Biofeedback

Question 1

What does biofeedback do?

Answer 1

It provides motor performance, kinesthetic performance or physiological responses. Uses an electromechanical device for visual and/or auditory feedback. This feedback is used to teach the patient to modify the response

Question 2

What can biofeedback measure?

Answer 2

muscle activity, heart rate, balance, skin temperature, BP, posture, abnormal movement, normal movement.

peripheral skin, temperature, changes in blood volume by vasodilation and constriction, sweat gland activity and electrical activity of muscle contraction.

Question 3

What is biofeedback also called?

Answer 3

EMG biofeedback & sometimes surface EMG (SEMG)

Question 4

What are the two type of EMG?

Answer 4

Surface–> for re-education (biofeedback) and gross muscle analysis. Needle electrode–> for diagnostic analysis of diseased muscle and denervated muscle

Question 5

What are the 7 types of biofeedback?

Answer 5

myoelectric/electromyographic, position, BP, respiratory, sphincter control, temperature and blood flow, & electroencephalographic biofeedback

Question 6

What are the 3 advantages of biofeedback?

Answer 6

provides rapid data to the patient and the clinician; its sensitive, objective, accurate, & quantitave; modern equipment can provide a variety of feedback signals to motivate and engage the patient

Question 7

What are the 10 indication of biofeedback?

Answer 7

muscle spasm, pain, SCI, urinary incontinence, improve neuromuscular control, muscle weakness, hemiplegia, cerebral palsy, bowel incontinence, promote relaxation

Question 8

What are the 2 contraindications of biofeedback?

Answer 8

any condition where muscle contraction is detrimental & skin irritation at electrode site

Question 9

What are the guidelines for using biofeedback?

Answer 9

two active electrodes and one ground in bipolar arrangement best eliminates noise, clean the skin and use gel, electrodes should be parallel to the muscle

Question 10

What is measured with biofeedback (muscle contraction or electrical activity of the contraction)?

Answer 10

electrical activity of the contraction

Question 11

There is a (low/high) sensitivity for muscle re-education, (low/high) sensitivity for relaxation.

Answer 11

low, high

Question 12

Motor unit potentials (MUP) have positive and negative phases an are called ________ due to many motor units firing at once

Answer 12

compound action potentials

Question 13

What are 3 physiological factors that determine amplitude of the EMG data?

Answer 13

size of active motor units, number of motor units activated, frequency of firing

Question 14

What 2 things can you do to the electrodes in order to record more EMG data?

Answer 14

use larger electrodes, increase the distance between electrodes

Question 15

Smaller recording electrodes placed closer together will result in more ____

Answer 15

specificity; this reduces the tissue which influences the signal, making it more specific

Question 16

What is cross talk?

Answer 16

the interference from surrounding activated muscles that will contaminate desired EMG signals from the targeted muscles

Question 17

What is a movement artifact?

Answer 17

contamination from sources other than surrounding muscles including input from the electrodes, input cables, and wires

Question 18

(True/False) Superficial muscles will have the greatest influence of recording electrodes with biofeedback.

Answer 18

True

Question 19

What can you do to minimize the motion artifact?

Answer 19

Clean the electrodes after each application, and a good ionic conductive gel applied at each use. Maintaining electrode position with quality adhesive tape or self adhesive electrodes. By lightly tape the electrode leads the skin surface as this will reduce drag on the leads and therefore reduce movement between the electrode and the skin surface.

Some people advocate light abrasion of the skin surface.

Question 20

The electrodes should be placed ____ with the dominant muscle fibers as this minimizes signal cancelation and maximizes the sensitivity of the biofeedback system

Answer 20

parallel

Question 21

What are 6 factors that need to be considered in selecting sites for electrode placement?

Answer 21

training goals, control level, available muscle, subcutaneous fat, movement artifact, cross talk

Question 22

What is the bipolar technique of electrode placement with biofeedback?

Answer 22

2 active, 1 ground (aka reference). Active electrodes 1-5cm apart, near muscle motor point. Ground may be between or near the other 2 electrodes.

Question 23

Active electrodes (close/far) will decrease cross talk.

Answer 23

close

Question 24

What are needle electrodes used for?

Answer 24

local detection for specific muscle, detects deep muscle, used in diagnosis or research, rarely in biofeedback, able to detects specific muscle, requires skill less acceptable to patient

Question 25

What are advantages of subcutaneous electrodes?

Answer 25

precise identification of targeted muscle, access to deeper muscles, signal not attenuated b y skin, fat or fascia

Question 26

What are the disadvantages of subcutaneous electrodes?

Answer 26

invasive and the patient is less accepting of this, movement artifact effect increases with subcutaneous electrodes

Question 27

Signal frequency of biofeedback is typically _____Hz, movement artifact occurs below ___Hz, electronic noise occurs above _____Hz.

Answer 27

100-1000, 100, 1,000

Question 28

What are the signal processing steps of biofeedback?

Answer 28

amplification, filtering, rectification, integration, level/threshold detection

Question 29

(True/False) Clinicians can't choose the type of feedback signals.

Answer 29

False; these options include raw, processed, auditory, visual, continuous, threshold triggered

Question 30

What are the advantages of using raw EMG signs for biofeedback?

Answer 30

It can provide the clinician with information regarding the signal source. Raw signals can tell experienced clinicians if the signal is physiological, movement artifact, or electronic noise.

Question 31

What are the disadvantages of using raw EMG signs for biofeedback?

Answer 31

Raw signals are difficult to use to objectively document progress. Raw signals are difficult to use in patient education.

Question 32

The procedure of administering biofeedback consists of treating in a quiet setting, cleaning site and electrodes, apply gel & secure electrodes. What should you do to INCREASE muscle activity?

Answer 32

Start wit electrodes FAR apart (increase sensitivity), have patient contract muscle, as pt can recruit muscle put electrodes closer, use tapping vibration as needed, progress from simple to complex tasks, start with short (10min sessions) and increase to 30+ min

Question 33

The procedure of administering biofeedback consists of treating in a quiet setting, cleaning site and electrodes, apply gel & secure electrodes. What should you do to DECREASE muscle activity?

Answer 33

Start with electrodes CLOSE and as pt improves separate the electrodes, have pt relax with deep breathing and imagery, progress from low-high sensitivity and pt improves, begin with 10min and progress to 30+ min

Question 34

Before starting biofeedback treatment what are some prerequisites for the patient?

Answer 34

must have normal vision & hearing, good comprehension & motor planning, no profound sensory or proprioception loss

Question 35

What are the 6 therapeutic effects of biofeedback?

Answer 35

muscle relaxation, improve muscle strength, decrease muscle spasm, neuromuscular control, decrease accessory muscle use, decrease pain