Positive Technology Journal

Biofeedback for robotic gait rehabilitation

Journal of NeuroEngineering and Rehabilitation

By Lars Lunenburger, Gery Colombo and Robert Riener

The significance of sigma neurofeedback training on sleep spindles and aspects of declarative memory.

Appl Psychophysiol Biofeedback. 2006 Jun;31(2):97-114

Authors: Berner I, Schabus M, Wienerroither T, Klimesch W

The functional significance of sleep spindles for overnight memory consolidation and general learning aptitude as well as the effect of four 10-minute sessions of spindle frequency (11.6-16 Hz, sigma) neurofeedback-training on subsequent sleep spindle activity and overnight performance change was investigated. Before sleep, subjects were trained on a paired-associate word list task after having received either neurofeedback training (NFT) or pseudofeedback training (PFT).Although NFT had no significant impact on subsequent spindle activity and behavioral outcomes, there was a trend for enhanced sigma band-power during NREM (stage 2 to 4) sleep after NFT as compared to PFT. Furthermore, a significant positive correlation between spindle activity during slow wave sleep (in the first night half) and overall memory performance was revealed. The results support the view that the considerable inter-individual variance in sleep spindle activity can at least be partly explained by differences in the ability to acquire new declarative information.We conclude that the short NFT before sleep was not sufficient to efficiently enhance phasic spindle activity and/or to influence memory processing. NFT was, however, successful in increasing sigma power, presumably because sigma NFT effects become more easily evident in actually trained frequency bands than in associated phasic spindle activity.

Controlling posture using a plantar pressure-based, tongue-placed tactile biofeedback system.

Exp Brain Res. 2006 Nov 30;

Authors: Vuillerme N, Chenu O, Demongeot J, Payan Y

The present paper introduces an original biofeedback system for improving human balance control, whose underlying principle consists in providing additional sensory information related to foot sole pressure distribution to the user through a tongue-placed tactile output device. To assess the effect of this biofeedback system on postural control during quiet standing, ten young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed reduced CoP displacements in the Biofeedback relative to the No-biofeedback condition. The present findings evidenced the ability of the central nervous system to efficiently integrate an artificial plantar-based, tongue-placed tactile biofeedback for controlling control posture during quiet standing.

Efficacy of biofeedback for migraine: A meta-analysis.

Pain. 2006 Nov 1;

Authors: Nestoriuc Y, Martin A

In this article, we meta-analytically examined the efficacy of biofeedback (BFB) in treating migraine. A computerized literature search of the databases Medline, PsycInfo, Psyndex and the Cochrane library, enhanced by a hand search, identified 86 outcome studies. A total of 55 studies, including randomized controlled trials as well as pre-post trials, met our inclusion criteria and were integrated. A medium effect size (d =0.58, 95% CI=0.52, 0.64) resulted for all BFB interventions and proved stable over an average follow-up phase of 17 months. Also, BFB was more effective than control conditions. Frequency of migraine attacks and perceived self-efficacy demonstrated the strongest improvements. Blood-volume-pulse feedback yielded higher effect sizes than peripheral skin temperature feedback and electromyography feedback. Moderator analyses revealed BFB in combination with home training to be more effective than therapies without home training. The influence of the meta-analytical methods on the effect sizes was systematically explored and the results proved to be robust across different methods of effect size calculation. Furthermore, there was no substantial relation between the validity of the integrated studies and the direct treatment effects. Finally, an intention-to-treat analysis showed that the treatment effects remained stable, even when drop-outs were considered as nonresponders.

Foundation and practice of neurofeedback for the treatment of epilepsy.

Appl Psychophysiol Biofeedback. 2006 Mar;31(1):21-35

Authors: Sterman MB, Egner T

This review provides an updated overview of the neurophysiological rationale, basic and clinical research literature, and current methods of practice pertaining to clinical neurofeedback. It is based on documented findings, rational theory, and the research and clinical experience of the authors. While considering general issues of physiology, learning principles, and methodology, it focuses on the treatment of epilepsy with sensorimotor rhythm (SMR) training, arguably the best established clinical application of EEG operant conditioning. The basic research literature provides ample data to support a very detailed model of the neural generation of SMR, as well as the most likely candidate mechanism underlying its efficacy in clinical treatment. Further, while more controlled clinical trials would be desirable, a respectable literature supports the clinical utility of this alternative treatment for epilepsy. However, the skilled practice of clinical neurofeedback requires a solid understanding of the neurophysiology underlying EEG oscillation, operant learning principles and mechanisms, as well as an in-depth appreciation of the ins and outs of the various hardware/software equipment options open to the practitioner. It is suggested that the best clinical practice includes the systematic mapping of quantitative multi-electrode EEG measures against a normative database before and after treatment to guide the choice of treatment strategy and document progress towards EEG normalization. We conclude that the research literature reviewed in this article justifies the assertion that neurofeedback treatment of epilepsy/seizure disorders constitutes a well-founded and viable alternative to anticonvulsant pharmacotherapy.

Artificial feedback for remotely supervised training of motor skills.

J Telemed Telecare. 2006;12 Suppl 1:50-2

Authors: van Dijk H, Hermens HJ

Electromyographic (EMG) biofeedback can be used to train motor functions at a distance, which makes therapy at home a possibility. To enable patients to train properly without the presence of a therapist, artificial feedback is considered essential. We studied the combined effect of age and timing of artificial feedback on training muscle relaxation in 32 healthy subjects (younger: 20-35 years; older: 55-70 years). All subjects improved their performance significantly (F = 6.1, P<0.001). The effect of different timing of feedback (feedback provided during or after performance) was similar in young and older adults. However, this conclusion should be interpreted with caution owing to the small sample size. It can be argued that the artificial feedback used was too complicated for older adults to interpret. When designing remotely supervised treatment programmes, one should consider carefully the way that artificial feedback is being applied as it may enable (elderly) subjects to train without the presence of a therapist.

Recent developments of biofeedback for neuromotor rehabilitation.

J Neuroengineering Rehabil. 2006 Jun 21;3(1):11

Authors: Huang H, Wolf SL, He J

ABSTRACT: The original use of biofeedback to train single muscle activity in static positions or movement unrelated to function did not correlate well to motor function improvements in patients with central nervous system injuries. The concept of task-oriented repetitive training suggests that biofeedback therapy should be delivered during functionally related dynamic movement to optimize motor function improvement. Current, advanced technologies facilitate the design of novel biofeedback systems that possess diverse parameters, advanced cue display, and sophisticated control systems for use in task-oriented biofeedback. In light of these advancements, this article: (1) reviews early biofeedback studies and their conclusions; (2) presents recent developments in biofeedback technologies and their applications to task-oriented biofeedback interventions; and (3) discusses considerations regarding the therapeutic system design and the clinical application of task-oriented biofeedback therapy. This review should provide a framework to further broaden the application of task-oriented biofeedback therapy in neuromotor rehabilitation.

Exploring spike transfer through the thalamus using hybrid artificial-biological neuronal networks.

J Physiol Paris. 2004 Jul-Nov;98(4-6):540-58

Authors: Debay D, Wolfart J, Le Franc Y, Le Masson G, Bal T

We use dynamic clamp to construct "hybrid" thalamic circuits by connecting a biological neuron in situ to silicon- or software-generated "neurons" through artificial synapses. The purpose is to explore cellular sensory gating mechanisms that regulate the transfer efficiency of signals during different sleep-wake states. Hybrid technology is applied in vitro to different paradigms such as: (1) simulating interactions between biological thalamocortical neurons, artificial reticular thalamic inhibitory interneurons and a simulated sensory input, (2) grafting an artificial sensory input to a wholly biological thalamic network that generates spontaneous sleep-like oscillations, (3) injecting in thalamocortical neurons a background synaptic bombardment mimicking the activity of corticothalamic inputs. We show that the graded control of the strength of intrathalamic inhibition, combined with the membrane polarization and the fluctuating synaptic noise in thalamocortical neurons, is able to govern functional shifts between different input/output transmission states of the thalamic gate.

Effects of age and timing of augmented feedback on learning muscle relaxation while performing a gross motor task

Am J Phys Med Rehabil. 2006 Feb;85(2):148-55; quiz 156-8

Authors: van Dijk H, Hermens HJ

OBJECTIVE: To examine the combined effect of age and timing of augmented feedback on learning muscle relaxation. Performing a gross motor task, subjects had to lower their trapezius muscle activity using the electromyographic signal as visual myofeedback. DESIGN: Healthy subjects (16 young adults: 20-35 yrs; and 16 older adults: 55-70 yrs) were randomly assigned to one of two timing conditions of myofeedback: concurrent (feedback was provided immediately during the trial) and terminal (feedback was provided delayed after the trial) condition. RESULTS: The results indicated that young adults had a higher level of motor performance (i.e., lower muscle activity) compared with older adults when myofeedback was provided. These effects persisted during short- (after 10 mins) and long-term retention (after 1 wk) when no myofeedback was provided. In contrast to young adults, older adults did not improve their performance throughout the experiment. There were no interactions of age with the timing conditions of myofeedback during acquisition and retention. CONCLUSIONS: Either timing condition of augmented feedback was equally helpful to young adults, whereas neither was helpful for older adults in learning muscle relaxation.

Increasing individual upper alpha power by neurofeedback improves cognitive performance in human subjects.

Appl Psychophysiol Biofeedback. 2005 Mar;30(1):1-10

Authors: Hanslmayr S, Sauseng P, Doppelmayr M, Schabus M, Klimesch W

The hypothesis was tested of whether neurofeedback training (NFT)--applied in order to increase upper alpha but decrease theta power--is capable of increasing cognitive performance. A mental rotation task was performed before and after upper alpha and theta NFT. Only those subjects who were able to increase their upper alpha power (responders) performed better on mental rotations after NFT. Training success (extent of NFT-induced increase in upper alpha power) was positively correlated with the improvement in cognitive performance. Furthermore, the EEG of NFT responders showed a significant increase in reference upper alpha power (i.e. in a time interval preceding mental rotation). This is in line with studies showing that increased upper alpha power in a prestimulus (reference) interval is related to good cognitive performance.

Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study.

Neurosci Lett. 2006 Feb 20;394(3):216-21

Authors: Lévesque J, Beauregard M, Mensour B

Attention Deficit Hyperactivity Disorder (AD/HD) is a neurodevelopmental disorder mainly characterized by impairments in cognitive functions. Functional neuroimaging studies carried out in individuals with AD/HD have shown abnormal functioning of the anterior cingulate cortex (ACC) during tasks involving selective attention. In other respects, there is mounting evidence that neurofeedback training (NFT) can significantly improve cognitive functioning in AD/HD children. In this context, the present functional magnetic resonance imaging (fMRI) study was conducted to measure the effect of NFT on the neural substrates of selective attention in children with AD/HD. Twenty AD/HD children-not taking any psychostimulant and without co-morbidity-participated to the study. Fifteen children were randomly assigned to the Experimental (EXP) group (NFT), whereas the other five children were assigned to the Control (CON) group (no NFT). Subjects from both groups were scanned 1 week before the beginning of the NFT (Time 1) and 1 week after the end of this training (Time 2), while they performed a Counting Stroop task. At Time 1, for both groups, the Counting Stroop task was associated with significant loci of activation in the left superior parietal lobule. No activation was noted in the ACC. At Time 2, for both groups, the Counting Stroop task was still associated with significant activation of the left superior parietal lobule. This time, however, for the EXP group only there was a significant activation of the right ACC. These results suggest that in AD/HD children, NFT has the capacity to normalize the functioning of the ACC, the key neural substrate of selective attention.

Physical and occupational therapists at Rush University Medical Center are using diagnostic technology and computerized balance retraining device for patients with disequilibrium, dizziness, orthopedic or head injuries regain their stability.
The computerized balance retraining device uses visual biofeedback, coupled with sensitive, real-time monitoring of patient movement on a force platform. According to Rush UMC rehabilitation professionals, the method improves a patient’s overall balance through motivating protocols that can be progressed as the patient‘s capabilities improve.

Biofeedback is a treatment technique in which people are trained to improve their health
by using signals from their own bodies. Physical therapists use biofeedback to help stroke
victims regain movement in paralyzed muscles. Psychologists use it to help tense and
anxious clients learn to relax. Specialists in many different fields use biofeedback to help
their patients cope with pain.

Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shown that we have more control over so-called involuntary bodily function than we once though possible. But it has also shown that nature limits the extent of such control. Scientists are now trying to determine just how much voluntary control we can exert.

Clinical biofeedback techniques that grew out of the early laboratory procedures are now
widely used to treat an ever-lengthening list of conditions. These include:

·Migraine headaches, tension headaches, and many other types of pain
·Disorders of the digestive system
·High blood pressure and its opposite, low blood pressure
·Cardiac arrhythmias (abnormalities, sometimes dangerous, in the rhythm of the heartbeat)
·Raynaud's disease (a circulatory disorder that causes uncomfortably cold hands)
·Epilepsy
·Paralysis and other movement disorders


Low-cost biofeedback devices and products

ProComp Infiniti
Powerful 8 channel encoder provides real-time biofeedback and data acquisition in any clinical setting.


The Journey to Wild Divine
Learn to relax while playing this immersive new biofeedback videogame. Take a deep breath...


RESPeRATE
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Freeze-Framer
You'll appreciate all you can learn about the power of your heart. It's also just plain fun to play the games while you learn.


Mini C2+
This tiny 6 channel unit is an affordable, powerful multi-modality biofeedback system.


More to explore

Biofeedback Foundation of Europe
The Association for Applied Psychophysiology and Biofeedback
Society for the Study of Neuronal Regulation
The Biofeedback Certification Institute of America