International Hypnosis Research Institute - Biofeedback

Behavioral therapy for chronic migraine.

Sun, 17 Mar 2013 16:24:00 -0500

Chronic migraine is a disabling condition which affects a considerable proportion of patients. Several risk factors and lifestyle habits contribute to the transformation of migraine into a chronic form. Behavioral treatments, including relaxation, biofeedback, and cognitive behavioral therapy reduce the risk of episodic into chronic migraine transformation, thus restraining the headache-related disability. The rationale of behavioral therapies is that a medical problem should be recognized and thoroughly examined by the patient to be successfully managed. Being aware of factors which precipitate or aggravate migraine allows patients to progressively modulate the frequency and duration of their attacks. Similarly, the acquisition of healthy habits improves the quality of life and the subjective well-being of patients and contributes to breaking the vicious cycle that leads to migraine chronification. The highest level of care is achieved when behavioral therapies are integrated with other treatments, including physical and pharmacological interventions. Curr Pain Headache Rep. 2013 Jan;17(1):304. doi: 10.1007/s11916-012-0304-9. Pistoia F, Sacco S, Carolei A. Department of Neurology, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy, francesca.pistoia@univaq.it.

Behavioural treatments for Tourette syndrome: An evidence-based review.

Sat, 16 Feb 2013 16:27:00 -0500

Tourette syndrome (TS) is a disorder characterised by multiple motor and vocal tics and is frequently associated with behavioural problems. Tics are known to be affected by internal factors such as inner tension and external factors such as the surrounding environment. A number of behavioural treatments have been suggested to treat the symptoms of TS, in addition to pharmacotherapy and surgery for the most severe cases. This review compiled all the studies investigating behavioural therapies for TS, briefly describing each technique and assessing the evidence in order to determine which of these appear to be effective. Different behavioural therapies that were used included habit reversal training (HRT), massed negative practice, supportive psychotherapy, exposure with response prevention, self-monitoring, cognitive-behavioural therapy, relaxation therapy, assertiveness training, contingency management, ahan controls). Statistically significant differences in RMU time between groups were seen post intervention (-7% at T1 and +15% at T2 for the intervention group). Fifty-five percent of the intervention group was willing to continue using the mouse. It appears feasible to perform an RCT for this type of intervention in a workplace setting. Further study including more participants is suggested. Practitioner Summary: The study findings support the feasibility of conducting randomised control trials in office settings to evaluate ergonomics interventions. The intervention resulted in reduced pain and discomfort in the shoulder. The intervention could be a relevant tool in the reduction of upper extremity musculoskeletal disorder. Further research will better explain the study's preliminary findings. Behav Neurol. 2012 Nov 27. Frank M, Cavanna AE. The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

Psychological issues in the evaluation and treatment of tension-type headache.

Sat, 02 Feb 2013 16:26:00 -0500

Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic tension-type headache, is rarely impairing, more frequent tension-type headache can occur with significant disability and psychological comorbidity. Appreciating the psychological impact, assessing the associated biopsychosocial issues, and understanding patients' coping styles are important in forming an appropriate treatment plan and maximizing treatment outcomes. A range of psychological therapies including relaxation training, cognitive behavioral therapy, biofeedback and mindfulness have demonstrated utility in treating chronic pain conditions and reducing the associated disability. This may be particularly applicable to special populations, including pediatric patients, pregnant patients and geriatric. Psychological assessment and treatment may be done conjointly with medication management and expands treatment options. There is great need to continue researching the effects of psychological treatments, standardizing interventions and making them available to the wider population. Curr Pain Headache Rep. 2012 Dec;16(6):545-53. doi: 10.1007/s11916-012-0301-z. Rosen NL. Hofstra North Shore LIJ Medical Center, 611 Northern Boulevard, Suite 150, Great Neck, NY, 11021, USA, noheadaches@gmail.com.

Heart rate variability biofeedback reduces food cravings in high food cravers.

Sat, 26 Jan 2013 16:25:00 -0500

Heart rate variability (HRV) biofeedback has been reported to increase HRV while decreasing symptoms in patients with mental disorders. In addition, associations between low HRV and lowered self-regulation were found in non-clinical samples, e.g., in individuals with strong chocolate cravings or unsuccessful dieting. The current study aimed at decreasing food cravings with HRV-biofeedback in individuals frequently experiencing such cravings. Participants (N = 56) with strong or low food cravings associated with a lack of control over eating were selected from the local community. Half of the participants with strong cravings (craving-biofeedback; n = 14) performed 12 sessions of HRV-biofeedback while the other half (craving-control; n = 14) and a group with low cravings (non-craving-control; n = 28) received no intervention. Subjective food cravings related to a lack of control over eating decreased from pre- to post-measurement in the craving-biofeedback group, but remained constant in the control groups. Moreover, only the craving-biofeedback group showed a decrease in eating and weight concerns. Although HRV-biofeedback was successful in reducing food cravings, this change was not accompanied by an increase in HRV. Instead, HRV decreased in the craving-control group. This study provides preliminary evidence that HRV-biofeedback could be beneficial for attenuating dysfunctional eating behavior although specific mechanisms remain to be elucidated. Appl Psychophysiol Biofeedback. 2012 Dec;37(4):241-51. doi: 10.1007/s10484-012-9197-y. Meule A, Freund R, Skirde AK, Vögele C, Kübler A. Department of Psychology I, University of Würzburg, Marcusstrasse 9-11, Würzburg, Germany. adrian.meule@uni-wuerzburg.de

A multi-modal approach to intervention for one adolescent's frontal lisp.

Sat, 12 Jan 2013 16:23:00 -0500

An adolescent with a persistent frontal lisp participated in a two-part 11-session intervention case study. The first phase used ultrasound imagery and acoustic, phonetic and voice education to provide information about articulatory setting (AS) and general awareness of the speech production process. The second phase used traditional articulation therapy, online visual-acoustic biofeedback and fluency strategies to target the frontal lisp directly (specifically /s/, /z/, /?/ and /?/). Trained listener evaluations of pre-intervention, post-phase 1 and post-phase 2 assessments showed no improvement after phase 1, but notable improvement in all treatment targets immediately after phase 2. These improvements were substantially maintained at assessment 4 months post-intervention. The outcomes suggest that direct training was more effective than the AS approach; however, the client's ability to self-monitor in phase 2, rapid acquisition of the targets and maintenance at 4 months post-intervention possibly reflected the knowledge gained in phase 1 about AS. Clin Linguist Phon. 2013 Jan;27(1):1-17. doi: 10.3109/02699206.2012.734366. Lipetz HM, Bernhardt BM. School of Audiology and Speech Sciences , University of British Columbia, Vancouver, BC , Canada V6T 1Z3.

Bio-inspired adaptive feedback error learning architecture for motor control.

Tue, 18 Dec 2012 17:36:00 -0500

This study proposes an adaptive control architecture based on an accurate regression method called Locally Weighted Projection Regression (LWPR) and on a bio-inspired module, such as a cerebellar-like engine. This hybrid architecture takes full advantage of the machine learning module (LWPR kernel) to abstract an optimized representation of the sensorimotor space while the cerebellar component integrates this to generate corrective terms in the framework of a control task. Furthermore, we illustrate how the use of a simple adaptive error feedback term allows to use the proposed architecture even in the absence of an accurate analytic reference model. The presented approach achieves an accurate control with low gain corrective terms (for compliant control schemes). We evaluate the contribution of the different components of the proposed scheme comparing the obtained performance with alternative approaches. Then, we show that the presented architecture can be used for accurate manipulation of different objects when their physical properties are not directly known by the controller. We evaluate how the scheme scales for simulated plants of high Degrees of Freedom (7-DOFs). Biol Cybern. 2012 Oct;106(8-9):507-22. Epub 2012 Aug 21. Tolu S, Vanegas M, Luque NR, Garrido JA, Ros E. CITIC-Department of Computer Architecture and Technology, ETSI Informática y de Telecomunicación, University of Granada, Granada, Spain, stolu@atc.ugr.es.

A bio-inspired glucose controller based on pancreatic ß-cell physiology.

Sun, 25 Nov 2012 17:37:00 -0500

Control algorithms for closed-loop insulin delivery in type 1 diabetes have been mainly based on control engineering or artificial intelligence techniques. These, however, are not based on the physiology of the pancreas but seek to implement engineering solutions to biology. Developments in mathematical models of the ß-cell physiology of the pancreas have described the glucose-induced insulin release from pancreatic ß cells at a molecular level. This has facilitated development of a new class of bio-inspired glucose control algorithms that replicate the functionality of the biological pancreas. However, technologies for sensing glucose levels and delivering insulin use the subcutaneous route, which is nonphysiological and introduces some challenges. In this article, a novel glucose controller is presented as part of a bio-inspired artificial pancreas. A mathematical model of ß-cell physiology was used as the core of the proposed controller. In order to deal with delays and lack of accuracy introduced by the subcutaneous route, insulin feedback and a gain scheduling strategy were employed. A United States Food and Drug Administration-accepted type 1 diabetes mellitus virtual population was used to validate the presented controller. Premeal and postmeal mean ± standard deviation blood glucose levels for the adult and adolescent populations were well within the target range set for the controller [(70, 180) mg/dl], with a percent time in range of 92.8 ± 7.3% for the adults and 83.5 ± 14% for the adolescents. This article shows for the first time very good glucose control in a virtual population with type 1 diabetes mellitus using a controller based on a subcellular ß-cell model. J Diabetes Sci Technol. 2012 May 1;6(3):606-16. Herrero P, Georgiou P, Oliver N, Johnston DG, Toumazou C. Center for Bio-Inspired Technology, Institute of Biomedical Engineering, Imperial College London, London, United Kingdom. pherrero@imperial.ac.uk

Dynamical Behaviors of Rb-E2F Pathway Including Negative Feedback Loops Involving miR449.

Sun, 11 Nov 2012 17:35:00 -0500

MiRNAs, which are a family of small non-coding RNAs, regulate a broad array of physiological and developmental processes. However, their regulatory roles have remained largely mysterious. E2F is a positive regulator of cell cycle progression and also a potent inducer of apoptosis. Positive feedback loops in the regulation of Rb-E2F pathway are predicted and shown experimentally. Recently, it has been discovered that E2F induce a cluster of miRNAs called miR449. In turn, E2F is inhibited by miR449 through regulating different transcripts, thus forming negative feedback loops in the interaction network. Here, based on the integration of experimental evidence and quantitative data, we studied Rb-E2F pathway coupling the positive feedback loops and negative feedback loops mediated by miR449. Therefore, a mathematical model is constructed based in part on the model proposed in Yao-Lee et al. (2008) and nonlinear dynamical behaviors including the stability and bifurcations of the model are discussed. A comparison is given to reveal the implication of the fundamental differences of Rb-E2F pathway between regulation and deregulation of miR449. Coherent with the experiments it predicts that miR449 plays a critical role in regulating the cell cycle progression and provides a twofold safety mechanism to avoid excessive E2F-induced proliferation by cell cycle arrest and apoptosis. Moreover, numerical simulation and bifurcation analysis shows that the mechanisms of the negative regulation of miR449 to three different transcripts are quite distinctive which needs to be verified experimentally. This study may help us to analyze the whole cell cycle process mediated by other miRNAs more easily. A better knowledge of the dynamical behaviors of miRNAs mediated networks is also of interest for bio-engineering and artificial control. PLoS One. 2012;7(9):e43908. doi: 10.1371/journal.pone.0043908. Epub 2012 Sep 18. Yan F, Liu H, Hao J, Liu Z. Department of Mathematics, Shanghai University, Shanghai, P. R. China ; Institute of System Biology, Shanghai University, Shanghai, P. R. China.

Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition.

Sun, 08 Jan 2012 16:08:00 -0500

It has been well established that swallowing kinematics are modified with different forms of exogenous and endogenous input, however the underlying neural substrates associated with these effects are largely unknown. Our objective was to determine whether the swallowing BOLD response is modulated with heightened sensory modalities (taste, cutaneous electrical stimulation, and visual biofeedback) compared to water ingestion (control) in healthy adults across the age span. Habituation and sensitization were also examined for each sensory condition. Our principal findings are that each sensory swallowing condition activated components of the swallowing cortical network, plus regions associated with the particular sensory modality (i.e. primarily frontal motor planning and integration areas with visual condition). Overall, the insula was most commonly active among the sensory modalities. We also discuss gradual increases and decreases in BOLD signal with repeated exposures for each condition. We conclude that both stimulus- and intention-based inputs have unique cortical swallowing networks relative to their modality. This scientific contribution advances our understanding of the mechanisms of normal swallowing cortical control and has the potential to impact clinical uses of these modalities in treatments for neurogenic dysphagia. Neuroimage. 2011 Aug 18. Humbert IA, Joel S. Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 98 North Broadway, Suite 403, Baltimore, MD 21231, USA.

Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study.

Sun, 25 Dec 2011 16:07:00 -0500

OBJECTIVE: To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke. DESIGN: Prospective multicenter research design. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: Patients (N=29) with chronic stroke. INTERVENTIONS: Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device. MAIN OUTCOME MEASURES: The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. RESULTS: There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. CONCLUSIONS: Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed. Arch Phys Med Rehabil. 2011 Sep;92(9):1364-70. Badke MB, Sherman J, Boyne P, Page S, Dunning K. Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA. mbadke5@aol.com

Virtual reality and pain management: current trends and future directions.

Sun, 18 Dec 2011 16:07:00 -0500

Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. While the exact neurobiological mechanisms behind VR's action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance. Pain Manag. 2011 Mar;1(2):147-157. Li A, Montaño Z, Chen VJ, Gold JI. Children's Hospital Los Angeles, Departments of Anesthesiology Critical Care Medicine & Radiology, 4650 West Sunset Boulevard, MS#12, Los Angeles, CA 90027, USA.

The Mozart effect in biofeedback visual rehabilitation: a case report.

Sun, 18 Dec 2011 16:06:00 -0500

PURPOSE: To evaluate the usefulness of acoustic biofeedback by means of Mozart's Sonata for Two Pianos in D Major K. 448 to maintain and/or restore visual performance in a patient with macular pucker and glaucoma. METHODS: A 74-year-old patient with open angle glaucoma in both eyes and macular pucker in the right eye (RE) underwent visual rehabilitation with acoustic biofeedback by means of the MAIA? Vision Training Module (Centervue, Padova, Italy) 10 minutes each eye once a week for 5 weeks. The patient was asked to move his eyes according to a sound which changed into Mozart's Sonata for Two Pianos when the patient locked the fixation target. RESULTS: Best-corrected visual acuity improved in his right eye (RE) and was stable in the left eye (LE). Fixation stability improved in both eyes, and retinal sensitivity decreased in the RE and improved in the LE. The characteristic of the macular pucker did not change during the training as demonstrated with optical coherence tomography. The patient was very satisfied with the training, as demonstrated by a 25-item questionnaire (National Eye Institute - Visual Functioning Questionnaire, NEI-VFQ-25). The patient's reading speed and the character size which he was able to read improved in his RE. CONCLUSION: Music could enhance synaptic plasticity and affect neural learning and fixation training by means of MAIA vision training. Therefore it can improve visual performance in patients with macular pucker, postpone the surgical time, and assure a better quality of life for the patient. Clin Ophthalmol. 2011;5:1269-72. Salvatore S, Librando A, Esposito M, Vingolo EM. Department of Ophthalmology, University La Sapienza, Polo Pontino, Alfredo Fiorini Hospital, Terracina, Italy.

Efficacy of electromyographic biofeedback and electrical stimulation...

Sun, 11 Dec 2011 16:05:00 -0500

Full Title: Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial. Objective: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. Design: Randomized, prospective, controlled single-blind trial. Setting: Department of physical medicine and rehabilitation, university hospital. Subjects: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group. Interventions: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise. Main measures: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion-extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after. Results: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017). Conclusions: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process. Clin Rehabil. 2011 Oct 4. Akkaya N, Ardic F, Ozgen M, Akkaya S, Sahin F, Kilic A. Universty of Pamukkale, Medicine Faculty, Department of Physical Medicine and Rehabilitation, Denizli, Turkey.

Biofeedback in the treatment of heart disease.

Sun, 04 Dec 2011 16:04:00 -0500

Biofeedback is a method of training subjects to regulate their own physiology using feedback from physiologic sensors connected to an output display. Biofeedback-assisted stress management (BFSM) incorporates the physiologic signals with instructions on stress management. The goal of BFSM training is to give subjects the tools to control their own mental and physiologic reactions, leading to improved health and wellness. In cardiovascular disease, over activation of the sympathetic component of the autonomic nervous system and psychologic stress together negatively affect quality of life and clinical status. BFSM targets both areas. We hypothesize that this intervention can be used in cardiovascular disease to improve clinical status and quality of life, as well as interfere with disease progression. We are conducting trials of BFSM in heart failure and stable coronary artery disease. Preliminary data suggest that use of BFSM by heart failure patients may actually cause cellular and molecular remodeling of the failing heart in the direction of normal. We are comparing the effects of BFSM with usual care in patients with stable coronary artery disease, testing the hypothesis that the intervention will decrease both sympathetic hyperarousal and activation of the inflammatory cascade. Since heart rate variability is abnormal in both cardiovascular disease and depression, and since BFSM has been successfully used to change heart rate variability, we also expect this intervention to have a positive impact on the depression that often accompanies cardiovascular disease. Cleve Clin J Med. 2011 Aug;78 Suppl 1:S20-3. Moravec CS, McKee MG. Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, NE61, Cleveland, OH 44195; moravec@ccf.org.

Neurofeedback in autism spectrum disorders.

Mon, 21 Nov 2011 16:13:00 -0500

Aim: To review current studies on the effectiveness of neurofeedback as a method of treatment of the core symptoms of autism spectrum disorders (ASD). Method Studies were selected based on searches in PubMed, Ovid MEDLINE, EMBASE, ERIC, and CINAHL using combinations of the following keywords: 'Neurofeedback' OR 'EEG Biofeedback' OR 'Neurotherapy' OR 'Mu-Rhythm' OR 'SMR' AND 'Autism' OR 'Autism Spectrum Disorder' OR 'Pervasive Developmental Disorder'. Results The existing evidence does not support the use of neurofeedback in the treatment of ASD. Studies with outcomes in favour of neurofeedback might be showing an improvement in comorbid attention-deficit-hyperactivity disorder symptoms rather than a true improvement in core ASD symptoms. Interpretation Limitations of this review are those inherent in the studies available, including small sample size, short duration, variable diagnostic criteria, and insufficient control interventions, all causing a lack of generalizability. Dev Med Child Neurol. 2011 Jul 14. doi: 10.1111/j.1469-8749.2011.04043.x. Holtmann M, Steiner S, Hohmann S, Poustka L, Banaschewski T, Bölte S. LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics of the Ruhr University Bochum, Hamm, Germany Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Department of Women's and Children's Health, Karolinska Institutet Centre of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden.