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Biofeedback's working principle is based on information from the body coded into an appropriate signal and provided back to the user in real time. The neurological mechanisms underlying the effectiveness of biofeedback training are still debated. The concept of task-oriented (functional) repetitive training suggests that biofeedback should be delivered during a functionally-related movement to optimize motor function (Ref: 3).
The clinician and patient decide that the main exercises should aim to ameliorate her gait, by increasing step length, and to improve balance, by correcting trunk posture, the preferred feedback is the audio one, to be modulated according to trunk position.
Whether we are talking about math or communication, good results start with defining one’s terms.
If you’re like me, the first image that comes to mind when thinking of BioFeedback entails a person with wires attached to their body. To truly understand BioFeedback, I think it’s necessary to understand where it came from.
Biofeedback is a noninvasive tool for helping you to be more aware of certain physiological activity patterns of your body so that you can reduce symptoms such as pain, tension, and physiological arousal. Our bodies respond to stress by activating a part of our nervous system called the autonomic nervous system, which is responsible for activating us with all of the physiological changes that were described above.
If the sympathetic nervous system is like the gas pedal, then the parasympathetic nervous system is like the brake pedal. Symptoms of stress-induced physiological arousal or tension may not be immediately noticeable, but may over time, develop into habits that persist, such as tensing your back and neck, clenching your teeth, favoring a certain muscle area after an injury, etc.
In addition to the purely physiological responses we have to stress, we have certain internal thought patterns that help us navigate through stressful situations, such as beliefs and expectations that we can get through something or know the way to master a given demand.
Biofeedback is used to reduce the stress response and increase the relaxation response that the parasympathetic nervous system controls.
Brain and muscle activities that are not normally controlled voluntarily may be changed according to the new available information (Ref: 1, 2). Biofeedback may enhance neural plasticity by engaging auxiliary sensory inputs, thus making it a plausible tool for neurorehabilitation and for a variety of population.
Only a few studies have evaluated different types of biofeedback in subjects with Parkinson’s disease (PD). Her major motor symptoms include: movement start hesitation, slow gait characterized by short step, and poor balance control. She is trained for a couple of hours in the clinical center, and then she is assured with on-site technical assistance if necessary.
In our foundational course, BioMechanics Level 1, we revisit definitions and at times, we redefine terms (but only because it has been necessitated by new information). Biofeedback involves using various computerized or electronic instrumentation tools to monitor specific, often unconscious physiological activities of your body.
Physiologically, our bodies will adapt to momentary stressors by changing our breathing rate so that we take in enough oxygen, by increasing our heart rate so that oxygen gets distributed to the brain and we can think better, or by giving us a burst of adrenaline to get our physiological responses moving faster so that we can get through something that is happening without being hurt.
The autonomic nervous system actually as two components, the sympathetic part, which activates us physiologically, and the parasympathetic part, which slows us back down after we have activated to respond to a demand.


The parasympathetic nervous system causes relaxing of our stress-related physiologic processes and returns our tissue and organ functioning back to normal. A habitual pattern such as this is usually not something you are aware of until it develops into chronic pain or discomfort. Our thoughts have an impact on our body and may result in the body temporarily working harder to accomplish something. Scientific evidence, and preliminary validation, on effects of cueing and rhythm for gait improvement with important results in patients show freezing of gait (Ref: 6, 7). Her clinician recommends her a rehabilitative program to be performed at home, by means of a new service and system based on recent technology.
Oddly, one of the terms that we don’t really spend much time on in the course is the term, “BioFeedback.” With such a simple name, one might think its meaning is self evident. With help from a biofeedback therapist, you can learn to change your heart rate or blood pressure, for example.
Though some form of auditory or visual means, such as computerized graphs or sounds, these physiological response patterns are fed back to you with these instruments.
This relaxation response allows recovery from the wear and tear on your body that is caused by sympathetic arousal and the stress response. Under certain situations, the internal processes of our thoughts and expectations may become part of the problem, such as when something extremely stressful or even hurtful happens and we continue to respond to the world as if we are in danger all the time. Before each training session starts, she records a self-assigned score about her motor status. At first you use the monitor to see your progress, but eventually you will be able to achieve success without the monitor or electrodes. We then teach you skills for gaining greater conscious control over the functioning of your body through a variety of techniques that are used in the sessions and practiced in your home environment.
If left on too long, the sympathetic nervous system causes various organ systems to become depleted. Under normal conditions, your body has the parasympathetic nervous system to help it return to a non-stressed state. Then, the body manifests anxiety or worry, fears, possibly even flashbacks of the prior event.
The clinician is so able to see if her evaluation (which can be strongly affected by mood and cognition) is in accordance to the objectivity that the system can measure. Once you are more aware of what your body is doing it is easier to change patterns of responding to stress in order to reduce or eliminate your unwanted symptoms.
Chronic stress may impair the working of this system and, as described above, begin to deplete systems of the body and cause symptoms. This is carried in the body in the form of constant tension in the muscles (through chronic sympathetic nervous system arousal)—the muscles are always ready to respond even when they should be at rest. The at-home rehabilitation exercise (consisting of 20 minutes walking with the audio biofeedback, and balance exercise with music on a daily base) will last for 6 weeks, after which a new medical examination will be performed in the neurological care center.
For those who respond to stress with a parasympathetic response, the explanation must be couched in these terms, again, with the aim of training being the balancing of the two systems.


When stress becomes intense over a long period of time or if stress is present chronically in your life, it is like the accelerator pedal gets stuck. The internal thought and physiological responses have become conditioned and are more related to past experiences that have nothing to do with the current situation. Medical examination will be done after a wash out, and then results evaluated to possibly perform a further stage of the rehabilitation protocol. Then, your body may show signs of wear and tear in the form of pain or discomfort, such as tension or migraine headaches, fibromyalgia symptoms, chronic tiredness, hypertension, immune system decline or a variety of other health problems which are triggered by stress. They may also learn to respond automatically to stress by contracting, for example, in the area of the neck and shoulders. Just as we can change habitual typing errors, or learn to swim more efficiently, so can we eliminate maladaptive psychophsyiological patterns and learn more adaptive patterns. Clinical biofeedback also involves learning relaxation techniques, using the instruments to the practitioner and client toward processes that are most effective for the client. The client is responsible for between-session practice of relaxation or other homework techniques and for maintaining awareness of symptom patterns as the relate to life-style factors. The temperature and weight readings from these devices give “feedback” about your body to tell you whether you have a fever or have gained weight. In a similar way, biofeedback therapists use specialized equipment to train patients how to improve their health by using signals from their own bodies. The therapist attaches sensors or electrodes to the body and these sensors provide a variety of readings–feedback–which is displayed on the equipment for the patient to see. With this information, patients can learn to make changes so subtle that at first they cannot be consciously perceived. People with urinary or fecal incontinence or other pelvic floor disorders can achieve improved bladder control.
What happens during a biofeedback session? In a normal biofeedback session, electrodes are attached to your skin. They send information to a small monitoring box that translates the measurements into a tone that varies in pitch, a visual meter that varies in brightness, or a computer screen that shows lines moving across a grid. For example, it shows promise for treating urinary incontinence, which is a problems for more than 15 million Americans. Based on findings in clinical studies, the Agency for Health Care Policy and Research has recommended biofeedback therapy as a treatment for urinary incontinence.
Treatment of headache, incontinence, and Raynaud's disease requires at least 10 weekly sessions and some follow-up sessions as health improves. Conditions like high blood pressure, however, usually require 20 weekly biofeedback sessions before you see improvement.




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