Research Database -
International Updates

Biofeedback

Issue 70

ARNDORFER and ALLEN, West Central Human Service Center, Bismark, ND, USA, explored the efficacy of a thermal biofeedback package as a treatment for tension-type headaches in children.
Methods: This was a within-subject, time-lagged, multiple-baseline study. 5 children aged 8-14 years were assigned to baselines of varying lengths. Treatment, involving 6 thermal biofeedback treatment visits, was introduced sequentially across subjects. Parents received guidelines on how best to encourage children to independently use the biofeedback skills. Subjects learned the hand-warming skill, practised the skill on a regular basis during treatment, and independently used the skill to manage their pain.
Results: Following treatment, all subjects showed clinically significant reductions in one or more headache parameters (frequency, duration, intensity). 4 of the 5 subjects were headache-free at 6-months’ follow-up.
Conclusion: The treatment package was generally effective in these children with tension-type headaches, although the specific response appeared to depend on the specific type of headache experienced. No single measure of headache activity was the best indicator of response to treatment. The results support the use of this thermal biofeedback treatment package as an alternative treatment for children suffering tension-type headaches.
Arndorfer RE, Allen KD. Extending the efficacy of a thermal biofeedback treatment package to the management of tension-type headaches in children. Headache 41 (2): 183-92. Feb 2001.
Comment: Although this study only included 5 children, it is encouraging that 4 out of the 5 children were free of headaches at the follow-up 6 months later.

Issue 37

BIRGER and colleagues, Psychiatric Day Care Dept, Chaim Sheba Medicine Center, Tel Hashomer, Israel write that Raynaud's disease is characterised by intermittent peripheral vasoconstriction, which leads to pallor, cyanosis and reactive vasodilation of arterioles of fingers and toes.
Discussion: These sensations occur along with cold or warmth, pain and difficulty in manipulating the palms. In severe cases ulceration of the fingertips can occur. Conservative medical treatment, using preventive measures and changing various habits, only alleviates symptoms in half the patients. Sympathectomy (surgical excision of part of the sympathetic nervous system) is often required. Psychological intervention, including biofeedback can play a significant role. Biofeedback involving relaxation techniques, guided imagery, in parallel with computer-assisted monitoring of sympathetic arousal, may lead to the reduction in symptoms either as a unique treatment or in conjunction with other treatment modalities.
Birger M et al. Biofeedback treatment of Raynaud's disease. Harefuah 133(9): 362-4. Nov 2 1997.

AUST and FISCHER, Berantungsstelle fur Horbehinderte Berlin Neukolln, Germany investigate whether the psychophysical breath work by Middendorf has an effect upon reactions of the body's equilibrium system.
Methods: Optical patterns were projected onto a video screen to the test person who was standing on a posturographic platform. The test subjects were instructed to shift their centre of gravity according to the patterns which were projected onto the video screen. The patterns consisted of a line which had to be followed in the anterior-posterior and lateral plane, and a circle to be followed clockwise and counterclockwise. There were 3 groups of test subjects, each with 17 healthy people as follows: Group 1: advanced in breath training; Group 2: beginners in breath training; Group 3: no experience in breath work at all.
Results: Compared to the subjects without breath work experience (Group 3), Groups 1 and 2 had significantly better results in the posturographic test with visual feedback. Additionally, the posturographic results immediately following one hour of breath work demonstrated clear improvements in body equilibrium.
Conclusions: Psychophysical breath work by Middendorf leads to a general improvement of the body equilibrium which remains stable over time. The positive results from this study suggests that breath work by Middendorf may be a valuable method for the treatment and rehabilitation of balance disorders.
Aust G and Fischer K. Changes in body equilibrium response caused by breathing. A posturographic study with visual feedback. Laryngorhinootologie 76(10): 577-82. Oct 1997.

ERNST, Department of Complementary Medicine, University of Exeter, UK writes in his review (35 references) that acupuncture is a popular complementary treatment for osteoarthritis. The author conducted a systematic review of the literature in order to define its therapeutic effectiveness.
Methods: Independent literature searches identified 11 studies of acupuncture for osteoarthritis.
Results: The results from these studies were highly contradictory and most trials suffered from methodological flaws. The most rigorous studies suggested that acupuncture was not superior to sham-needling with regard to reduction of pain from osteoarthritis.
Conclusions: These results could indicate that either sham-needling has similar specific effects as acupuncture or that both methods produce considerable non-specific effects. Further research is required in order to clarify these results.
Ernst E. Acupuncture as a symptomatic treatment of osteoarthritis. A systematic review. Scand J Rheumatol 26(6): 444-7. 1997.

ZHANG, Yanta District Hospital of Traditional Chinese Medicine, Xi'an, China writes that Huatuojiaji are extra-channel acupoints which have been first described in A Handbook of Prescriptions for Emergencies. The clinical application of these acupoints have been expanded to a great extent in modern times.
Background: The successful application of Huatuojiaji points in acupuncture anaesthesia and research on these points peaked toward the end of the 1970s, great progress in their clinical application has been achieved in recent years.
Methods: According to acupuncture and moxibustion theories, puncturing Huatuojiaji points can dredge channels, promote the flow of qi, regulate yin and yang and activate the Du and Urinary Bladder Channel. The authors treated 300 cases of apoplexy (cerebrovascular accident). There are 56 points, altogether, 28 on each side of the spine. The prescription for apoplexy includes C1-7, T1-9 and L2-4.
Results: Of the 300 cases of apoplexy, 100 were cured, 107 improved markedly, 87 improved and 6 were ineffective. The total effective rate was 98%.
Zhang Y. Observation of curative effects of Huatuojiaji in the treatment of 300 cases of apoplexy. J Tradit Chin Med. 16(2): 117-20. Jun 1996.

WANG, Shandan County Hospital of TCM, Gansu Province, China describes the combined treatment of gonococcal arthritis using acupuncture, garlic moxibustion, pricking blood, cupping and drawing hydrarthrus.
Methods: 116 cases of gonococcal arthritis were treated. Dazhui (Du 14), Quchi (LI 11)and Zusanli (St 36) points were selected, in addition to points along the meridian which were needled by the affected joint.
Results: Of the 116 cases, 74 were cured, 13 were markedly improved, 11 improved and 11 failed. The total effective rate was 84.5%
Wang K. 116 cases of gonococcal arthritis treated with acupuncture. J Tradit Chin Med 16(2): 108-11. Jun 1996.

COMMENTS: Although research published regarding the treatment of osteoarthritis using acupuncture may be flawed, it is clear from these clinical studies in China that practitioners achieve a high rate of cure using a variety of acupuncture methods. These studies may not be clinical trials, but they are bona fide case studies documenting effective treatment.

Issue 29

SHERMAN and colleagues, Department of Clinical Investigation, Madigan Army Medical Center, Tacoma WA 98431 USA write that one third of 450 women soldiers surveyed indicated they had problematic urinary incontinence experiences during exercise and field training. Moreover, 13.3% of those women who responded indicated that they significantly restricted fluid intake during field exercises. 5.3% indicated that urine leakage significantly impacted upon their regular duties and many more worried enough about leakage to put themselves at risk for dehydration. The authors studied whether behavioural intervention techniques useful for older people helped younger soldiers. METHODS: 39 women soldiers who reported exercise-induced urinary incontinence were assessed for bladder capacity, urethral closure pressure, detrusor contraction pressure and completed a symptom questionnaire prior to and following therapy. The women were stratified by diagnosis of physical stress incontinence or mixed urge/stress incontinence and randomised into two groups. Group 1 (n=23) performed pelvic muscle exercises with urethral biofeedback for 8 weeks Group 2 (n=16) performed pelvic muscle exercises alone. RESULTS: All participants improved significantly, as indicated both from patient reports and post-treatment examinations. Only five women in the biofeedback/exercise and three women in the exercise-only group needed further treatment. All women with detrusor dysfunction at the beginning of the study had normal readings at study completion. CONCLUSIONS: Behavioural treatments, including exercise and biofeedback, are effective for exercise-induced urinary incontinence in female soldiers.
Sherman RA et al. Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Mil Med 162(10): 690-4. Oct 1997.

McGRADY and colleagues, Department of Psychiatry, Medical College of Ohio, Toledo 43699-0008 USA studied the use of psychophysiological approaches in the treatment of fainting. METHODS: 10 patients with histories of recurrent unexplained fainting or near fainting, headache and poor response to or tolerance for drugs were treated with electromyographic, thermal, biofeedback as well as progressive and autogenic relaxation. RESULTS: 6 of the 10 patients experienced a major decrease in symptoms at the end of treatment. Descriptive comparisons between the improved and unimproved group were made and the authors present a detailed case study of one improved patient. The biofeedback-assisted relaxation treatment appeared to be most effective in younger patients whose fainting was associated with a strong psychophysiological response and whose headaches were intermittent, rather than daily occurrences. CONCLUSIONS: Biofeedback and relaxation is effective in treating fainting and headache in certain patients.
McGrady AV et al. Outcome of biofeedback-assisted relaxation for neurocardiogenic syncope and headache: a clinical replication series. Appl Psychophysiol Biofeedback. 22(1): 63-72. Mar 1997.

LEHRER and colleagues, UMDNJ-RW Johnson Medical School, Piscataway NJ 08854 USA studied the use of different biofeedback techniques in asthmatic adults. METHODS: Biofeedback to increase respiratory sinus arrhythmia (RSA) was compared with EMG and incentive inspirometry biofeedback. Patients were assigned to one of three groups: 1) Waiting List Control (n=5) 2) RSA Biofeedback (n-6) and 3) EMG biofeedback (n=6). Six training sessions were provided to each of the biofeedback groups. For each of the three testing sessions, 5 min respiratory resistance and EKG were obtained prior to and following a 20-min biofeedback session. Additional 5 min epochs of data were gathered at the beginning and end of the biofeedback period, or in the control group, self relaxation. RESULTS: There were decreases in respiratory impedance were seen only in the RSA biofeedback group, with Traub-Hering-Mayer (THM) waves increasing significantly in amplitude. The participants did not report significantly more relaxation during EMG or RSA biofeedback compared to the control condition. However decreases in pulmonary impedance across groups were associated with increases in relaxation. CONCLUSIONS: These results are consistent with Vaschillo's theory that RSA biofeedback exercises homoeostatic autonomic reflex mechanisms by increasing the amplitude of cardiac oscillations however, deep breathing during RSA biofeedback may be an alternate explanation.
Lehrer P et al. Respiratory sinus arrhythmia versus neck/trapezium EMG and incentive inspirometry biofeedback for asthma: a pilot study. Appl Psychophysiol Biofeedback. 22(2): 95-109. Jun 1997.