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Clinical Gastroenterology and... Oct 2023Anorectal manometry (ARM) is a comprehensive diagnostic tool for evaluating patients with constipation, fecal incontinence, or anorectal pain; however, it is not widely... (Review)
Review
BACKGROUND & AIMS
Anorectal manometry (ARM) is a comprehensive diagnostic tool for evaluating patients with constipation, fecal incontinence, or anorectal pain; however, it is not widely utilized for reasons that remain unclear. The aim of this roundtable discussion was to critically examine the current clinical practices of ARM and biofeedback therapy by physicians and surgeons in both academic and community settings.
METHODS
Leaders in medical and surgical gastroenterology and physical therapy with interest in anorectal disorders were surveyed regarding practice patterns and utilization of these technologies. Subsequently, a roundtable was held to discuss survey results, explore current diagnostic and therapeutic challenges with these technologies, review the literature, and generate consensus-based recommendations.
RESULTS
ARM identifies key pathophysiological abnormalities such as dyssynergic defecation, anal sphincter weakness, or rectal sensory dysfunction, and is a critical component of biofeedback therapy, an evidence-based treatment for patients with dyssynergic defecation and fecal incontinence. Additionally, ARM has the potential to enhance health-related quality of life and reduce healthcare costs. However, it has significant barriers that include a lack of education and training of healthcare providers regarding the utility and availability of ARM and biofeedback procedures, as well as challenges with condition-specific testing protocols and interpretation. Additional barriers include understanding when to perform, where to refer, and how to use these technologies, and confusion over billing practices.
CONCLUSIONS
Overcoming these challenges with appropriate education, training, collaborative research, and evidence-based guidelines for ARM testing and biofeedback therapy could significantly enhance patient care of anorectal disorders.
Topics: Humans; Fecal Incontinence; Defecation; Quality of Life; Manometry; Constipation; Rectum; Rectal Diseases; Anal Canal; Biofeedback, Psychology
PubMed: 37302444
DOI: 10.1016/j.cgh.2023.05.025 -
International Journal of Environmental... Oct 2022This narrative review is aimed at presenting the galvanic skin response (GSR) Biofeedback method and possibilities for its application in persons with mental disorders... (Review)
Review
This narrative review is aimed at presenting the galvanic skin response (GSR) Biofeedback method and possibilities for its application in persons with mental disorders as a modern form of neurorehabilitation. In the treatment of mental disorders of various backgrounds and courses, attention is focused on methods that would combine pharmacological treatment with therapies improving functioning. Currently, the focus is on neuronal mechanisms which, being physiological markers, offer opportunities for correction of existing deficits. One such indicator is electrodermal activity (EDA), providing information about emotions, cognitive processes, and behavior, and thus, about the function of various brain regions. Measurement of the galvanic skin response (GSR), both skin conductance level (SCL) and skin conductance responses (SCR), is used in diagnostics and treatment of mental disorders, and the training method itself, based on GSR Biofeedback, allows for modulation of the emotional state depending on needs occurring. Summary: It is relatively probable that neurorehabilitation based on GSR-BF is a method worth noticing, which-in the future-can represent an interesting area of rehabilitation supplementing a comprehensive treatment for people with mental disorders.
Topics: Humans; Galvanic Skin Response; Emotions; Biofeedback, Psychology; Psychiatry; Mental Disorders
PubMed: 36294009
DOI: 10.3390/ijerph192013428 -
Cleveland Clinic Journal of Medicine Jul 2010This review traces the application of electroencephalographic (EEG) operant conditioning, or biofeedback, from animal research to its emergence as an alternative... (Review)
Review
This review traces the application of electroencephalographic (EEG) operant conditioning, or biofeedback, from animal research to its emergence as an alternative treatment for the major types of seizure disorder. Initial animal studies focusing on brain mechanisms that mediate learned behavioral inhibition revealed a uniquely correlated 12- to 15-Hz EEG rhythm localized to sensorimotor cortex. We labeled this the sensorimotor rhythm, or SMR. The similarity of the SMR to the known EEG spindle pattern during quiet sleep led to the novel idea of attempting to increase the SMR using EEG operant conditioning. The hypothesis was that this might produce a corresponding increase in sleep spindle activity, thus establishing a common EEG marker for the state of motor inhibition. Results supported this hypothesis but led also to the accidental discovery of an anticonvulsant effect on drug-induced seizures in cats and monkeys. Continuing animal studies identified a pattern of neurophysiologic responses correlated with the SMR in primary motor pathways. These and other findings were indicative of reduced motor excitability. Simultaneously, we undertook studies in human epileptic subjects that documented a significant reduction in seizure incidence and severity, together with EEG pattern normalization. This work expanded internationally, resulting in numerous well-controlled group and single-case studies summarized in recent meta-analyses. Exciting new findings in functional neuroimaging/EEG correlation studies provide a rational model for the basis of these clinical effects. In recognition of the diversity of clinical applications of EEG biofeedback and the complexity of seizure disorders, this review also details specific methods used in our EEG biofeedback program.
Topics: Animals; Biofeedback, Psychology; Cats; Conditioning, Operant; Electroencephalography; Epilepsy; Humans
PubMed: 20622079
DOI: 10.3949/ccjm.77.s3.11 -
Journal of Neuroengineering and... Aug 2017Millions of patients around the world are affected by neurological and psychiatric disorders. Deep brain stimulation (DBS) is a device-based therapy that could have... (Review)
Review
BACKGROUND
Millions of patients around the world are affected by neurological and psychiatric disorders. Deep brain stimulation (DBS) is a device-based therapy that could have fewer side-effects and higher efficiencies in drug-resistant patients compared to other therapeutic options such as pharmacological approaches. Thus far, several efforts have been made to incorporate a feedback loop into DBS devices to make them operate in a closed-loop manner.
METHODS
This paper presents a comprehensive investigation into the existing research-based and commercial closed-loop DBS devices. It describes a brief history of closed-loop DBS techniques, biomarkers and algorithms used for closing the feedback loop, components of the current research-based and commercial closed-loop DBS devices, and advancements and challenges in this field of research. This review also includes a comparison of the closed-loop DBS devices and provides the future directions of this area of research.
RESULTS
Although we are in the early stages of the closed-loop DBS approach, there have been fruitful efforts in design and development of closed-loop DBS devices. To date, only one commercial closed-loop DBS device has been manufactured. However, this system does not have an intelligent and patient dependent control algorithm. A closed-loop DBS device requires a control algorithm to learn and optimize the stimulation parameters according to the brain clinical state.
CONCLUSIONS
The promising clinical effects of open-loop DBS have been demonstrated, indicating DBS as a pioneer technology and treatment option to serve neurological patients. However, like other commercial devices, DBS needs to be automated and modernized.
Topics: Algorithms; Animals; Biofeedback, Psychology; Deep Brain Stimulation; Equipment Design; Humans
PubMed: 28800738
DOI: 10.1186/s12984-017-0295-1 -
Sensors (Basel, Switzerland) Sep 2022Heart rate variability is an important physiological parameter in medicine. This parameter is used as an indicator of physiological and psychological well-being and even...
Heart rate variability is an important physiological parameter in medicine. This parameter is used as an indicator of physiological and psychological well-being and even of certain pathologies. Research on biofeedback integrates the fields of biological application (physiological behavior), system modeling, and automated control. This study proposes a new method for modeling and controlling heart rate variability as heart rate acceleration, a model expressed in the frequency domain. The model is obtained from excitation and response signals from heart rate variability, which through the instrumental variables method and the minimization of a cost function delivers a transfer function that represents the physiological phenomenon. This study also proposes the design of an adaptive controller using the reference model. The controller controls heart rate variability based on the light actuators designed here, generating a conditioned reflex that allows individuals to self-regulate their state through biofeedback, synchronizing this action to homeostasis. Modeling is conducted in a target population of middle-aged men who work as firefighters and forest firefighters. This study validates the proposed model, as well as the design of the controllers and actuators, through a simple experiment based on indoor cycling. This experiment has different segments, namely leaving inertia, non-controlled segment, and actively controlled segment.
Topics: Biofeedback, Psychology; Heart Rate; Humans; Male; Middle Aged; Wearable Electronic Devices
PubMed: 36236257
DOI: 10.3390/s22197153 -
Cleveland Clinic Journal of Medicine Mar 2008Hypnosis and biofeedback are cyberphysiologic strategies that enable subjects to develop voluntary control of certain physiologic processes for the purpose of improving... (Review)
Review
Hypnosis and biofeedback are cyberphysiologic strategies that enable subjects to develop voluntary control of certain physiologic processes for the purpose of improving health. Self-hypnosis has been used with and without biofeedback for a wide range of therapeutic applications, and both laboratory studies and clinical trials have shown it to be effective in improving symptoms and outcomes in various disorders. More formal Cochrane reviews of hypnotherapeutic interventions are currently under way. Thorough patient assessment should precede training in self-hypnosis in order to properly tailor training strategies to patient preferences and characteristics, especially for children. Workshops offered by various clinical societies are available to train health professionals in self-hypnosis.
Topics: Adolescent; Adult; Biofeedback, Psychology; Child; Chronic Disease; History, 18th Century; History, 19th Century; Humans; Hypnosis; Mental Disorders; Pain Management; Teaching
PubMed: 18540145
DOI: 10.3949/ccjm.75.suppl_2.s39 -
Prilozi (Makedonska Akademija Na... Sep 2020Stress, as a kind of emotion, is inevitable in everyday life. In psychosomatic medicine stress represents a powerful link in the pathophysiological chain of disorder....
Stress, as a kind of emotion, is inevitable in everyday life. In psychosomatic medicine stress represents a powerful link in the pathophysiological chain of disorder. Having evidence about the power of stress on the body, the interest in medicine was how to measure it in appropriate, fast way and with minimal cost. Electrodermal activity seems to be available for this purpose. The galvanic skin response (GSR) is an objective, transient indication of autonomic nervous system arousal in response to a stimulus. It refers to changes in sweat gland activity that are reflective of the intensity of our emotional arousal. In this article we discuss physiological specifics of skin conductance/resistance and how it is measured in practice. The most used application of GSR is in biofeedback methodology. Biofeedback assessment and training exactly uses skin reaction to different stimuli and aims to gain voluntary control over this autonomic response. The aim of this article is to show effectiveness of this method in paediatric practice.
Topics: Arousal; Autonomic Nervous System; Biofeedback, Psychology; Child; Emotions; Galvanic Skin Response; Humans
PubMed: 33011695
DOI: 10.2478/prilozi-2020-0028 -
Current Opinion in Psychology Dec 2019Heart rate variability (HRV) biofeedback is an accessible, cost-effective intervention that has demonstrated clinical value for numerous physical and mental health... (Review)
Review
Heart rate variability (HRV) biofeedback is an accessible, cost-effective intervention that has demonstrated clinical value for numerous physical and mental health conditions; however, research on HRV biofeedback in substance use disorders (SUD) is in its nascence. We argue that HRV biofeedback may be particularly beneficial as an adjunct treatment for SUD by targeting bodily systems that are known to be disrupted by chronic substance use and are not historically the focus of psychosocial or pharmacological SUD treatment approaches. In addition to advocating for HRV biofeedback applications in SUD, we identify several gaps within the existing experimental literature, and propose new studies that could accelerate understanding of how and for whom HRV biofeedback is most likely to promote positive behavior change.
Topics: Biofeedback, Psychology; Heart Rate; Humans; Substance-Related Disorders
PubMed: 31055246
DOI: 10.1016/j.copsyc.2019.03.008 -
Sensors (Basel, Switzerland) May 2021Wearable devices are used in rehabilitation to provide biofeedback about biomechanical or physiological body parameters to improve outcomes in people with neurological... (Meta-Analysis)
Meta-Analysis Review
Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases.
Wearable devices are used in rehabilitation to provide biofeedback about biomechanical or physiological body parameters to improve outcomes in people with neurological diseases. This is a promising approach that influences motor learning and patients' engagement. Nevertheless, it is not yet clear what the most commonly used sensor configurations are, and it is also not clear which biofeedback components are used for which pathology. To explore these aspects and estimate the effectiveness of wearable device biofeedback rehabilitation on balance and gait, we conducted a systematic review by electronic search on MEDLINE, PubMed, Web of Science, PEDro, and the Cochrane CENTRAL from inception to January 2020. Nineteen randomized controlled trials were included (Parkinson's = 6; stroke = 13; mild cognitive impairment = 1). Wearable devices mostly provided real-time biofeedback during exercise, using biomechanical sensors and a positive reinforcement feedback strategy through auditory or visual modes. Some notable points that could be improved were identified in the included studies; these were helpful in providing practical design rules to maximize the prospective of wearable device biofeedback rehabilitation. Due to the current quality of the literature, it was not possible to achieve firm conclusions about the effectiveness of wearable device biofeedback rehabilitation. However, wearable device biofeedback rehabilitation seems to provide positive effects on dynamic balance and gait for PwND, but higher-quality RCTs with larger sample sizes are needed for stronger conclusions.
Topics: Biofeedback, Psychology; Exercise; Gait; Humans; Postural Balance; Prospective Studies; Wearable Electronic Devices
PubMed: 34063355
DOI: 10.3390/s21103444 -
Wiener Klinische Wochenschrift Jan 2022Virtual reality (VR)-based biofeedback is a relatively new intervention and is increasingly being used for the treatment of anxiety disorders. This is the first... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Virtual reality (VR)-based biofeedback is a relatively new intervention and is increasingly being used for the treatment of anxiety disorders. This is the first research synthesis regarding effects and efficacy of this novel mode of treatment.
METHOD
We conducted a systematic review and meta-analysis of the VR biofeedback literature on treating anxiety symptoms. The MEDLINE/PubMed, Scopus and Web of Science databases were searched for eligible pre-post comparisons and randomized controlled trials (RCTs). We used self-reported anxiety, heart rate (HR), and heart rate variability (HRV) as primary outcome measures.
RESULTS
A total of 7 studies with 191 participants reported VR biofeedback interventions. Of these studies 5 were RCTs, with 103 participants receiving VR biofeedback and 99 control participants (either 2D biofeedback or waiting list controls). We found that VR biofeedback significantly lowers self-reported anxiety (g = -0.28) and HR (g = -0.45), but not HRV. Furthermore, there were no significant differences in outcomes between VR biofeedback and 2D biofeedback but a significant reduction in HR in the VR biofeedback group compared with the waiting list (g = -0.52).
CONCLUSION
While the first findings are optimistic, more controlled studies with a wider variety of samples are needed to bring this field forward. Particularly, children and adolescents may profit from the combination of gamification elements, VR, and biofeedback.
Topics: Adolescent; Anxiety; Anxiety Disorders; Biofeedback, Psychology; Child; Heart Rate; Humans; Virtual Reality
PubMed: 34989862
DOI: 10.1007/s00508-021-01991-z