum tendon excursion, full joint motion, and the execution of normal daily activities. This may be accomplished through purposeful graded activities and progressive resistive exercises. Strengthening is traditionally divided into isometric, eccentric, and concentric exercises. Emphasis includes improving endurance and or strengthening. Caution is needed in adapting strengthening programs for patients with repetitive strain disorders, especially if pain is experienced for 1 to 2 hours after exercise. An external splinting force applied to a wrist or hand joint has little appreciable effect on improving muscle strength, since strengthening requires voluntary effort of muscles to enhance power. In addition to strengthening muscles, resistive exercises may be used to provide a form of biofeedback to the patient, allowing increased awareness of the position and function of key muscle groups (Fig. 15-6)....

The Fetzer Institute

Biofeedback Association for Applied Psychophysiology and Biofeedback (formerly the Biofeedback Society of America) and the Biofeedback Certification Institute of America An international organization of professionals from various disciplines doing neurotherapy, neurofeedback training, and research. Supports education and excellence in the field of neurofeedback training and neurotherapy and seeks the validation and acceptance of this discipline by a broad spectrum of society. 394 Road 34 Merino, CO 80741 E-mail office snr-jnt.org

Objective

Effective treatment of tinnitus is difficult and usually requires various approaches. Finding and eliminating potential causes (especially pharmaceutical) is imperative. Patients should be counseled to avoid caffeine and nicotine. No single medicine has been proved effective in treating tinnitus. Antidepressants have shown promise, especially if depression coexists. Intravenous lidocaine eliminates tinnitus in some patients but is not practical and has obvious potential side effects. Various homeopathic treatments and nutritional supplements are effective in some cases, but most have not been evaluated in controlled studies. Hearing aids are beneficial in masking the tinnitus if hearing loss exists. Tinnitus maskers can be purchased that essentially drown out the tinnitus with various distracting noises. Biofeedback and a technique called tinnitus retraining therapy are helpful for some patients. These techniques can be learned through various publications or at a tinnitus treatment...

Tension Type Headache

Preventive therapy should be administered when a patient has frequent headaches that produce disability or may lead to symptomatic medication overuse. Medications used for TTHs prevention include antidepressants, beta blockers, and anticonvulsants. Antidepressants, the medication of first choice, should be started at a low dose and increased slowly every three to seven days. An adequate trial period of at least one to two months must be allowed. The addition of biofeedback therapy or beta-blocking agents may improve the therapeutic benefit derived from anti- depressants. '291 , '301