Biofeedback

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Biofeedback

• Veronica Southard PT MS GCS

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Biofeedback

• Used to enable to pt. To gain some element of
  voluntary control over m or ANS.
• Produces an Auditory or Visual signal.
• Pt. Receives no electricity, instead some
  physiologic process is recorded
• Pt. Must actively participate to transform a
  response from unconscious to conscious

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Indications Biofeedback

• Improve m activation for ortho problems and
  neurological dysfunction.
• This is a tool not treatment.
• Auditory or visual cues provide pt. With
  information
• Small adjustments are picked up and identified
• Also used in limbloading and monitoring, force
  platforms, position or kinematic feedback

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What happens?

• The unit will process the EMG signal and produce
  visual auditory feedback proportional to the
  input signal.
• Electrodes record summated info from M sensor
• Electrodes are referred to as sensors

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Gain

• The relationship between the input signal and
  output amplitude of the amplifier.
• Factor by which the input signal is multiplied to
  obtain the output.
• Signal is controlled by adjusting the gain or
  sensitivity.
• BF units range in sensitivity scales from 0-1,
  0-10, 0-100, 0-1000uv

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Gain cont

• First assess the pts capability to control the
  targeted m in order to properly adjust the
  sensitivity of the BF unit.
• For ex if a pt is just learning to recruit a m
  and the m is producing only 5uv of activity, the
  appropriate range would be 0-10uv.
• If it is a goal to relax choose to have the
  auditory or visual cue turned on when EMG
  activity exceeds the set threshold. Have cues
  off with relaxation. Signal is set to a point
  below threshold.

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Visual cues

• 1. Meter read outs
• 2. Flashing lights
• 3. Oscilloscope
• 4. Computer screens

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Auditory cues

• 1. Changing tones
• 2. Clicks

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Common indications

• Promote increased motor recruitment
• Inhibition of spasticity and spasm
• General body relaxation

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Contraindications

• None
• PRECAUTIONS
• Skin irritation from gel or tape with prolonged
  use
• Deep relaxation for Diabetics may adversely
  affect metabolic levels. Use with caution

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Instructions

• Explain to pt.
• Select m- superficial can be monitored reliably.
• Select sensor size.
• Make sure everything is clean and free of
  residue. Prepare skin with alcohol.
• Apply gel to sensor.
• Secure sensor. Closer get a more precise signal,
  but smaller. Generally 1-5 cm apart

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About sensors

• There are three components to a set. One ground
  and two signal sensors
• Ground is placed between 2 signal sensors or
  adjacent to sensors when close together
• Place sensors allong the longitudinal axis of the
  m

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Technique for Motor Recruitment

• Position pt., Explain to pt. Work in quiet area.
• Apply sensors to an area to demonstrate the
  desired A-V signal and activity.
• Adjust to the most sensitive level that picks up
  any MUAP that pt. Can produce
• Instruct pt. To try to produce an A-V signal

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Recruitment cont

• As voluntary m activity improves, the A-V signal
  will increase. Adjust the gain to decrease the
  sensitivity, so pt. Has to work harder to recruit
  more mu.
• As pt. Masters in one position, change positions
• Document all parameters. Tx duration 30-60 min
• Clean up

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Inhibition of Spasticity

• Goal decrease undesirable mu activity that may
  be interfering with functional movement.
• Eval spasticity, Explain to pt. Apply sensors
  and demonstrate desired activity.
• Find the least sensitive setting that produces
  minimal A-V feedback

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Spasticity

• Have pt relax, use techniques and have pt. Lower
  the A-V signal.
• As the signal decreases, lower the shaping
  controls(gain), to a more sensitive level. As
  pt. Relaxes better, continue to increase
  sensitivity
• Change positions
• Consider a m recruitment set up for antagonist.
  For a dual channel unit. ½-1 hour

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