Biofeedback

Question 1

What is biofeedback?

Answer 1

the use of electronic instrumentation to provide objective information (or feedback) to an individual about a physiologic function or response so that the individual becomes aware of his or her response

Question 2

How is biofeedback used in clinical practice?

Answer 2

it is used to help the patient develop greater voluntary control following injury or dysfunction

Question 3

______ are instruments of biofeedback

Answer 3

Clinicians

Question 4

Feedback includes information related to what 2 things?

Answer 4

• Sensations associated with movements itself

- Result of the action relative to some goal or objective

Question 5

Feedback is ongoing. What does this mean?

Answer 5

It is occurring before, during, and after any motor or movement task

Question 6

What are 5 types of intrinsic feedback?

Answer 6

• Kinesthetic
• Visual
• Cutaneous
• Vestibular
• Auditory

Question 7

What are 4 types of extrinsic feedback?

Answer 7

• Knowledge of results
• Verbally
• Mechanically
• Electronically

Question 8

How do biofeedback instruments work?

Answer 8

They provide moment to moment information about a biologic function

Question 9

What are the advantages of biofeedback?

Answer 9

• Information is provided with speed and continuity
• EMG biofeedback is sensitive, objective, accurate and quantitative
• Eventually larger changes or improvement in performance can be accomplished

Question 10

What is the goal of biofeedback?

Answer 10

to teach the patient to perceive these changes without the use of the instrument

Question 11

What are the 5 things biofeedback instruments measure?

Answer 11

• Peripheral skin temperature
• Finger phototransmission
• Skin conductance activity
• Electroencephalograph (EEG)
• Electromyographic activity (EMG)

Question 12

What does peripheral skin temperature indicate?

Answer 12

vasoconstriction

Question 13

What does finger phototransmission indicate?

Answer 13

vasoconstriction or vasodilation

Question 14

What does skin conductance activity indicate?

Answer 14

sweat gland activity

Question 15

What does EEG record?

Answer 15

The brain’s spontaneous electrical activity over a period of time

Question 16

What does EMG record?

Answer 16

electrical activity during muscle contraction

Question 17

What causes EMG activity?

Answer 17

Changes in potential difference as the ACh binds to receptor sites on the sarcolemma causing depolarization

Question 18

The amount of tension developed in a muscle is proportional to?

Answer 18

the number of active motor units

Question 19

What does the pattern of motor unit recruitment depend on?

Answer 19

• Inherent properties of specific motor neurons
• Force required during the activity
• Speed of contraction

Question 20

Do fast or slow muscle contractions tend to excite larger motor units? Why?

Answer 20

Fast, because they depress smaller motor units

Question 21

Does biofeedback measure muscle contraction?

Answer 21

No, it measures electrical activity associated with muscle contraction

Question 22

When can biofeedback readings be compared?

Answer 22

Only when the same equipment is used for all readings

Question 23

How can electrical activity be amplified?

Answer 23

By using two active electrodes and one ground “reference” electrode

Question 24

The electrodes are arranged in __polar arrangement

Answer 24

bipolar

Question 25

How should the 3 electrodes be placed?

Answer 25

- Active electrodes should be placed in close proximity, with the reference electrode placed between the tow of them

Question 26

Which electrode picks up the electrical activity from the motor units firing in the muscles?

Answer 26

The active electrodes

Question 27

How are 2 separate signals created?

Answer 27

Because the magnitude of the voltages detected will differ with respect to the reference electrode

Question 28

What amplifies the difference between the 2 signals?

Answer 28

A differential amplifier

Question 29

What does the differential amplifier uses to compare the signals of the 2 active electrodes?

Answer 29

the reference electrode

Question 30

Describe the concept of "raw" activity

Answer 30

After amplification and filtering, the signal is indicative of the true electrical activity within the muscles being monitored and can be referred to the raw activity

Question 31

The direction of raw EMG polarity is constantly reversing, making it an _____ voltage.

Answer 31

alternating

Question 32

Biofeedback measures the overall increase and decrease in what?

Answer 32

electrical activity

Question 33

What does rectification of the wave create?

Answer 33

a pulsed direct current

Question 34

Following rectification of the wave what can happen to it?

Answer 34

It can be smoothed and integrated

Question 35

What does smoothing mean?

Answer 35

eliminating the high-frequency fluctuations that are produced with a changing electrical signal

Question 36

How is the wave integrated?

Answer 36

the area under the curve is measured for a specified period of time

Question 37

What forms the basis for quantification of EMG activity?

Answer 37

wave integration

Question 38

What are the 3 questions you must ask in order to determine of a patient is appropriate for biofeedback?

Answer 38

1) Does the patient have a motor impairment that would suggest that the information provided by biofeedback would be of benefit? 2) Do they have the ability for voluntary control? 3) Are they motivated and cognitively aware?

Question 39

What are the 9 health issues biofeedback is used to help manage?

Answer 39

- Anxiety or stress - Asthma - Chemotherapy side effects - Chronic pain - Constipation - High blood pressure - Incontinence - Irritable bowel syndrome - Raynaud's disease

Question 40

What are the 7 indications for biofeedback?

Answer 40

- muscle re-education - regaining neuromuscular control - increasing isometric and isotonic strength - relaxation of muscle spasm - decreasing muscle guarding - pain reduction - psychological relaxation

Question 41

What is the main contraindication to biofeedback?

Answer 41

Any musculoskeletal condition that a muscular contraction might exacerbate

Question 42

What are some reasons that biofeedback appeals to people?

Answer 42

- It's non-invasive - It may reduce or eliminate the need for medications - It may be a treatment alternative for those who can't tolerate medications - It may be an option when medications haven't worked well - It may be an alternative to medications for some conditions during pregnancy - It helps people take charge of their health

Question 43

Describe the requirements of the electrodes that are used during biofeedback

Answer 43

They must be surface electrodes that are 4 mm to 12.5 mm and have conducting gel with a high salt content

Question 44

Where should the electrodes be placed?

Answer 44

Near to the muscle being monitored and parallel to the direction of the muscle fibers

Question 45

The electrodes are able to detect measurable signals that are how far away?

Answer 45

from a distance equal to that of the interelectrode spacing

Question 46

What does increased spacing between electrodes allow?

Answer 46

other muscles to interfere with signal processing

Question 47

How does the skin need to be prepared for biofeedback?

Answer 47

Excessive hair, oil, and dead skin have to be removed

Question 48

What are the 2 types of biofeedback?

Answer 48

Visual and auditory

Question 49

____ sensitivity should be used for muscle relaxation. | ____ sensitivity should be used for muscle re-education.

Answer 49

High Low

Question 50

What are some examples of unique biofeedback uses?

Answer 50

- Pelvic Floor Dysfunction - Stress Urinary Incontinence - Fecal Incontinence - Erectile Dysfunction