AAPB White Paper
Applications of Biofeedback to Rehabilitation of Physical Disabilities in Baltimore, MD
Bernard S. Brucker, Ph.D.
Physical disabilities can result from many causes which damage the central and peripheral nervous system such as traumatic accidents, which cause spinal cord injuries, head injuries, and peripheral nervous system damage; birth trauma and congenital defects causing cerebral palsy, spina bifida, among others; infection, causing Guillain-Barre syndrome, multiple sclerosis, amyotrophic lateral sclerosis, encephalitis, myelitis, polio, and Bell's palsy; and cerebral vascular diseases causing strokes. An estimated 35,000,000 people in the United States suffer from some form of physical impairment('). These physical impairments not only have a dramatic impact on the quality of human life but also are extremely costly to American society.
Most disabling conditions will result in a degree of permanent paralysis preventing the individual from walking, and in some cases even accomplishing the necessary tasks of everyday life such as feeding and dressing one's self, requiring full or part-time attendant care and perhaps lifetime institutionalization. With the advances in medicine and technology many people who would have previously died from trauma and disease are now surviving with resulting paralysis and living longer which increases the disabled population in America.
The field of rehabilitation medicine emerged after World War 11 as a medical specialty with the purpose of improving function and quality of life for disabled individuals. The specialty fields of occupational, physical, and speech therapy as well as rehabilitation psychology have emerged with specific techniques for restoring function and quality of life. Numerous inpatient rehabilitation centers and outpatient rehabilitation programs have developed throughout the United States which have helped disabled individuals become more functional through specific exercises in the use of adaptive devices and equipment such as wheelchairs, braces, and electrical devices.
Biofeedback, a behavioral technique for establishing learned control of specific physiological responses has been shown to be effective in obtaining more specific learned control over neuromuscular responses than would otherwise be obtained by exercise or general learning techniques alone. As early as 1960(3), biofeedback techniques were successfully applied in rehabilitation to restore function to a person who had paralysis resulting from stroke. Since that time, biofeedback techniques have been applied to individuals with paralysis resulting from head and spinal cord injuries, strokes, cerebral palsy, torticollis, Guillain-Bane syndrome, Bell's palsy, among others('). Through the use of visual or auditory feedback that instantaneously reflects the electrical activity of targeted muscles, patients can be trained to inhibit unwanted spastic motor activity of targeted muscles, patients can be trained to inhibit unwanted spastic motor activity and facilitate improved strength, range of motion, and control of paretic muscle("). With the advances in technology it is possible to accurately measure the electrical activity of muscle (EMG) and rapidly process these electrical signals for display on the monitor. This display shows the patient slight changes in neuromuscular activity which would normally go unnoticed by the patient or therapist. Operant conditioning techniques can then be utilized to have the patient learn greater control over the EMG signals to the muscle than would otherwise be possible. In this way, biofeedback can restore functional control over paretic muscles which might not be achieved by other therapeutic modalities alone. There have been more than 150 published scientific articles on applications of biofeedback in rehabilitation.
Biofeedback has been shown to be a valuable technique in rehabilitation resulting in greater increases in function and quality of life for people with physical disabilities(3).
Gans, B.M., Mann, N.R., Becker, B.E. Delivery of Primary Care to Physically Challanged. Arch. Physical Medical Rehabilitation:1993 Dec. Vol 74 (12-S) S-15-S-19.
Basmajian, J.V. Muscles Alive. Williams & Wilkins, Baltimore, 1979
Brucker, B.S. Biofeedback in Rehabilitation. In: Current Topics in Rehabilitation Psychology: Grunne & Stratton, 1984.
Basmajian, J.V. Biofeedback in Rehabilitation: A Review of Principles and Practices. Arch. Physical Medical Rehabilitation: 1981, 62 (10): 469.
Congleton, J.J. The effect of Biofeedback on Carpel Tunnel Syndrome: Ergonomics, 1993 April Vol 36 (4), 353- 361.
Flodmark, A. Augmented Auditory Feedback as an Aid in Gait Training of the Cerebral Palsied Child. Dev Med. Child Neurol.1986,28 (2): 147-55.
Goldsmith, M.F.Computerized Biofeedback Training Aids in Spinal' Injury Rehabilitation, JAMA. 1985, 253 (8): 1097-9.
Health & Public Policy Committee, American College of Physicians. Biofeedback for Neuromuscular Disorders. Ann Int Med.1985, 102: 854-8
Jahanshahi, M., Sartory, G., Marsden, C.D. EMG Biofeedback Treatment of Torticollis:A Controlled Outcome Study. Biofeedback and Self Regulation: 1991 Dec. 16 (4) 413-48.
May, M., Croxson, G.R., Klein, S.R. Bell's Palsy: Management of Sequelae Using EMG Rehabilitation, Botulinum Toxin, and Surgery. Amer. J. Otology, 1989, 10 (3): 220-9.
Schleenbaker, R.E., Mainous, A.G.III. Electromyographic Biofeedback for Neuromuscular Reduction in Hemiplegic Stroke Patients: A Meta-Analysis. Arch Phys Med Rehab. 1993, 74(12): 1301-4.
Stein, R.E., Brucker, B.S., Ayyar, D.R. Motor Units in Incomplete Spinal Cord Injury: Electrical Activity, Contractile Properties and the Effect of Biofeedback. J Neurol Neurosurg Psych. 199053(10): 880.