Positive Technology Journal

The Heart Chamber Orchestra consists of classical musicians who use their heartbeats to control a computer composition and visualization environment. To my best knowledge, this is the first example of "group biofeedback".

The musicians are equipped with ECG (electrocardiogram) sensors. A computer monitors and analyzes the state of these 12 hearts in real time. The acquired information is used to compose a musical score with the aid of computer software. It is a living score dependent on the state of the hearts.

While the musicians are playing, their heartbeats influence and change the composition and vice versa. The musicians and the electronic composition are linked via the hearts in a circular motion, a feedback structure. The emerging music evolves entirely during the performance.

The resulting music is the expression of this process and of an organism forming itself from the circular interplay of the individual musicians and the machine.

The sensor network consists of 12 individual sensors; each one is fitted onto the body of a musician. A computer receives the heartbeat data. Software analyzes the data and generates via different algorithms the real-time musical score for the musicians, the electronic sounds and the computer graphic visualization

Below is a video documentation from the Heart Chamber Orchestra performance on the 28th of March 2010 at Kiasma Theatre at Pixelache Festival in Helsinki, Finland.

Neurofeedback Outcomes in Clients with Asperger's Syndrome.

Appl Psychophysiol Biofeedback. 2009 Nov 12;

Authors: Thompson L, Thompson M, Reid A

This paper summarizes data from a review of neurofeedback (NFB) training with 150 clients with Asperger's Syndrome (AS) and 9 clients with Autistic Spectrum Disorder (ASD) seen over a 15 year period (1993-2008) in a clinical setting. The main objective was to investigate whether electroncephalographic (EEG) biofeedback, also called neurofeedback (NFB), made a significant difference in clients diagnosed with AS. An earlier paper (Thompson et al. 2009) reviews the symptoms of AS, highlights research findings and theories concerning this disorder, discusses QEEG patterns in AS (both single and 19-channel), and details a hypothesis, based on functional neuroanatomy, concerning how NFB, often paired with biofeedback (BFB), might produce a change in symptoms. A further aim of the current report is to provide practitioners with a detailed description of the method used to address some of the key symptoms of AS in order to encourage further research and clinical work to refine the use of NFB plus BFB in the treatment of AS. All charts were included for review where there was a diagnosis of AS or ASD and pre- and post-training testing results were available for one or more of the standardized tests used. Clients received 40-60 sessions of NFB, which was combined with training in metacognitive strategies and, for most older adolescent and adult clients, with BFB of respiration, electrodermal response, and, more recently, heart rate variability. For the majority of clients, feedback was contingent on decreasing slow wave activity (usually 3-7 Hz), decreasing beta spindling if it was present (usually between 23 and 35 Hz), and increasing fast wave activity termed sensorimotor rhythm (SMR) (12-15 or 13-15 Hz depending on assessment findings). The most common initial montage was referential placement at the vertex (CZ) for children and at FCz (midway between FZ and CZ) for adults, referenced to the right ear. Metacognitive strategies relevant to social understanding, spatial reasoning, reading comprehension, and math were taught when the feedback indicated that the client was relaxed, calm, and focused. Significant improvements were found on measures of attention (T.O.V.A. and IVA), core symptoms (Australian Scale for Asperger's Syndrome, Conners' Global Index, SNAP version of the DSM-IV criteria for ADHD, and the ADD-Q), achievement (Wide Range Achievement Test), and intelligence (Wechsler Intelligence Scales). The average gain for the Full Scale IQ score was 9 points. A decrease in relevant EEG ratios was also observed. The ratios measured were (4-8 Hz)(2)/(13-21 Hz)(2), (4-8 Hz)/(16-20 Hz), and (3-7 Hz)/(12-15 Hz). The positive outcomes of decreased symptoms of Asperger's and ADHD (including a decrease in difficulties with attention, anxiety, aprosodias, and social functioning) plus improved academic and intellectual functioning, provide preliminary support for the use of neurofeedback as a helpful component of effective intervention in people with AS.

The use of biofeedback in clinical virtual reality: the intrepid project.

Stud Health Technol Inform. 2009;144:128-32

Authors: Repetto C, Gorini A, Algeri D, Vigna C, Gaggioli A, Riva G

In our protocol for the treatment of Generalized Anxiety Disorders we use Virtual reality (VR) to facilitate emotional regulation and the relaxation process. Using a biofeedback biomonitoring system (GSR, HR, Thermal) the patient is made aware of his or her reactions through the modification of some features of the VR environment in real time. Using mental exercises the patient learns to control these physiological parameters and using the feedback provided by the virtual environment is able to gauge his or her success. To test this concept, we planned a randomized controlled trial (NCT00602212), including three groups of 15 patients each (for a total of 45 patients): (1) the VR group, (2) the non-VR group, and (3) the waiting list (WL) group.

Neurofeedback-based motor imagery training for brain-computer interface (BCI).

J Neurosci Methods. 2009 Apr 30;179(1):150-6

Authors: Hwang HJ, Kwon K, Im CH

In the present study, we propose a neurofeedback-based motor imagery training system for EEG-based brain-computer interface (BCI). The proposed system can help individuals get the feel of motor imagery by presenting them with real-time brain activation maps on their cortex. Ten healthy participants took part in our experiment, half of whom were trained by the suggested training system and the others did not use any training. All participants in the trained group succeeded in performing motor imagery after a series of trials to activate their motor cortex without any physical movements of their limbs. To confirm the effect of the suggested system, we recorded EEG signals for the trained group around sensorimotor cortex while they were imagining either left or right hand movements according to our experimental design, before and after the motor imagery training. For the control group, we also recorded EEG signals twice without any training sessions. The participants' intentions were then classified using a time-frequency analysis technique, and the results of the trained group showed significant differences in the sensorimotor rhythms between the signals recorded before and after training. Classification accuracy was also enhanced considerably in all participants after motor imagery training, compared to the accuracy before training. On the other hand, the analysis results for the control EEG data set did not show consistent increment in both the number of meaningful time-frequency combinations and the classification accuracy, demonstrating that the suggested system can be used as a tool for training motor imagery tasks in BCI applications. Further, we expect that the motor imagery training system will be useful not only for BCI applications, but for functional brain mapping studies that utilize motor imagery tasks as well.

Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial.

J Child Psychol Psychiatry. 2009 Jul;50(7):780-9

Authors: Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H

BACKGROUND: For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition. METHODS: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment. RESULTS: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group. CONCLUSIONS: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

QEEG guided neurofeedback therapy in personality disorders: 13 case studies.

Clin EEG Neurosci. 2009 Jan;40(1):5-10

Authors: Surmeli T, Ertem A

According to DSM-IV, personality disorder constitutes a class only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress. Classical treatment of choice for personality disorders has been psychotherapy and/or psychopharmacotherapy. Our study is to determine if subjects with antisocial personality disorders will benefit from quantitative EEG (qEEG) guided neurofeedback treatment. Thirteen subjects (9 male, 4 female) ranged in age from 19 to 48 years. All the subjects were free of medications and illicit drugs. We excluded subjects with other mental disorders by clinical assessment. Psychotherapy or psychopharmacotherapy or any other treatment model was not introduced to any of the subjects during or after neurofeedback treatment. For the subject who did not respond to neurofeedback, training was applied with 38 sessions of LORETA neurofeedback training without success. Evaluation measures included qEEG analysis with Nx Link data base, MMPI, T.O.V.A tests and SA-45 questionaries at baseline, and at the end of neurofeedback treatment. Lexicor qEEG signals were sampled at 128 Hz with 30 minutes-neurofeedback sessions completed between 80-120 sessions depending on the case, by Biolex neurofeedback system. At baseline and after every 20 sessions, patients were recorded with webcam during the interview. Twelve out of 13 subjects who received 80-120 sessions of neurofeedback training showed significant improvement based on SA-45 questionaries, MMPI, T.O.V.A. and qEEG/Nx Link data base (Neurometric analysis) results, and interviewing by parent/family members. Neurofeedback can change the view of psychiatrists and psychologists in the future regarding the treatment of personality disorders. This study provides the first evidence for positive effects of neurofeedback treatment in antisocial personality disorders. Further study with controls is warranted.

A learning theory for reward-modulated spike-timing-dependent plasticity with application to biofeedback.

PLoS Comput Biol. 2008 Oct;4(10):e1000180

Authors: Legenstein R, Pecevski D, Maass W

Reward-modulated spike-timing-dependent plasticity (STDP) has recently emerged as a candidate for a learning rule that could explain how behaviorally relevant adaptive changes in complex networks of spiking neurons could be achieved in a self-organizing manner through local synaptic plasticity. However, the capabilities and limitations of this learning rule could so far only be tested through computer simulations. This article provides tools for an analytic treatment of reward-modulated STDP, which allows us to predict under which conditions reward-modulated STDP will achieve a desired learning effect. These analytical results imply that neurons can learn through reward-modulated STDP to classify not only spatial but also temporal firing patterns of presynaptic neurons. They also can learn to respond to specific presynaptic firing patterns with particular spike patterns. Finally, the resulting learning theory predicts that even difficult credit-assignment problems, where it is very hard to tell which synaptic weights should be modified in order to increase the global reward for the system, can be solved in a self-organizing manner through reward-modulated STDP. This yields an explanation for a fundamental experimental result on biofeedback in monkeys by Fetz and Baker. In this experiment monkeys were rewarded for increasing the firing rate of a particular neuron in the cortex and were able to solve this extremely difficult credit assignment problem. Our model for this experiment relies on a combination of reward-modulated STDP with variable spontaneous firing activity. Hence it also provides a possible functional explanation for trial-to-trial variability, which is characteristic for cortical networks of neurons but has no analogue in currently existing artificial computing systems. In addition our model demonstrates that reward-modulated STDP can be applied to all synapses in a large recurrent neural network without endangering the stability of the network dynamics.

Development and preliminary evaluation of a prototype audiovisual biofeedback device incorporating a patient-specific guiding waveform.

Phys Med Biol. 2008 May 12;53(11):N197-N208

Authors: Venkat RB, Sawant A, Suh Y, George R, Keall PJ

The aim of this research was to investigate the effectiveness of a novel audio-visual biofeedback respiratory training tool to reduce respiratory irregularity. The audiovisual biofeedback system acquires sample respiratory waveforms of a particular patient and computes a patient-specific waveform to guide the patient's subsequent breathing. Two visual feedback models with different displays and cognitive loads were investigated: a bar model and a wave model. The audio instructions were ascending/descending musical tones played at inhale and exhale respectively to assist in maintaining the breathing period. Free-breathing, bar model and wave model training was performed on ten volunteers for 5 min for three repeat sessions. A total of 90 respiratory waveforms were acquired. It was found that the bar model was superior to free breathing with overall rms displacement variations of 0.10 and 0.16 cm, respectively, and rms period variations of 0.77 and 0.33 s, respectively. The wave model was superior to the bar model and free breathing for all volunteers, with an overall rms displacement of 0.08 cm and rms periods of 0.2 s. The reduction in the displacement and period variations for the bar model compared with free breathing was statistically significant (p = 0.005 and 0.002, respectively); the wave model was significantly better than the bar model (p = 0.006 and 0.005, respectively). Audiovisual biofeedback with a patient-specific guiding waveform significantly reduces variations in breathing. The wave model approach reduces cycle-to-cycle variations in displacement by greater than 50% and variations in period by over 70% compared with free breathing. The planned application of this device is anatomic and functional imaging procedures and radiation therapy delivery.

Energetic assessment of trunk postural modifications induced by a wearable audio-biofeedback system.

Med Eng Phys. 2008 Jul 2;

Authors: Giansanti D, Dozza M, Chiari L, Maccioni G, Cappello A

The effect of biofeedback training on affective regulation and simulated car-racing performance: A multiple case study analysis.

J Sports Sci. 2008 May;26(7):761-73

Authors: Edmonds WA, Tenenbaum G, Mann DT, Johnson M, Kamata A

The foundation of this study was based on an idiosyncratic concept, which uses probabilistic determinations (Kamata, Tenenbaum, & Hanin, 2002) to verify the utility and effectiveness of a biofeedback intervention by manipulating affective performance states in a race-car simulator. Nine males completed five separate time-trials of a simulated racing task and were then randomly assigned to one of three arousal regulation treatment conditions: (1) optimal, (2) poor, and (3) attention control. Following the biofeedback intervention, participants underwent another series of race trials to determine the effectiveness of the arousal regulation intervention. The results indicated that there were relative similarities in the strength and direction of the perceived and physiological states between the participants; however, the subtle details of the participants' unique performance zones and the probability of achieving each zone were revealed to be unique among the participants. The results also indicated that: (a) the biofeedback manipulation resulted in the expected changes for each participant, and (b) there were some large individual differences among the participants, necessitating the idiosyncratic approach. Limitations and future directions are also addressed.

Alpha neurofeedback improves the maintaining ability of alpha activity.

Neuroreport. 2008 Feb 12;19(3):315-7

Authors: Cho MK, Jang HS, Jeong SH, Jang IS, Choi BJ, Lee MG

Integrating a Portable Biofeedback Device into Clinical Practice for Patients with Anxiety Disorders: Results of a Pilot Study.

Appl Psychophysiol Biofeedback. 2008 Feb 20;

Authors: Reiner R

This study examined the effectiveness of a portable Respiratory Sinus Arrhythmia (RSA) biofeedback device as an adjunct to CBT in persons with anxiety disorders and other disorders associated with autonomic dysfunction attending outpatient treatment. Participants were 24 individuals attending outpatient cognitive behavioral treatment for a range of anxiety disorders. Participants were assessed over a 3 week period. Outcomes included measures of anxiety (STAI-Y), sleep disturbances (PSQI), anger (STAEI), and subjective questions about the effectiveness of the device as a treatment adjunct. Significant reductions were found for anxiety and anger and for certain sleep variables (e.g. sleep latency). There was a significant dos-effect in that those who were more compliant had significantly greater reductions in most domains including sleep, anger and trait anxiety. Overall, participants found the device more helpful than other relaxation techniques such as mediation, yoga and unassisted breathing techniques but less helpful than exercise. The most frequently endorsed side effects were dizziness (15%) and sleepiness (55%). These preliminary results suggest that portable RSA biofeedback appears to be a promising treatment adjunct for disorders of autonomic arousal and is easily integrated into treatment. Results support the need for further investigation with more rigorous experimental designs.

Novel Design of Interactive Multimodal Biofeedback System for Neurorehabilitation.

Conf Proc IEEE Eng Med Biol Soc. 2006;1:4925-4928

Authors: Huang H, Chen Y, Xu W, Sundaram H, Olson L, Ingalls T, Rikakis T, He J

A previous design of a biofeedback system for Neurorehabilitation in an interactive multimodal environment has demonstrated the potential of engaging stroke patients in task-oriented neuromotor rehabilitation. This report explores the new concept and alternative designs of multimedia based biofeedback systems. In this system, the new interactive multimodal environment was constructed with abstract presentation of movement parameters. Scenery images or pictures and their clarity and orientation are used to reflect the arm movement and relative position to the target instead of the animated arm. The multiple biofeedback parameters were classified into different hierarchical levels w.r.t. importance of each movement parameter to performance. A new quantified measurement for these parameters were developed to assess the patient's performance both real-time and offline. These parameters were represented by combined visual and auditory presentations with various distinct music instruments. Overall, the objective of newly designed system is to explore what information and how to feedback information in interactive virtual environment could enhance the sensorimotor integration that may facilitate the efficient design and application of virtual environment based therapeutic intervention.

Effects of electromyography biofeedback-assisted relaxation on pain in patients with advanced cancer in a palliative care unit.

Cancer Nurs. 2007 Sep-Oct;30(5):347-53

Authors: Tsai PS, Chen PL, Lai YL, Lee MB, Lin CC

Most patients with advanced cancer experience pain. However, many cancer patients do not find satisfaction with conventional treatment of pain relief. This study examined the effect of electromyography (EMG) biofeedback-assisted relaxation on cancer-related pain in advanced cancer patients. We hypothesized that changes in EMG activity in frontal muscles underlie the efficacy of EMG biofeedback-assisted relaxation. This was a randomized control study. The experimental group (n = 12) received 6 EMG biofeedback-assisted relaxation sessions over a 4-week period, whereas the control group (n = 12) received conventional care. The primary efficacy measure was the level of pain, measured by the Brief Pain Inventory. Findings from this study show that relaxation training supplemented with visual and auditory EMG biofeedback signals is effective in reducing cancer-related pain in advanced cancer patients, possibly through a mechanism of attenuation of physiological arousal. Electromyography biofeedback-assisted relaxation training may be used along with medications for effective pain management in patients with advanced cancer.

Cortical activation changes induced by visual biofeedback tracking training in chronic stroke patients.

NeuroRehabilitation. 2007;22(2):77-84

Authors: Cho SH, Shin HK, Kwon YH, Lee MY, Lee YH, Lee CH, Yang DS, Jang SH

Objectives: We tried to examine whether visual biofeedback tracking training (VBTT) can improve both the gait performance and cortical activation pattern in chronic stroke patients. Design: We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 +/- 5.19 years). The patients were randomly assigned to the training group (5 patients) or the control group (5 patients). VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer, and the two sine waves should appear as close to overlapping as possible on the PC monitor. The training was performed for 39 minutes/day, 5 days/week, for 4 weeks. Pre-training and post-training accuracy of tracking, functional status of gait, and functional MRI (fMRI) were measured. fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate. Results: The accuracy of the tracking performance, walking speed, and motor scale for gait improved in the training group. Primary sensorimotor cortex (SM1) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group. Conclusions: We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program. It seems that the cortical reorganization was induced by VBTT.

EEG biofeedback in the treatment of attention deficit hyperactivity disorder.

Altern Med Rev. 2007 Jun;12(2):146-151

Authors: Friel PN

EEG neurofeedback: a brief overview and an example of peak alpha frequency training for cognitive enhancement in the elderly.

Clin Neuropsychol. 2007 Jan;21(1):110-29

Authors: Angelakis E, Stathopoulou S, Frymiare JL, Green DL, Lubar JF, Kounios J

Neurofeedback (NF) is an electroencephalographic (EEG) biofeedback technique for training individuals to alter their brain activity via operant conditioning. Research has shown that NF helps reduce symptoms of several neurological and psychiatric disorders, with ongoing research currently investigating applications to other disorders and to the enhancement of non-disordered cognition. The present article briefly reviews the fundamentals and current status of NF therapy and research and illustrates the basic approach with an interim report on a pilot study aimed at developing a new NF protocol for improving cognitive function in the elderly. EEG peak alpha frequency (PAF) has been shown to correlate positively with cognitive performance and to correlate negatively with age after childhood. The present pilot study used a double-blind controlled design to investigate whether training older individuals to increase PAF would result in improved cognitive performance. The results suggested that PAF NF improved cognitive processing speed and executive function, but that it had no clear effect on memory. In sum, the results suggest that the PAF NF protocol is a promising technique for improving selected cognitive functions.

Neurofeedback for Children with ADHD: A Comparison of SCP and Theta/Beta Protocols.

Appl Psychophysiol Biofeedback. 2007 Mar 14;

Authors: Leins U, Goth G, Hinterberger T, Klinger C, Rumpf N, Strehl U

Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4-8 Hz) while increasing Beta (12-20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8-13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.

Preliminary Results of an Open Label Study of Heart Rate Variability Biofeedback for the Treatment of Major Depression.

Appl Psychophysiol Biofeedback. 2007 Mar 1;

Authors: Karavidas MK, Lehrer PM, Vaschillo E, Vaschillo B, Marin H, Buyske S, Malinovsky I, Radvanski D, Hassett A

Major depressive disorder (MDD) is a common mood disorder that can result in significant discomfort as well as interpersonal and functional disability. A growing body of research indicates that autonomic function is altered in depression, as evidenced by impaired baroreflex sensitivity, changes in heart rate, and reduced heart rate variability (HRV). Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in participants with MDD, and baroreflex gain is decreased. Study objectives: To assess the feasibility of using HRV biofeedback to treat major depression. Design: This was an open-label study in which all eleven participants received the treatment condition. Participants attended 10 weekly sessions. Questionnaires and physiological data were collected in an orientation (baseline) session and Treatment Sessions 1, 4, 7 and 10. Measurements and results: Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI-II) by Session 4, with concurrent increases in SDNN, standard deviation of normal cardiac interbeat intervals) an electrocardiographic estimate of overall measure of adaptability. SDNN decreased to baseline levels at the end of treatment and at follow-up, but clinically and statistically significant improvement in depression persisted. Main effects for task and session occurred for low frequency range (LF) and SDNN. Increases in these variables also occurred during breathing at one's resonant frequency, which targets baroreflex function and vagus nerve activity, showing that subjects performed the task correctly Conclusions: HRV biofeedback appears to be a useful adjunctive treatment for the treatment of MDD, associated with large acute increases in HRV and some chronic increases, suggesting increased cardiovagal activity. It is possible that regular exercise of homeostatic reflexes helps depression even when changes in baseline HRV are smaller. A randomized controlled trial is warranted.

From diagnostics to therapy-conceptual basis for real-time movement feedback in rehabilitation medicine.

Biomed Tech (Berl). 2006;51(5-6):299-304

Authors: Schablowski-Trautmann M, Kögel M, Rupp R, Mikut R, Gerner HJ

Recently, locomotion therapy on a treadmill has become part of rehabilitation programs for neurological gait disorders (spinal cord injury, hemiplegia). Instrumental gait analysis is an important tool for quantification of therapy progress in terms of functional changes in a patient's gait patterns. Whereas most of current applications focus on diagnostic assessment of gait, the current paper presents an extension of movement analysis offering enhanced therapeutic options. Specifically, the conceptual basis for application of real-time movement feedback in rehabilitation medicine is outlined and is put into context with recent developments in the field. A first technical realization of these concepts is presented and first results are reported. Furthermore, open questions towards a universal environment for movement feedback in rehabilitation medicine are discussed and future lines of research are identified.