For many years it has been an axiom among practitioners of heart rate variability biofeedback that heart rate and breathing vary in phase with each other when people do resonance frequency breathing. ...When people breathe at the frequency of the baroreflex system, about 0.1 Hz, heart rate and blood pressure have been found to oscillate 180° out of phase, while heart rate and breathing are in phase (zero-degree phase). Thus breathing stimulates the baroreflex by augmenting the baroreflex response with each breath, an effect that is magnified by resonance properties in the baroreflex system. The original data on these relationships came from a study of highly athletic healthy young people. To test this relationship we analyzed phase relationship data between cardiac interbeat interval and breathing during 5-min periods of resonance frequency breathing among 24 adults from a recent study of heart rate variability biofeedback to treat adults with mild to moderate currently symptomatic asthma, ages between 18 and 70. For the specific frequency near 0.1 Hz with the highest amplitude of HRV we calculated coherence and phase between cardiac interbeat interval (IBI) and the respiration curve using the WinCPRS program. Among records with coherence > 0.8, we found a phase relationship of 109° rather than the expected 180°, with IBI changes leading breathing. We computed Spearman correlation coefficients between phase and various subject characteristics, including age, gender, height, and asthma severity. We found no relationship between phase and gender, height, or asthma physiology or symptoms. However, when controlled for gender and height, we found a moderate size significant correlation between phase and age, with younger participants having values closer to 180°,
r
= 0.47,
p
< 0.03. It is possible that cardiovascular characteristics of older people affect the phase relationship. Despite the deviation from the in-phase relationship among older individuals, breathing nevertheless stimulated the baroreflex and produced high-amplitude heart rate oscillations. Implications are discussed for HRV biofeedback training protocols. Replication in a healthy population is needed in order to determine the universality of these findings.
Some evidence suggests that heart rate variability (HRV) biofeedback might be an effective way to treat anxiety and stress symptoms. To examine the effect of HRV biofeedback on symptoms of anxiety ...and stress, we conducted a meta-analysis of studies extracted from PubMed, PsycINFO and the Cochrane Library.
The search identified 24 studies totaling 484 participants who received HRV biofeedback training for stress and anxiety. We conducted a random-effects meta-analysis.
The pre-post within-group effect size (Hedges' g) was 0.81. The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. Moderator analyses revealed that treatment efficacy was not moderated by study year, risk of study bias, percentage of females, number of sessions, or presence of an anxiety disorder.
HRV biofeedback training is associated with a large reduction in self-reported stress and anxiety. Although more well-controlled studies are needed, this intervention offers a promising approach for treating stress and anxiety with wearable devices.
This paper describes the conceptual design of a virtual reality-based stress management training tool and evaluation of the initial prototype in a pilot efficacy study. Performance Edge ...virtual-reality (VR) was co-developed with the Australian Defence Force (ADF) to address the need for practical stress management training for ADF personnel. The VR application is biofeedback-enabled and contains key stress management techniques derived from acceptance and commitment and cognitive behavioural therapy in a modular framework. End-user-provided feedback on usability, design, and user experience was positive, and particularly complimentary of the respiratory biofeedback functionality. Training of controlled breathing delivered across 3 sessions increased participants' self-reported use of breath control in everyday life and progressively improved controlled breathing skills (objectively assessed as a reduction in breathing rate and variability). Thus the data show that a biofeedback-enabled controlled breathing protocol delivered through Performance Edge VR can produce both behaviour change and objective improvement in breathing metrics. These results confirm the validity of Performance Edge VR platform, and its Controlled Breathing module, as a novel approach to tailoring VR-based applications to train stress management skills in a workplace setting.
Weit verbreitet, aber oft verschwiegen, stellt Harninkontinenz besonders im höheren Alter ein Problem für Männer und Frauen dar. Nach wie vor gilt dagegen, dass die Art und Menge der ...Flüssigkeitsaufnahme überprüft und gegebenenfalls modifiziert werden soll. Laser als Option Wenn konservative Verfahren wie Beckenbodentraining sowie medikamentöse Behandlungen, vor allem mit Antimuskarinika, keinen befriedigenden Erfolg bringen, kommen operative Verfahren in Betracht.
Background
To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for ...patients who underwent primary surgery +/− adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine‐enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after “standard‐of‐care” SOC rehabilitation.
Method
Pilot prospective 8‐week (TEBER) program following 8 weeks of (SOC) rehabilitation.
Results
Twenty‐seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, “range‐of‐liquids” improved by +0.36 95% CI, 0.02–0.70, p = 0.05 and “range‐of‐solids” improved by +0.73 95% CI, 0.12–1.34, p = 0.03. There was a positive trend toward better oral cavity obliteration; residual volume decreased by −1.2 95% CI, −2.45 to 0.053, p = 0.06, and “nutritional‐mode” increased by +0.55 95% CI, −0.15 to 1.24, p = 0.08.
Conclusion
This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion.
We assessed the feasibility of using a consumer friendly, heart rate variability biofeedback (HRVB) wearable device in conjunction with a remote stress management coach to reduce symptoms of anxiety. ...We utilized a discreet, continuously wearable electrocardiogram device, the Lief Smart Patch, which measures and records heart rate and HRV in real time, and guides HRVB exercises using vibrations and visual cues. During the 8-week study, participants (
N
= 14) wore the Lief Smart Patch, participated in HRVB with the device, utilized the mobile app, and communicated with a remote stress management coach. We collected self-report survey responses to measure symptoms of anxiety (GAD-2) and depression (PHQ-2) every 2 weeks, as well as HRV data throughout the study. Participants’ mean GAD-2 score began at 4.6 out of 6. By the trial’s completion, the group’s mean GAD-2 score dropped to 1.7 (t
(13)
= 11.0,
p
< .001) with only 2 of the 14 subjects remaining over the clinical threshold of high anxiety. Similarly, the group’s mean PHQ-2 score dropped from 2.93 to 1.29 (t
(13)
= 3.54,
p
< .01). In addition, participants increased their HRV (RMSSD) by an average of + 11.4 ms after participating in a low dose biofeedback exercise. These findings suggest that engaging in HRVB through a discreet wearable device in conjunction with a remote stress management program may be effective for reducing symptoms of anxiety and depression.
The adjunctive use of biofeedback systems with exoskeletons may accelerate post-stroke gait rehabilitation. Wearable patient-oriented human-robot interaction-based biofeedback is proposed to improve ...patient-exoskeleton compliance regarding the interaction torque's direction (joint motion strategy) and magnitude (user participation strategy) through auditory and vibrotactile cues during assisted gait training, respectively. Parallel physiotherapist-oriented strategies are also proposed such that physiotherapists can follow in real-time a patient's motor performance towards effective involvement during training. A preliminary pre-post controlled study was conducted with eight healthy participants to conclude about the biofeedback's efficacy during gait training driven by an ankle-foot exoskeleton and guided by a technical person. For the study group, performance related to the interaction torque's direction increased during (
-value = 0.07) and after (
-value = 0.07) joint motion training. Further, the performance regarding the interaction torque's magnitude significantly increased during (
-value = 0.03) and after (
-value = 68.59×10
) user participation training. The experimental group and a technical person reported promising usability of the biofeedback and highlighted the importance of the timely cues from physiotherapist-oriented strategies. Less significant improvements in patient-exoskeleton compliance were observed in the control group. The overall findings suggest that the proposed biofeedback was able to improve the participant-exoskeleton compliance by enhancing human-robot interaction; thus, it may be a powerful tool to accelerate post-stroke ankle-foot deformity recovery.
Introduction: In the United States, over 8% of adults are affected by anal incontinence (AI). When therapy mainstays such fiber supplements and anti-diarrheal medications fall short for patients, ...biofeedback (BFB) therapy is a key intervention, although a universal protocol has not been established. The Rao pro-tocol for BFB is a physician-led program that consists of an active phase tailored to each patient, focusing on increasing sphincter tone and endurance, followed by refresher sessions. A solid state manometry catheter is utilized with sensors in the rectum and anal canal (instead of digital, EMG or ultrasound-based approaches). Biofeedback is performed with a rectal balloon that can be inflated to simulate stool. Methods: This is a retrospective analysis of patients enrolled in BFB for AI between 2015 to 2018 at a tertiary referral motility program. For patients that had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each AI BFB visit. 36 patients met criteria whose clinical characteristics are presented in table 1. Results: Self-reported mean global stool satisfaction on a scale of 1 (very dissatisfied) to 10 (very satisfied) showed a statistically significant increase from 3.6±2.6 at the start to 5.5±2.6 (p=0.0032) by the final visit. The mean number of AI accidents in one week was significantly reduced from 6±11 to 2±4 (p=0.0497). There were notable reductions in the number of patients using pads, stooling medications, and reporting urge AI symptoms by 20%, 32% and 19%, respectively. HR-ARM features were measured during each session and there was an improvement in endurance, defined as length of time able to maintain 50% of max squeeze pressure. With rectal balloon inflated to simulate stool, mean time (seconds) improved from 22 at session one to 24, and 29 by session three (p=0.0387). Contractile index, an integration of average squeeze over the first 10 seconds, was calculated for each BFB visit but did not show statistically significant change. Conclusion: Biofeedback with the Rao protocol in conjunction with use of HR-ARM catheters shows durable improvement in both meaningful clinical outcomes and objective endurance. The manometric data suggest gains in endurance may be predominantly responsible for the clinical benefits. We propose that the Rao protocol's endurance training be given important consideration in BFB therapy for AI.
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