A. Understanding biofeedback therapy technology Biofeedback technology in China’s clinical application is only the last decade or so, but it has shown its pivotal role in the clinical treatment of psychosomatic diseases.
1. Biofeedback therapy is a kind of cognitive-behavioral therapy
Biofeedback technology is different from other physical therapy methods, it is a kind of cognitive-behavioral therapy, and also one of the methods of natural therapy or non-pharmacological therapy. The “closed-loop feedback diagram of biofeedback therapy system” vividly illustrates the principle of biofeedback therapy. Source: www.examda.com河南中医学院第一附属医院儿科张建奎
2. What is biofeedback therapy?
Biofeedback therapy refers to the use of modern electronic means, the original imperceptible faint psychophysiological change process of information collection and amplification processing, in the form of easy to identify, recognize the visual and audio display, to the level of human perceptible, when people recognize the signal that feedback to the brain, the brain and the central nervous system to regulate and control their own physiological and psychological state, and output new beneficial information. At this point, if the desired goal can be achieved, then the reward and reinforcement should be given, so as to constitute a closed-loop self-regulation system. We refer to this entire process as the biofeedback therapy process. Multiple realizations of this process can establish operant conditioning or shape new patterns of behavior. To explain it in one sentence: the instrument is used to understand the information processes related to one’s own physiology and psychology, and to learn to control and change these processes at will.
In the schematic diagram one can see that each link in the feedback loop is labeled with a backward and forward sequence of labels, such as (1), (2), (3), (4), and (5). This indicates that when a trainee first receives biofeedback therapy, he does not know enough about his own sense of participation and does not know where to start, the first step at this time is to start by collecting information from the trainee, showing this information through the next step (2) that moves in the direction of the arrow, and then making the trainee understand and know himself through step (3), followed by the information that has been understood through step (4) brain Then, the trainee will be able to understand and recognize himself/herself through step (3). Once the trainee is familiar with this process, he will soon start from the penultimate step (4) above. In other words, the trainee first shows the best result of the last training according to the previous learning experience, and then goes through each step in the direction of the arrow to achieve a deeper experience than the previous experience, and outputs more favorable information for disease regression. After so many times, the trainee is able to enter the fifth link at the beginning, that is, to complete the best adjustment program through the brain and central nervous system as soon as he sees the signal, and to adjust the mental and physical processes to be stable and balanced as soon as possible. Source
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3. The treatment principle of biofeedback technology: let patients participate in their own mind-body related factors to recognize their own disease and participate in the regression of their own disease.
4. Characteristics of biofeedback therapy technology: patient-oriented, changing the relationship between the doctor and the patient.
Second, the application of biofeedback technology
1. Self-monitoring, learning to relax
Relaxation training can regulate mental-emotional activities and improve the physiological internal environment in a timely and effective manner during stresses that occur due to life events. However, commonly used relaxation methods such as qigong, imagery, meditation in the learning process are not an objective indicator to show the trainer his real-time response in the training process, the trainer can not actively participate in the whole process of training. Therefore, sometimes the trainer cannot control his own state, or even “go off” or “get into the devil” type of deviation, but rather counterproductive, not only does not regulate the mental and physical process, but also affects the mental control, internal and external environmental homeostasis disorder, and even occur The behavior is even abnormal. In contrast, biofeedback relaxation training has been involved in the whole process of understanding oneself, changing oneself, from tension to relaxation in the closed-loop feedback between human and the instrument from the beginning to the end. As a result, the trainee can quickly recognize the meaning of the information, objectively realize the result of his subjective participation and relate it to his own state, understand the changes of various physiological parameters in the general state, the relaxed state and the state of different degrees of tension, understand the relationship between the subjective factors and the objective data for such changes, learn relaxation techniques in the process of complete self-monitoring, and build up conditioned reflexes in the process of learning again and again. In the process of complete self-monitoring, relaxation techniques are learned and conditioned reflexes are established in the course of learning. Source:exams.com
Once this conditioned reflex is established, people are able to control many of their own physiological information at will, regardless of whether this physiological information is perceived to be regulated by the autonomic nervous system or by the vegetative nervous system. At this point, people have the autonomous ability to change their own physiology and psychology, and have the ability to participate in the treatment of their own diseases.
2. Biofeedback is often the treatment of choice for psychosomatic disorders Source: Examiner
In many psychological and behavioral treatment methods, biofeedback therapy is often one of the preferred methods, this is because the patient will have a variety of psychological or emotional reactions at the same time after the act of seeking medical treatment, and the level of trust in the doctor will make him turn himself into a passive role. Therefore, if the patient does not have a correct psychological perception of the objective body, there is no real sense to start the treatment. The biofeedback technique precisely makes the actual process of the human psyche acting on the objective body visible to people and helps them to complete this cognitive process. It is also in this process that the patient participates in and tries out the results obtained by treating himself for himself, and is therefore convinced that the psyche and the physiology are interacting with each other and that the person is able to control the results of this interaction. This type of treatment will bring the patient to a realization and will save the physician the trouble of repeatedly convincing the patient and proving the psycho-physical interaction to the patient. This treatment helps the patient and the doctor at the same time, especially for the clinical problems that are the most troublesome for the doctor, such as the patient’s lack of cooperation, the patient’s excessive tension, and the ineffectiveness of the medication.
3. EMG feedback monitoring, relaxation of body and mind at will Source: the beautiful editors of the examination
EMG is the electrical impulse activity of muscles, and this activity is controlled by the brain and spinal cord by directing the increase or decrease in the amount of motor neuron discharge. Any normal person has the ability to command skeletal muscles at will, so that people can learn and train to perform heavy physical work or fine manual operations. The movement of skeletal muscles has a psychosomatic relevance and importance when we choose EMG signals for human regulation of psychophysiological processes.
When a person’s tension and discomfort due to environmental, emotional or psychological factors lead to an increase in the amount of non-random discharge of motor neurons, the muscle is tense and the EMG value increases, but in the usual state the person does not notice, only by using EMG biofeedback instrument, the change process of EMG as a physiological signal is displayed, the person can notice and recognize, then using the person’s ability to control the muscle at will can quickly learn to Muscle relaxation. In the process of muscle relaxation, people can also quickly feel the mental and psychological relaxation process.
4. The specific operation method of clinical treatment Source: the beautiful editors of the examination
(1)Introduce biofeedback therapy and explain it well
Let the patient understand the principle, meaning and purpose of biofeedback therapy, and explain to the patient to target their own problems (for example, for their own hypertension, headache, insomnia, etc.), you can first try to connect with the instrument, and experience the closed-loop feedback relationship between the person and the instrument, which is also the initial attempt of self-control. When connected to the electrodes connected to the myoelectric biofeedback instrument, you can first try to let the patient frown or lift the forehead, but also try to “clench your teeth”, and then release. At this point, the patient can appreciate the relationship and difference between tightening and loosening. As a result, the patient becomes sensitive to physiological changes that were not easily perceived.
(2) Connecting electromyographic instruments Source: Exam
The patient is placed in a comfortable, stable, semi-recumbent position and is able to see the digital display of the instrument and the movement of the cursor. For treatment of psychosomatic diseases, the electrodes are best placed on the forehead, with the heterochromatic of the three electrodes placed above the eyebrows and the other two placed above the left and right pupils, and there should be a distance of about 1 cm between the three electrodes.
(3) Record the basal EMG value (baseline value) and start the preset switch Examda – the largest educational website in the country (www. Examda. com)
When the patient is quiet for 3-5 minutes, the basal EMG value (baseline value) microvolts (μV) can be recorded and the preset switch can be activated to modulate the preset value at a value lower than the baseline value.
For the patient, this is a target preset and a specially designed reinforcement on the instrument. As the patient relaxes, the EMG signal will drop, and if it drops to the preset position or below, the instrument will automatically emit a pleasant “beep” sound to tell the trainee or patient the result of self-regulation. When the patient hears this sound, he establishes a psychological connection with the instrument and tells himself, “The goal has been reached and I can continue to work on it. At this point, the physician should also prompt the patient to say that he or she has succeeded and is doing a good job, to pay attention to the inner feelings and try to remember them. In fact, the patient is encouraged to feel the most sensitive part or target part of his or her relaxation process. For example: a patient with a headache feels a reduced headache while relaxing, getting more and more relaxed and comfortable until there is no more pain. The source of this article:ExamDaily.com
(4) Downward adjustment of the preset at the patient’s likely value
Again adjust the preset downward in the patient may reach the value, and observe the patient, but also let the patient himself observe, in the treatment process can be maintained in more than 10 minutes to maintain the value, and this value as the baseline value of the next training, in order to stimulate the patient to the next training have new goals to pursue. This article is from:exams.com
(5) Everyone can have the potential to reach less than 1 μV (the author believes that reaching less than 1 μV is considered to be truly relaxed from somatic to psychosomatic.)
The baseline level of EMG value is not always the same for each person, which is related to the regularity and intensity of an individual’s activity of a particular muscle in daily life, as well as to the real-time nature of the individual’s emotional activity, so each patient should first measure the baseline value. However, based on the instrument’s designed sensitivity of 0.01 μV, generally everyone can have the potential to achieve less than 1 μV.
Give the patient some feasible relaxation options www.Examda.CoM考试就到考试大
(6) Repeat the exercise regularly according to the treatment course
Generally 7-10 times is a course of treatment, and conditioned reflexes (operative) can be established after one to four courses of treatment. The first course of treatment is usually once a day, so that the patient can experience the feeling of relaxation frequently, so that he can recognize the operability of this feeling as soon as possible and actively go to establish it. In the second course, depending on the patient’s actual learning results, the decision is made whether to continue with 1 time per day or 1 time every other day. The third and fourth courses can be twice a week, this is to let the patient in the process of establishing this conditioned reflex to continuously enhance the active relaxation consciousness, to avoid the formation of dependence on the consultation room, on the doctor, on the instrument, so that the active learning to get stable results, finally, when the conditioned reflex is established, also need the doctor to remind the patient to come to the consultation room once a month or once every two months to review this method, because this is the behavior operation If a certain behavior occurs frequently, it will not be forgotten for life, and if the behavior is not repeated for a long time, it will be lost.
(7) Pay attention to home training
①You can rent a portable biofeedback instrument for patients to practice at home; Source: Examinations
②If there is no instrument, let the patient will be in the office treatment obtained feelings in home training repeatedly rehearsed, can not be bound to time, not bound to the number of times, in order to experience the office training feelings for the purpose, which can make the patient in the real environment to strengthen, consolidate the learned regulatory skills.
(8) neuromuscular retraining therapy – specific feedback mode exam forum
For neuromuscular improper use, resulting in uncoordinated movements, or due to vascular overflow caused by the nervous system obstruction, the formation of limb rest activity disorders, but still have residual EMG activity signal, but also can use the method of EMG biofeedback to conduct neuromuscular retraining treatment. Due to the high sensitivity of the instrument and the high fidelity amplification of the weak electrical signals, the patient can see his real muscle activity after being amplified after being connected to the instrument, so he has the confidence and determination to train autonomously, and the preset system designed on the instrument can be used in both directions, whether the muscle is spastic or too relaxed or paralyzed, the patient’s autonomous muscle activity can be reinforced through the preset Loose or tight training until they return to normal.
III. Autonomic control of skin temperature and regulation of sympathetic activity technique
(I) Principle
Regulation of skin temperature of the fingers is closely related to sympathetic activity of the autonomic nervous system. When the sympathetic system is excited, it causes the smooth muscle around the blood vessels near the skin surface to contract, generating vascular pressure, this pressure reduces the blood flow, the blood flow in the capillaries is reduced, and the skin temperature drops. Conversely, sympathetic excitation decreases, causing the smooth muscle around the capillaries of the fingers to relax, the pressure on the blood vessels decreases, the blood vessels expand, blood flow increases, and the skin temperature of the fingers rises, generally from a hand temperature of about 32°C (about 90H) to more than 35°C (more than 95H), and even some patients relax well and are very involved, and the hand temperature sometimes rises to 36.7°C (about 98H) .
According to this reasoning, people who can learn to control the change of their finger temperature also learn to use the physiological signal of skin temperature to control the excitation of sympathetic nerves or the inhibition of it. An increase in temperature at the ends of the hands and feet is indicative of peripheral vasodilation and increased blood flow, which has clinical implications for the treatment of a variety of conditions. However, attention should be drawn to the fact that individual basal temperatures vary, even greatly, but any individual is capable of learning to regulate their own temperature changes, so that whatever a patient’s basal temperature is, they have a great potential for warming, provided there are no irreversible temperature changes following organic pathology. Source: www.examda.com
Based on the above principles, the monitoring display and feedback of temperature is implemented to the individual using a skin temperature biofeedback instrument. This allows people to know in real time the level of circulation in the peripheral blood vessels, informing them of the results of the physiological impact of the intricate emotional changes that they did not notice, and to “see the light” with this skin temperature feedback. For example, knowing that blood pressure can be lowered if peripheral vascular resistance is reduced, skin temperature feedback is used clinically to lower blood pressure by increasing temperature.
(B) Clinical operation method.
The patient is in a semi-recumbent comfortable position, and the instrument is placed at a place where it can be easily seen visually, and the skin temperature sensor is connected to record the basal temperature value (baseline value).
Teach the patient some warming techniques exam big forum
EMG biofeedback therapy and dermal temperature biofeedback therapy in reducing the level of somatic and mental arousal, reduce sympathetic excitability of research and clinical treatment have shown that they can have a wide range of applications, because due to sympathetic system tension and all kinds of physical symptoms (psychosomatic diseases) are suitable for the regulation of these two signals to suppress and change, so we also call these two signal feedback for non-specific Signal feedback mode, of course, it is also the specific side, especially myoelectric biofeedback therapy.
Fourth, biofeedback treatment requires special attention to the problem
1. The place of biofeedback training is comfortable and simple
The place should be arranged to make people feel relaxed as much as possible. Doctors in telling patients about biofeedback principles should be easy to understand, it is best to use non-verbal learning experience as an analogy, for example, when people learn to use chopsticks, walk or control the process of urination and defecation in early childhood, which contains a series of behavioral manipulation of the feedback process. In this way, the patient will easily compare the steps of biofeedback to some of the skills he or she has already mastered, so that he or she can experience and figure out how to operate his or her own skills and realize that the key to learning biofeedback techniques is simply time and practice. Source: Examinations
2. Select the instrument with stable performance, high sensitivity and applicable test range
The existing domestic JD-2A type myoelectric biofeedback instrument, JD/PW–5 type advanced computerized myoelectric skin temperature biofeedback instrument, etc., are the most clinically used models.
3. The use of “reinforcement” measures www.Examda.CoM考试就到考试大
4. Inspire the trainees to combine the quantitative parameters obtained from biofeedback training with daily life
5. Relevant physiological indicators should be measured before and after each treatment, and the degree of corresponding symptoms should be assessed Source: Examinations
6. Emphasize the patient’s active position in the whole treatment process, and finally leave the help of the instrument in order to truly biofeedback treatment purpose.
7. Note that the doctor in the patient’s biofeedback treatment process is the role of the guide, or even a confidant friend