Usefulness of Biofeedback Psychotheraphy
Introduction of Biofeedback Psychotheraphy
Our human mind is very powerful, it affects everything about us, for example; a person who has high self-esteem will have good posture, talks with confidently, looks at people in the eyes, has strong handshakes, but a person who is depressed will have the pale and dead look, loss of appetite, talks in an in-auditable manner. When a person is sad he will have lowered blood pressure and lowered heart rate; in the other hand if he is happy he produces more hormones, elevated fight-or-flight sympathetic responses. If only we can learn how to control our mind, then we too could make modifications to our body’s function.
Biofeedback is a therapeutic technique which is safe, powerful and is non-drug intervention where by it improves one’s physiological body processes. That person will be able to understand, realize and therefore given the opportunity to control involuntary processes through his mind by looking at the interpretations from various machines which translates bodily language to human language through graphs, sounds, etc. The interpretations will response in relationship and synchronized with the body, so it gives the opportunity for the patient to control it on-the-spot with the help and assistance from the psychotherapists. The patient will be attached a few electrodes around a specific area which detects and picks up changes through electrical or other stimulus. It requires the patients’ active participations, and a little patience as things won’t happen overnight.
The end results will improve some involuntary processes such as heart rate, blood pressure, relieve muscle tension, headache, migraine, muscle re-education after injury, and etc.,. Soon the patient will be accustomed to the control and is trained indirectly to control successfully these body processes independently and without the help of machines in the future. Improvements are due to negative feedback is by observing the magnitude or severity in the readings and work against the reading and thus reducing the readings, positive is the least common one is by further increasing the existing readings to a higher level, through this way; the patients are motivated to further improving himself, feeling less depressed, and obtained hope in recovery. It is alike a trial-and-error treatment whereby the patient feels for himself on how to bring the problem down to a normal level, and when he gets it; the graph will show a positive change, through this way the patient who was once unable to perceive those small changes has learned on how to bring down or up a certain physiological processes.
Patients who are indicated or should receive biofeedback treatment had recent; Stroke, Spinal cord injury, is Recovering and plans in increasing muscle activity through neuromuscular re-education, Postural control; Balance and mobility, Stress reduction, reduce Stuttering, Hyperactivity, Headaches, ADD/ADHD (Attention deficit hyperactivity disorder), Addictions, Spasmodic torticollis, curing from Functional gastrointestinal disorders and other muscular and vascular conditions. Other health problems could also be solve through biofeedback, they are; Anorexia nervosa, Anxiety, Asthma, Autism, Neck & Back pain, Bed wetting, Chronic pain, Constipation, Depression, Diabetes, Epilepsy and related seizure disorders, Head injuries, Hypertension (High Blood Pressure), Learning disabilities, Migraine, Motion sickness, Muscle spasms, Sexual disorders including pain with intercourse and etc.
There are different modalities to measure different body processes of which three are most widely and commonly used, they are; Electromyography (EMG), Feedback Thermometer and Electroencephalography (EEG). Although these machines could measure the physiological changes, but it is not measuring the process itself, it gives some kind of reading which is very similar and highly correlated with the original response, so the readings can be used as indications of any changes which only need some easy skills to interpret it.
The other various measurements and their function are the;
Galvanic skin response (GSR) or Electrodermograph measures the skin conductance activity; it uses the amount of sweat produced under stress to measure the conductivity of your skin (electrodermal activity). There are small amount of salts found in sweats, an increase in sweat volume means an increase in salt concentration which in return increases the electrical conductivity, thus sweaty skins is more conductive than dry skin. The electrodes are applied at the palms of hands where sweat glands are mostly found, and produce very small electrical voltage throughout the skin. They are often used as lie detectors, but in clinics used to teach patient to reduce anxiety.
A Photoplethysmograph (PPG) works by monitoring the amount of light passing through the tissues of fingers and toes, reflected over the bones and back to a light sensor; this is to know the degree of peripheral vasoconstriction, so; as the blood volume increases, the light bounced back will also be reduced as it is dampen by the blood, this will give some indications about the blood supply to that area, since there is no standardize unit of measure, this instrument is used to monitor pulse, in clinics they are used as a supplement treatment together in treating chronic pain, oedema, headache, migraine, hypertension, Raynaud’s disease, anxiety, and stress. Another variation of this instrument is the Hemoencephalography (HEG), which measures the blood flow around the scalp.
The Feedback Thermometer, detects skin temperature with a thermistor; a temperature sensitive device that is usually attached at the fingers or toes measuring temperature in 0C or 0F. The temperature is affected by the arteriole diameter which means an increase in the size results in an increase in blood flow and thus increases the temperature. They are mainly used in patients with the same conditions PPG and HEG measurements
A Capnometer or Capnograph is used to measure the partial pressure of carbon dioxide in expired air at the end of expiration. The patient is asked to exhale through the nostrils into a tube and is detected by the instrument; a shallow, rapid, and forceful breathing decreases the reading as the CO2 concentration is lower compared to vice versa. So this can be used in controlling anxiety disorders, asthma, chronic pulmonary obstructive disorder (COPD), hypertension, panic attacks, and stress through negative feedback as these cases tend to breathe shallow.
A Pneumograph measures the thoracic and abdominal expansion during breathing; this is also used to determine any variation or abnormality in breathing pattern. It functions as a respiratory strain gauge where a flexible sensor belt is wound around the chest or the abdomen, this will monitor the expansion/contraction of the chest and abdomen, and can also measure the respiration rate (the number of breaths per minute). It is used again on patients who have anxiety disorders, asthma, chronic pulmonary obstructive disorder (COPD), hypertension, panic attacks, and stress. The therapist will advise the patient to breathe deeply, slowly, rhythmically and expand the chest in the right way with the reference to the pneumograph readings.
The Rheoencephalography (REG) measures the blood flow around the scalp, is by placing a few electrodes at different points on the skin of the head. More blood to the structure or tissue the greater the readings due to emission of electrical impulses from the tissues.
An Electrocardiography (ECG) monitors the heart rate by emitting beeping sounds and displays onto a graph background with various peaks; the electrodes are placed on the chest, wrists, or legs. It is more accurate compared with the PPG measurement. It uses the 12-leads to measure the different areas of the body for the electrical activity of the heart, the simpler version is a portable one with only one lead that is normally used to measure the heart rate throughout the day. It is useful in relieving on overly rapid heartbeat and controlling high blood pressure through negative feedback.
The Electroencephalography (EEG) measures brain-wave activity through electrodes placed all around the scalp. The EEG shows the amplitude of electrical activity and in various wave forms from each cortical site of the brain. It records the; excitatory postsynaptic potentials (EPSPs) and inhibitory postsynaptic potentials (IPSPs), and slow cortical potentials (>300ms), and the fast cortical potential (0.5Hz-100Hz) which has main frequencies including delta, theta, alpha, the sensorimotor rhythm, low beta, high beta, and gamma waves. Conditions that may benefit from training with these machines include; tooth grinding, head injuries and depression (including bipolar depression and seasonal affective disorder), in treating addiction, attention deficit hyperactivity disorder (ADHD), learning disability, anxiety disorders (including worries, obsessive-compulsive disorder and post-traumatic stress disorder), migraine, and generalized seizures.
The Electromyography (EMG) measures muscle tension and is most widely and commonly used in all biofeedback therapies, the machine is known as an Electromyogram. Therapists use them to relieve muscle stiffness, treat incontinence and recondition injured muscles, after long disused or post-tendon transplant. Electrode connects the patient with the machine which works to pick up any electrical activity of the muscle. Muscles are innervated by motor nerves which carry impulses from the brain forming motor units; this is the point where depolarization takes place as more sodium rushes into the post-synaptic membrane, there will be some slight electrical changes and activity will be picked up by those electrodes, rectified, filtered, amplified in the machine and emits as sound, light, graph, meter, or images.
The electrodes are placed proximally and distally of the examining area, they are the active electrodes, normally a reference electrode is placed between them, it is used to compare the readings obtained by the two electrodes, the electrodes comes in two kinds; one is a fine needle pierced into to the skin, and the other version is a sticky gel pad which is most commonly used now although it is less accurate compared to the invasive one. The readings normally obtained are in AC (alternating current), so it needs to be rectified and be converted into DC (direct current), without the conversion; the sum total of the deflections will be cancelling each other out. The AC is formed due to the increase and decrease in polarity during muscle contraction. The current now must be smoothened to convert all the peaks into one larger curve, this way; we could use that area under the graph to calculate or to quantify the results.
The main function of the EMG biofeedback is to relieve muscle spasms, decrease muscle guarding, therefore induce relaxation of muscle, mental relaxation and decrease pain; this will be useful for low back pain and migraine patients, or clerks who worked on the computer over long hours and who developed repetitive strain injuries (RSI). Besides relaxation, it can be used for increasing muscle strength, physical rehabilitation and neuromuscular control; especially in muscle re-education after a stroke, spinal cord injury, in cerebral palsy, for urinary and faecal incontinence and other neurological complications, furthermore it can be used in treating cardiovascular conditions like hypertension, and Raynaud’s disease. The advantage of this treatment is not requiring a surgery, and it has no negative effect, and sometimes only some mild skin burns due to electric.
How to use the EMG machine? Or the treatment protocol; before everything; you must first explain to the patient that the treatment is to improve your muscle strength and to control your relaxation, then electrodes are placed onto your body, then after a period of time a beep sound or a graph will soon appear and that is the reading obtained from your muscular activity, then get his consent and his cooperation. Position the patient in the most comfortable way (supine, sitting), expose the treatment part, and also ask to remove any restrictive items and watches, chains, rings, jewelleries. Then check the machine and the electrodes make sure it is working and the patient should take a bath before the treatment as to remove any dirt, dead skins, or oils which will affect the reading, if not clean the treatment part with alcohol. Place the electrodes onto the skin as close as possible to the muscle to be monitored to get the most accurate results, also stabilization of the limb or part is also important preventing the skin from stretching away causing the displacement of the electrode. The electrodes are placed parallel to the muscle fibres and are separated fairly, the further the distance, the lesser the readings and may even record other muscles’ activity, which is misleading.
The treatment will be started when the patient actively contract or relaxes the muscle, so whatever the muscles activity will be recorded and be displayed onto the machine, if the patient’s goal is to improve muscle strength, then he has to bring the readings to a higher level, and if to reduce muscle spasm (relaxation), he has to bring the readings down. Communication, encouragement, moral support and especially positive attitude and comments from the therapist are essential in bringing this treatment to a success. The treatment time is normally a minimum of 30min per day and the patient is asked to do it at home at least three times a week, the therapist must emphasize that doing at home will improve the speed of recovery. Normally results can be seen after few weeks (after 8-10 sessions) and must convince the patient if there is no improvement that everything does not happen overnight and thus preventing him from giving up. It is good to have 5min pre and post treatment of mental relaxation to allow the patient to be more focused on what he is doing. Finally the therapist should follow up the patients’ home programme and note any improvement prior his treatment.
Conclusion; it is very useful and a lot of research has been done and is proven effective. Now with our growing technology and knowledge; we can now use these methods as a modern treatment to treat our modern problems. It is also safer compared to other interventions and once the patient masters it, he can practice this at home by himself and in the future when his faces this problem. The Biofeedback treatment is also cost effective making this a right choice of treatment. Furthermore it improves the patient’s confidence over himself thus preventing other complications like anxiety or depression which is also common in our modern time. Therefore biofeedback treatment is highly recommended to those who need help in rehabilitation and in recovery.
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