Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting

Six children were provided with long-term biofeedback and academic treatment for attention deficit disorders. Their symptoms were primarily specific learning disabilities, and, in some cases, there were varying degrees of hyperkinesis. The training consisted of two sessions per week for 10 to 27 months, with a gradual phase-out. Feedback was provided for either increasing 12-to 15-Hz SMR or 16- to 20-Hz beta activity. Inhibit circuits were employed for blocking the SMR or beta when either gross movement, excessive EMG, or theta (4–8 Hz) activity was present. Treatment also consisted of combining the biofeedback with academic training, including reading, arithmetic, and spatial tasks to improve their attention. All children increased SMR or beta and decreased slow EEG and EMG activity. Changes could be seen in their power spectra after training in terms of increased beta and decreased slow activity. All six children demonstrated considerable improvement in their schoolwork in terms of grades or achievement test scores. None of the children are currently on any medications for hyperkinetic behavior. The results indicate that EEG biofeedback training, if applied comprehensively, can be highly effective in helping to remediate children who are experiencing attention deficit disorders.The authors would like to thank Mr. Kevin Bianchini for his assistance in this study.     

Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting

Six children were provided with long-term biofeedback and academic treatment for attention deficit disorders. Their symptoms were primarily specific learning disabilities, and, in some cases, there were varying degrees of hyperkinesis. The training consisted of two sessions per week for 10 to 27 months, with a gradual phase-out. Feedback was provided for either increasing 12- to 15-Hz SMR or 16- to 20-Hz beta activity. Inhibit circuits were employed for blocking the SMR or beta when either gross movement, excessive EMG, or theta (4-8 Hz) activity was present. Treatment also consisted of combining the biofeedback with academic training, including reading, arithmetic, and spatial tasks to improve their attention. All children increased SMR or beta and decreased slow EEG and EMG activity. Changes could be seen in their power spectra after training in terms of increased beta and decreased slow activity. All six children demonstrated considerable improvement in their schoolwork in terms of grades or achievement test scores. None of the children are currently on any medications for hyperkinetic behavior. The results indicate that EEG biofeedback training, if applied comprehensively, can be highly effective in helping to remediate children who are experiencing attention deficit disorders.     

Frontal EMG-biofeedback training of athetoid cerebral palsy patients

Six athetoid cerebral palsy patients participated in the following: speech and motor prebiofeedback training evaluation; frontal EMG biofeedback training, 6 wk; speech and motor postbiofeedback training evaluation, Frontal pretraining levels for the subjects averaged 28.9 µV p-p. Subjects' feedback consisted of an auditory signal(clicks) varying proportionately with frontal EMG activity. A visual meter display of the integrated EMG was also provided. Self-regulation of frontal EMG was evident for all subjects within session 1. Throughout all sessions, EMG levels of 2–4 µV were often attained. Trend analysis of EMG acquisition curves showed significant reduction in frontal tension across sessions for all but one subject. Frontal posttraining levels averaged 13.0 µV p-p. Parents or subjects, or both, reported subtle improvements in various speech and motor functions, a finding confirmed by objective postbiofeedback training evaluation. Only the 2 most severely impaired subjects, JA and DS, failed to improve significantly on the speech measures. All subjects improved significantly on those measures that tapped fine and gross motor skills. Collectively, these results indicate that EMG biofeedback training shows promise as an additional treatment modality in the habilitation of cerebral palsy patients.     

Operant conditioning of EEG rhythms and ritalin in the treatment of hyperkinesis

Enhanced voluntary motor inhibition regularly accompanies conditioned increases in the sensorimotor rhythm (SMR), a 12–14-Hz Rolandic EEG rhythm in cats. A similar rhythm, presumably SMR, has also been identified in the human EEG. The clinical effectiveness of SMR operant conditioning has been claimed for epilepsy, insomnia, and hyperkinesis concurrent with seizure disorders. The present report attempts to follow up and replicate preliminary findings that suggested the technique's successful application to hyperkinesis uncomplicated by a history of epilepsy. SMR was defined as 12–14-Hz EEG activity in the absence of high-voltage slow-wave activity between 4 and 7 Hz. Anticipated treatment effects were indexed by systematic behavioral assessments of undirected motor activity and short attention span in the classroom. EEG and behavioral indices were monitored in four hyperkinetic children under the following six conditions: (1) No Drug, (2) Drug Only, (3) Drug and SMR Training I, (4) Drug and SMR Reversal Training, (5) Drug and SMR Training II, (6) No Drug and SMR Training. All hyperkinetic subjects were maintained on a constant drug regimen throughout the phases employing chemotherapy. Contingent increases and decreases in SMR occurred in three of four training subjects and were associated with similar changes in classroom assessments of motor inactivity. Combining medication and SMR training resulted in substantial improvements that exceeded the effects of drugs alone and were sustained with SMR training after medication was withdrawn. In contrast, these physiological and behavioral changes were absent in one highly distractible subject who failed to acquire the SMR task. Finally, pretraining levels of SMR accurately reflected both the severity of original motor deficits and the susceptibility of hyperkinetic subjects to both treatments. Although the procedure clearly reduced hyperkinetic behavior, a salient, specific therapeutic factor could not be identified due to the dual EEG contingency imposed combined with associated changes in EMG. Despite these and other qualifying factors, the findings suggested the prognostic and diagnostic value of the SMR in the disorder when overactivity rather than distractibility is the predominant behavioral deficit.     

EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR)

Reduced seizure incidence coupled with voluntary motor inhibition accompanied conditioned increases in the sensorimotor rhythm(SMR), a 12–14 Hz rhythm appearing over rolandic cortex. Although SMR biofeedback training has been successfully applied to various forms of epilepsy in humans, its potential use in decreasing hyperactivity has been limited to a few cases in which a seizure history was also a significant feature. The present study represents a first attempt to explore the technique's applicability to the problem of hyperkinesis independent of the epilepsy issue. The results of several months of EEG biofeedback training in a hyperkinetic child tend to corroborate and extend previous findings. Feedback presentations for SMR were contingent on the production of 12–14-Hz activity in the absence of 4–7-Hz slow-wave activity. A substantial increase in SMR occurred with progressive SMR training and was associated with enhanced motor inhibition, as gauged by laboratory measures of muscular tone(chin EMG) and by a global behavioral assessment in the classroom. Opposite trends in motor inhibition occurred when the training procedure was reversed and feedback presentations were contingent on the production of 4–7 Hz in the absence of 12–14-Hz activity. Although the preliminary nature of these results is stressed, the subject population has recently been increased to establish the validity and generality of the findings and will include the use of SMR biofeedback training after medication has been withdrawn.This research was a segment of the junior author's dissertation research.     

Ten-year stability of EEG biofeedback results for a hyperactive boy who failed fourth grade perceptually impaired class

Ten years ago, the first successful application of a clinical,private-practice based, EEG 14-Hz biofeedback training regimen for the treatment of learning disorders was performed by the author. After the 10-year-old boy, with presenting symptomology including a developmental reading disorder, hyperactivity, and an educational classification of perceptually impaired, continued symptom free for a period oftwo years, his case was submitted for publication. Ten years after his termination from successful treatment, his ongoingly normal social and academic functioning is noted and his EEG brainwave signature examined and compared with a population of 24 used-to-be learning disabled, one-half of which had a pretreatment state including the educational classification of perceptually impaired. This 10-year follow-up confirms the long-term stability of the results of this EEG 14-Hz biofeedback regimen. Current findings on recent medical research identifying a major cerebral locus of dysfunction for hyperkinesis and how it supports the electrode placements of this clinical office setting regimen is also discussed.     

Operant conditioning of EEG rhythms and ritalin in the treatment of hyperkinesis

Enhanced voluntary motor inhibition regularly accompanies conditioned increases in the sensorimotor rhythm (SMR), a 12--14-Hz Rolandic EEG rhythm in cats.A similar rhythm, presumably SMR, has also been identified in the human EEG. The clinical effectiveness of SMR operant conditioning has been claimed for epilepsy, insomnia, and hyperkinesis concurrent with seizure disorders. The present report attempts to follow up and replicate preliminary findings that suggested the technique's successful application to hyperkinesis uncomplicated by a history of epilepsy. SMR was defined as 12--14-Hz EEG activity in the absence of high-voltage slow-wave activity between 4 and 7 Hz. Anticipated treatment effects were indexed by systematic behavioral assessments of undirected motor activity and short attention span in the classroom. EEG and behavioral indices were monitored in four hyperkinetic children under the following six conditions: (1) No Drug, (2) Drug Only, (3) Drug and SMR Training I, (4) Drug and SMR Reversal Training, (5) Drug and SMR Training II, (6) No Drug and SMR Training. All hyperkinetic subjects were maintained on a constant drug regimen throughout the phases employing chemotherapy. Contingent increases and decreases in SMR occurred in three of four training subjects and were associated with similar changes in classroom assessments of motor inactivity. Combining medication and SMR training resulted in substantial improvements that exceeded the effects of drugs alone and were sustained with SMR training after medication was withdrawn. In contrast, these physiological and behavioral changes were absent in one highly distractible subject who failed to acquire the SMR task. Finally, pretraining levels of SMR accurately reflected both the seve-ity of original motor deficits and the susceptibility of hyperkinetic subjects to both treatments. Although the procedure clearly reduced hyperkinetic behavior, a salient, specific therapeutic factor could not be identified due to the dual EEG contingency imposed combined with associated changes in EMG. Despite these and other qualifying factors, the findings suggested the prognostic and diagnostic value of the SMR in the disorder when overactivity rather than distractibility is the predominant behavioral deficit.     

Muscle control in chronic tic disorders

EMG was recorded in nine subjects suffering from chronic tic disorder. Six subjects suffered asymmetrical tics and three had symmetrical tics. EMG in tic-affected and contralateral nonaffected sites was recorded at rest, during a baseline period, and at postbiofeedback training. All subjects received 2–4 biofeedback training sessions aimed at enhancing their ability to control levels of muscle contraction in both affected and nonaffected sites. All nine subjects met the criterion of discriminating unaided between levels of 0, 25%, 50%, and 75% of their fullest contraction. Five of the six people with asymmetrical tics showed lower resting EMG on the affected side at baseline, but EMG significantly increased in tic-affected but not nonaffected muscles after exercises aimed at enhancing muscle control. Six subjects reported a clinically significant 40% decrease in tic frequency. The reflexlike quality of tic muscles can be modified by biofeedback training, and this constitutes a useful and relatively quickly acquired aid to tic management.     

The Raynaud's Treatment Study: Biofeedback Protocols and Acquisition of Temperature Biofeedback Skills

The Raynaud's Treatment Study (RTS) compared temperature biofeedback training and a behavioral control procedure (frontalis EMG biofeedback) with nifedipine-XL and a medication placebo for treatment of primary Raynaud's phenomenon (RP) in a large (N = 313) multicenter trial. The present study describes the RTS biofeedback protocols and presents data on the acquisition of digital skin temperature and frontalis EMG responses in the RTS. The findings point to substantial problems with acquisition of physiological self-regulation skills in the RTS. Only 34.6% of the Temperature Biofeedback group (N = 81) and 55.4% of the EMG Biofeedback group (N = 74) successfully learned the desired physiological response. In contrast, 67.4% of a Normal Temperature Biofeedback group (N = 46) learned hand warming. Multivariate analysis found that coping strategies, anxiety, gender, and clinic site predicted acquisition of hand-warming skills whereas variables related to RP disease severity did not. Physiological data showed vasoconstriction in response to the onset of biofeedback and also found that performance in the initial sessions was critical for successful acquisition. These findings indicate that attention to the emotional and cognitive aspects of biofeedback training, and a degree of success in the initial biofeedback sessions, are important for acquisition.     

Generalization of EMG biofeedback training

Five young adults received audio biofeedback training to reduce trapezius EMG levels while they engaged in reading in an office, seated at a table. A multiple-baseline-across subjects design was employed in two separate studies. After training, all subjects demonstrated reduced EMG levels while reading in a home or library setting. The first study suggested that subjects reduced EMG levels by minimizing movements and altering their postures; the second study systematically demonstrated changes in such behavior, which was correlated with EMG levels. The data provide evidence that EMG biofeedback resulted in response generalization across several motoric classes, and in stimulus generalization from the training setting to the natural environment. The importance of assessing generalization is discussed.     

Generalization of EMG biofeedback training

Five young adults received audio biofeedback training to reduce trapezius EMG levels while they engaged in reading in an office, seated at a table. A multiple-baseline-across subjects design was employed in two separate studies. After training, all subjects demonstrated reduced EMG levels while reading in a home or library setting. The first study suggested that subjects reduced EMG levels by minimizing movements and altering their postures; the second study systematically demonstrated changes in such behavior, which was correlated with EMG levels. The data provide evidence that EMG biofeedback resulted in response generalization across several motoric classes, and in stimulus generalization from the training setting to the natural environment. The importance of assessing generalization is discussed.     

Variations in digital temperature during frontal EMG biofeedback training in normal subjects

During frontal EMG biofeedback training, the relationship between frontal EMG and digital skin temperature was investigated in two experiments, which varied the number of baseline and feedback sessions. The results of Experiment 1 suggested a general relaxation effect, where digital temperature increased as frontal EMG decreased, especially for subjects with initially low hand temperature. Experiment 2 extended the number of baseline and feedback sessions and qualified the results of Experiment 1. EMG and digital temperature did not simultaneously converge toward general relaxation over the extended baseline or feedback sessions in Experiment 2. Furthermore, when the feedback signal was introduced, digital temperature dropped quickly but recovered to baseline levels within three feedback sessions; this drop in digital temperature was interpreted within the context of attentional demands of the biofeedback task. The results appeared consistent with the view that frontal biofeedback training teaches a discriminative skill of lower frontal EMG, and that this skill does not readily generalize to digital skin temperature.This research was supported by Grant 2 S06RR08038-17 funded by the National Institutes of Mental Health.     

EMG biofeedback treatment of torticollis: A controlled outcome study

Successful treatment of torticollis with electromyographic (EMG) biofeedback has been reported in a number of single case and single group studies. The present investigation represents the first controlled outcome study. Twelve torticollis patients were randomly assigned to EMG biofeedback or relaxation training and graded neck exercises (RGP). The procedure involved three sessions of baseline assessment, 15 sessions of EMG BF or RGP, 6 sessions of EMG BF or RGP plus home-management, 6 sessions of home-management alone, and follow-up 3 months after the end of treatment. A variety of outcome measures were used including physiological (EMG from the two sternocleidomastoid muscles, skin conductance level), behavioral (angle of head deviation, range of movement of the head), and self-report (depression, functional disability, body concept), therapist and significant other reports and independent observer assessment of videos. In both groups, neck muscle activity was reduced from pre- to posttreatment. This reduction was greater in the EMG biofeedback group. There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group. Therefore, the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects. Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of arousal. Significant improvements of extent of head deviation, and range of movement of the head, as well as reductions of depression were present, which were not different in the two groups. At the end of treatment, no patient was asymptomatic. Any therapeutic benefit was generally maintained at follow-up. The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one. Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger samples are required.This work was funded by grants from the Medical Research Council and the Dystonia Society.     

Concordance among self-regulated responses: Is self-regulatory ability a psychophysiological “trait”?

The purposes of this study were to examine whether or not self-regulation of physiological responses demonstrates day-to-day reliability, to determine the degree of individual subject consistency (or concordance) in the ability to self-regulate across several different physiological responses, and, finally, to explore the impact of biofeedback training on interresponse concordance. Twenty normal subjects participated in six bidirectional self-regulation sessions—the first and last sessions involving instructions only, and the remainder, biofeedback. Self-regulation scores consisted of the absolute difference between increase and decrease trial means. The average test-retest reliability coefficients (r _s) for the self-regulation scores, across the four biofeedback sessions, were a highly significant .50, .68, .30, and .47 for EEG, EMG, HR, and SCL, respectively. By contrast, the average concordance among the self-regulation scores for the four feedback sessions, estimated by Kendall's coefficient of concordance, was a marginally significant 39% of the possible variance of the rank sums. This corresponds to an average between-responser _s value only of .19. The concordance level from the initial no-feedback (i.e., instructions only) session was not significant. Multivariate concordance levels did increase during the first three feedback sessions, but declined at the fourth, and again was nonsignificant during the final no-feedback session. Among the individual self-regulation response pairings, only the EEG/EMG combination was consistently associated during the no-feedback sessions. The present results suggest that self-regulatory ability is neither a highly unitary “trait”-like phenomenon nor an entirely response-specific event, but may vary considerably as a function of subject factors, or the situational circumstances, under which it is measured.     

An educational format for teaching stress management to groups with a wide range of stress symptoms

In view of the pervasiveness of stress reactions in contemporary society, together with the limited availability of effective coping techniques, the authors attempted to develop a stress management program that combined education on the nature of stress disorders with instruction on several practical procedures useful in coping with stress. Our study used a general population drawn from a small rural university community. There were 38 subjects, 17 male and 21 female, in the final statistical analyses. One independent variable was a lecture-discussion format to present cognitive and relaxation skills. A second independent variable was biofeedback training to decrease frontal EMG activity. The subjects were divided into five treatment groups that consisted of one or some combination of these two treatment conditions. Dependent variables were the two scales—A-State and A-Trait—of Spielberger's STAI(Spielberger, Gorsuch, & Lushene, 1970) and an adaptive application of Kerle and Bialek's(1958) Subjective Stress Scale(SSS). The SSS served as an instrument to keep subjects aware of their physical and psychological responses to stress as well as providing a pre/post measure of reactions to stress as they experienced it. Results indicated that the lecture-discussion format was effective in reducing the subjects' level of stress as measured by the State-Trait Anxiety Inventory and the Subjective Stress Scale. There was no evidence that frontal EMG feedback relaxation training contributed to the reduction of stress.     

Predictors of success in the EMG biofeedback training of hyperactive male children

EMG biofeedback training is continuing to evolve as a promising treatment of hyperactivity. But while research on its application suggests that this technique induces significantly lower EMG levels in experimental samples as a whole, it also discloses that some children evidence but limited reductions. Most likely, this variability is introduced by differences in subject attributes. This study assessed that prospect by examining whether four common subject characteristics correlated with the extent of decrease in EMG level achieved by 59 hyperactive school-aged boys. Those variables were pretreatment EMG level, age degree of hyperactivity, and locus of control. Number of applications or training sessions was included as the fifth predictor. A multiple regression analysis determined that only locus of control was predictive of success in EMG training; however, it accounted for 72% of the variance Implications of these findings are discussed.     

Effectiveness of multiple-site EMG biofeedback in the reduction of arousal

During the training phase, 36 subjects received (a) EMG biofeedback from multiple muscle sites, (b) EMG biofeedback from the frontal site, or (c) no biofeedback. Results indicated that neither biofeedback procedure reduced self-reports of anxiety, but that multiple-site biofeedback was effective in reducing several indices of autonomic arousal (pulse rate, finger pulse volume, and skin temperature) while frontal biofeedback was not. During the generalization/stress phase, all subjects were threatened with and received electric shocks and were told to apply the relaxation techniques they learned during the training phase even though no additional biofeedback would be provided. Results indicated that multiple-site biofeedback was effective in reducing self-reports of anxiety and autonomic arousal but that frontal biofeedback was not. These results confirm previous data indicating that frontal biofeedback is not an effective procedure for controlling stress, but suggest that EMG biofeedback can be effective in reducing self-reported anxiety and autonomic arousal if a multiple muscle-site feedback procedure is employed.     

Effects of alternative control procedures for electromyographic biofeedback relaxation training

Twenty-four college students participated in a single session of electromyographic (EMG) biofeedback in a comparison of three experimental control procedures commonly employed in biofeedback relaxation training research. One group received contingent EMG biofeedback from the forehead area, and each subject in this group served as his or her own control. Subjects in a second group received noncontingent EMG feedback from a tape recorder but were instructed to use the feedback signal to relax their forehead muscles (single blind). Subjects in a third group received the same auditory feedback as those in the second group but were not told the purpose or source of the feedback stimulus (yoked control). The contingent feedback group showed significantly less EMG activity when compared to the other two groups. However, this group did not exhibit significant EMG level decrements from the beginning to end of the session. This seemingly contradictory finding may have been due to statistically capitalizing on the artifactually high EMG level of the experimental and control groups, although the single-blind and yoked-control groups showed nonsignificant increases across the session. The single-blind group's data had a variance several times larger than the other two groups' variance. Findings are discussed with respect to a probing hypothesis as opposed to the previously offered frustration hypothesis. Of the three control procedures, the data suggest the yoked control as the procedure of choice for EMG biofeedback relaxation research.The authors would like to thank David Kazar and Claudia Coleman for their technical assistance with this article.