The use of EMG feedback and progressive relaxation in the treatment of a woman with chronic back pain

In this systematic single-case study, a 71-year-old white female with chronic back pain and paravertebral muscle spasm was treated with 17 sessions of electromyographic (EMG) feedback, with recording site just below the right inferior scapular angle. Progressive relaxation practice was also employed. EMG level was monitored during baseline, treatment, and follow-up phases. Backaches were recorded by the subject on a daily basis. There was a marked decrease in both EMG level and frequency of backaches, as well as an increase in activities at home. Improvement was maintained 12 weeks after the last treatment session.     

The use of EMG feedback and progressive relaxation in the treatment of a woman with chronic back pain.

In this systematic single-case study, a 71-year-old white female with chronic back pain and paravertebral muscle spasm was treated with 17 sessions of electromyographic (EMG) feedback, with recording site just below the right inferior scapular angle. Progressive relaxation practice was also employed. EMG level was monitored during baseline, treatment, and follow-up phases. Backaches were recorded by the subject on a daily basis. There was a marked decrease in both EMG level and frequency of backaches, as well as an increase in activities at home. Improvement was maintained 12 weeks after the last treatment session.     

Simultaneous biofeedback of heart rate and frontal EMG as a pretraining for the control of EEG theta activity

Following one base-line session, 20 normal subjects received four half hour sessions consisting of simultaneous feedback of heart rate and frontalis muscle (pretraining). Ten subjects received contingent (CF), the other ten noncontingent feedback (NCF). Subjects were asked to lower heart rate and frontal muscle tension (EMG). Heart rate within sessions decreased up to 19 bpm, with a mean of 4 bpm for the CF group. There was only a weak decrease over sessions, however, because of the strong habituation effect. The following events accompanied the heart rate decrease: (1) an increase of the variability of the heart rate, (2) a decrease of the variance of the EMG, (3) an increased correlation between heart rate slowing and EMG decrease, and (4) an increasing subjective experience of control of heart rate and EMG. After pretraining, subjects received eight sessions of auditory feedback of their frontal EEG theta activity (four sessions with CF and four sessions with NCF in balanced order). There was a weak increase of theta for the CF condition over sessions, but a decrease within the sessions. Pretraining on heart rate and frontal EMG control had no influence on the performance during theta training. It was hypothesized that control of heart rate slowing and theta control involve different mechanisms.     

Effect of therapist's active presence on EMG biofeedback training of headache patients

Sixteen patients suffering from tension or mixed headaches participated in a frontalis EMG treatment schedule of 15 sessions where the therapist was either actively present or almost completely absent. The aim of this study was to evaluate the impact of the therapist's active presence on the subject's ability to lower the EMG level. The active presence of the therapist consistently led to higher frontalis EMG level than that during the therapist's absence. Data also show that the EMG feedback administered was apparently effective in reducing subjective headache intensity along with EMG levels. The findings raise the question of an optimal dosage of presence and activity of the therapist during EMG feedback training.     

Contingentvs. noncontingent EMG feedback and hand temperature in relation to anxiety and locus of control

This study was designed to measure the effects of contingent and noncontingent EMG feedback on hand temperature, anxiety, and locus of control. Two groups of six subjects each were selected on the basis of high test-anxiety scores. The groups participated in a reverse design study in which Group 1 received five sessions of contingent EMG feedback followed by five sessions of noncontingent feedback. Group 2 received noncontingent feedback followed by contingent feedback. Results indicate a significant order of treatment effect. Subjects who received contingent feedback first produced lower EMG readings, lower test-anxiety scores, and higher hand temperatures during noncontingent feedback sessions. Receiving noncontingent feedback first may actually have interfered with utilizing contingent feedback.     

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.     

Contingent vs. noncontingent EMG feedback and hand temperature in relation to anxiety and locus of control

This study was designed to measure the effects of contingent and noncontingent EMG feedback on hand temperature, anxiety, and locus of control. Two groups of six subjects each were selected on the basis of high test-anxiety scores. The groups participated in a reverse design study in which Group 1 received five sessions of contingent EMG ffedback followed by five sessions of noncontingent feedback. Group 2 received noncontingent feedback followed by contingent feedback. Results indicate a significant order of treatment effect. Subjects who received contingent feedback first produced lower EMG readings, lower test-anxiety scores, and higher hand temperatures during noncontingent feedback sessions. Receiving noncontingent feedback first may actually have interfered with utilizing contingent feedback.     

Low-level activity of the trunk extensor muscles causes electromyographic manifestations of fatigue in absence of decreased oxygenation

This study was designed to determine whether trunk extensor fatigue occurs during low-level activity and whether this is associated with a drop in muscle tissue oxygenation. Electromyography (EMG) feedback was used to impose constant activity in a part of the trunk extensor muscles. We hypothesized that electromyographic manifestations of fatigue and decreased oxygenation would be observed at the feedback site and that EMG activity at other sites would be more variable without fatigue manifestations. Twelve volunteers performed 30-min contractions at 2% and 5% of the maximum EMG amplitude (EMGmax) at the feedback site. EMG was recorded from six sites over the lumbar extensor muscles and near-infrared spectroscopy was used to measure changes in oxygenation at the feedback site (left L3 level, 3 cm paravertebral). In both conditions, mean EMG activity was not significantly different between electrode sites, whereas the coefficient of variation was lower at the feedback site compared to other recording sites. The EMG mean power frequency (MPF) decreased consistently at the feedback site only. At 5% EMGmax, the decrease in MPF was significant at the group level at all sites ipsilateral to the feedback site. These results suggest that the limited variability of muscle activity at the EMG feedback site and at ipsilateral locations enhances fatigue development. No decreases in tissue oxygenation were detected. In conclusion, even at mean activity levels as low as 2% EMGmax, fatigue manifestations were found in the trunk extensors. These occured in absence of changes in oxygenation of the muscle tissue.     

Evidence of long term muscle fatigue following prolonged intermittent contractions based on mechano- and electromyograms.

The focus of the present study is the long term element of muscle fatigue provoked by prolonged intermittent contractions at submaximal force levels and analysed by force, surface electromyography (EMG) and mechanomyogram (MMG). It was hypothesized that fatigue related changes in mechanical performance of the biceps muscle are more strongly reflected in low than in high force test contractions, more prominent in the MMG than in the EMG signal and less pronounced following contractions controlled by visual compared to proprioceptive feedback. Further, it was investigated if fatigue induced by 30 min intermittent contractions at 30% as well as 10% of maximal voluntary contraction (MVC) lasted more than 30 min recovery. In six male subjects the EMG and MMG were recorded from the biceps brachii muscle during three sessions with fatiguing exercise at 10% with visual feedback and at 30% MVC with visual and proprioceptive feedback. EMG, MMG, and force were evaluated during isometric test contractions at 5% and 80% MVC before prolonged contraction and after 10 and 30 min of recovery. MVC decreased significantly after the fatiguing exercise in all three sessions and was still decreased even after 30 min of recovery. In the time domain significant increases after the fatiguing exercise were found only in the 5% MVC tests and most pronounced for the MMG. No consistent changes were found for neither EMG nor MMG in the frequency domain and feedback mode did not modify the results. It is concluded that long term fatigue after intermittent contractions at low force levels can be detected even after 30 min of recovery in a low force test contraction. Since the response was most pronounced in the MMG this may be a valuable variable for detection of impairments in the excitation-contraction coupling.     

Identification and classification of involuntary leg muscle contractions in electromyographic records from individuals with spinal cord injury

Involuntary muscle contractions (spasms) are common after human spinal cord injury (SCI). Our aim was to compare how well two raters independently identified and classified different types of spasms in the same electromyographic records (EMG) using predefined rules. Muscle spasms were identified by the presence, timing and pattern of EMG recorded from paralyzed leg muscles of four subjects with chronic cervical SCI. Spasms were classified as one of five types: unit, tonic, clonus, myoclonus, mixed. In 48 h of data, both raters marked the same spasms most of the time. More variability in the total spasm count arose from differences between muscles (84%; within subjects) than differences between subjects (6.5%) or raters (2.6%). Agreement on spasm classification was high (89%). Differences in spasm count, and classification largely occurred when EMG was marked as a single spasm by one rater but split into multiple spasms by the other rater. EMG provides objective measurements of spasm number and type in contrast to the self-reported spasm counts that are often used to make clinical decisions about spasm management. Data on inter-rater agreement and discrepancies on muscle spasm analysis can both drive the design and evaluation of software to automate spasm identification and classification.     

Differential shaping of EEG theta rhythms

Heart rate, EEG, frontal EMG, and forearm EMG were recorded in 20 subjects for 3 baseline, 8 feedback, and 2 postbaseline sessions in order to compare two biofeedback methods of teaching subjects to increase theta EEG activity. Subjects were divided into high- and low-EMG groups. Five high-EMG subjects, and 5 low-EMG subjects then received 8 sessions of strictly theta feedback. The remaining 10 subjects, 5 from the high-EMG group, and 5 from the low-EMG group, received a “graduated” training which involved shaping the target response. This procedure consisted of 4 initial sessions of EMG feedback, followed by a second phase consisting of 4 sessions of theta feedback. Results showed a clear relationship between subjects' baseline frontal EMG levels and the effect of the training methods. Although subjects with high-EMG baseline increased their theta output only with the two-phase training, subjects with low-EMG baseline levels performed better when given theta feedback only. This result shows not only that amounts of theta can be reliably increased, but that training techniques should be adapted to the physiological characteristics of the individual—in this case, baseline levels of frontal EMG levels.     

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.     

The effect of frontal EMG biofeedback training on the behavior of children with activity-level problems

N=1 withdrawal designs were employed with three children evidencing activity-level problems. Tutoring sessions occurred daily over a 2 1/2-month period. Each child was reinforced for decreasing frontalis muscle tension during auditory feedback while working arithmetic problems. Feedback was faded while tension reduction reinforcement was maintained. These procedures were repeated with reinforcement for increasing, rather than decreasing, muscle tension. Frontal EMG level, percent time on task, and motoric activity rate were obtained during sessions. Parent ratings of problem behavior in the home were recorded daily. Biofeedback with reinforcement was effective in both raising and lowering muscle tension. Effects were maintained by reinforcement. Results suggest a direct relationship between tension and activity levels. Academic performance and problem behavior improved significantly with reductions in EMG activity, although individual exceptions to these findings were present. Results lend support to the efficacy of frontal EMG biofeedback training in reducing activity, increasing attention to an academic task, and reducing problem behaviors.     

EMG stability as a biofeedback control.

Factors that may confound comparisons between electromyographic (EMG) biofeedback training and its control conditions include feedback quality and experience of success. We investigated the usefulness of a control procedure designed to overcome these potential sources of confounding. The procedure consisted of training muscle tension stability. We used it as a control for frontal EMG relaxation training in children with asthma. To equate the groups for feedback quality and experience of success, we gave each child in the control condition audio feedback decreasing in pitch when muscle tension was at or near baseline levels, and feedback increasing in pitch when muscle tension was either substantially above or below baseline levels. Children in both groups were instructed to decrease the pitch of the tone. In comparison to children in the relaxation condition, the children in the control condition exhibited stable levels of muscle tension throughout eight training sessions. We concluded that feedback for stable muscle tension may be a useful control procedure for EMG biofeedback training whenever experimental and control procedures differ in either feedback quality of degree to which they permit subjects to experience success.     

EMG stability as a biofeedback control

Factors that may confound comparisons between electromyographic (EMG) biofeedback training and its control conditions include feedback quality and experience of success. We investigated the usefulness of a control procedure designed to overcome these potential sources of confounding. The procedure consisted of training muscle tension stability. We used it as a control for frontal EMG relaxation training in children with asthma. To equate the groups for feedback quality and experience of success, we gave each child in the control condition audio feedback decreasing in pitch when muscle tension was at or near baseline levels, and feedback increasing in pitch when muscle tension was either substantially above or below baseline levels. Children in both groups were instructed to decrease the pitch of the tone. In comparison to children in the relaxation condition, the children in the control condition exhibited stable levels of muscle tension throughout eight training sessions. We concluded that feedback for stable muscle tension may be a useful control procedure for EMG biofeedback training whenever experimental and control procedures differ in either feedback quality of degree to which they permit subjects to experience success.This research was supported by NIH-Grant HL 27402. We are grateful to Paul Schnitter who constructed the EMG stability feedback device.     

Reproducibility of surface EMG variables in isometric sub-maximal contractions of jaw elevator muscles.

The aims of this study were: (1) to develop and assess reproducibility of a new method for measuring masticatory force in the intercuspal position; (2) to test the reproducibility of surface EMG signal amplitude and spectral variables in constant force contractions of jaw elevator muscles and its dependency on inter-electrode distance. The study was performed on the masseter and temporalis anterior muscles of both sides of nine healthy volunteers. An intraoral compressive-force sensor was used to measure maximal voluntary contraction forces in the intercuspal position and to provide a visual feedback on sub-maximal forces to the subject. Three experimental sessions were performed in three days. In each session, three isometric contractions at 80% of the maximal force were sustained by the subjects for 30s. The intra-class correlation coefficient (ICC) of the maximal force measure was 71.9%. ICC of average rectified value and mean power spectral frequency of the EMG signal increased with inter-electrode distance, with values larger than 70% with 30 mm inter-electrode distance. It was concluded that surface EMG variables measured in isometric contractions of the jaw elevator muscles with the proposed force recording system show good reproducibility for clinical applications when a 30 mm inter-electrode distance is considered.     

Biofeedback training in frontalis muscle relaxation and enhancement of belief in personal control

The hypothesis that biofeedback training in frontalis muscle relaxation increases beliefs in internal (personal) locus of control was tested. Subjects were divided into two groups (internals and externals) based on Mirels' (1970) factor analyzedpersonal control subscale of Rotter's (1966) I-E Scale. Internal and external subjects were assigned randomly to one of three conditions: biofeedback (BF), false feedback (FF), or no feedback (NF). All subjects were measured on frontalis electromyographic (EMG) activity. Training consisted of three sessions spaced 1 week apart. Each session was comprised of a 5-minute baseline (nonfeedback) trial followed by a 20-minute experimental session. After each experimental session, subjects completed a questionnaire which assessed the extent to which they attributed their EMG performance to personal and environmental sources. After three sessions, subjects were posttested on the I-E Scale. Results indicated that subjects receiving BF reduced their EMG activity more than did subjects in either the FF or NF conditions, and this effect was maintained across all three sessions. Subjects who received BF shifted toward internal personal locus of control from pre- to posttesting, whereas no such change was found for either FF or NF subjects. Also, the relationship between BF training and change in personal locus of control was mediated by subjects attributing their EMG reduction more to personal effort than to properties of the task. Results are discussed in terms of the importance of contingent feedback as a determinant of cognitions of control.     

Neuromuscular fatigue differs with biofeedback type when performing a submaximal contraction.

The aim of the study was to examine alterations in contractile and neural processes in response to an isometric fatiguing contraction performed with EMG feedback (constant-EMG task) when exerting 40% of maximal voluntary contraction (MVC) torque with the knee extensor muscles. A task with a torque feedback (constant-torque task) set at a similar intensity served as a reference task. Thirteen men (26+/-5 yr) attended two experimental sessions that were randomized across days. Endurance time was greater for the constant-EMG task compared with the constant-torque task (230+/-156 s vs. 101+/-32s, P<0.01). Average EMG activity for the knee extensor muscles increased from 33.5+/-4.5% to 54.7+/-21.7% MVC EMG during the constant-torque task (P<0.001), whereas the torque exerted during the constant-EMG task decreased from 42.8+/-3.0% to 17.9+/-5.6% MVC torque (P<0.001). Comparable reductions in knee extensors MVC (-15.7+/-8.7% for the constant-torque task vs. -17.5+/-9.8% for the constant-EMG task, P>0.05) and voluntary activation level were observed at exhaustion. In contrast, excitation-contraction coupling process, assessed with an electrically evoked twitch and doublet, was altered significantly more at the end of the constant-EMG task despite the absence of M-wave changes for both tasks. Present results suggest that prolonged contractions using EMG biofeedback should be used cautiously in rehabilitation programs.     

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.     

A comparison of direct blood pressure feedback and electromyographic feedback on the blood pressure of normotensives

Groups of 20 normotensive subjects were assigned to one of three conditions to help them lower their blood pressure: (1) intermittent visual feedback of blood pressure; (2) continuous analogue auditory feedback of frontal EMG; (3) an instructed, no-feedback condition. Both groups receiving feedback showed greater within-session lowering of systolic blood pressure than the no-feedback control group. Although the group receiving intermittent visual feedback of blood pressure lowered blood pressure more than the EMG feedback group at the first session, in three subsequent sessions, the two feedback groups did not differ.