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.     

Flexibility development in sprinters using EMG biofeedback and relaxation training

This study compared the effectiveness of electromyographic (EMG) biofeedback and relaxation treatment in producing flexibility increases at the hip joint. Retention of flexibility gains and changes in sprinting performance were also examined. Fifteen male and 15 female athletes, predominantly sprinters, were matched according to age, sex, and flexibility and were randomly assigned to one of three groups. The control group received only the testing, the biofeedback group received visual and auditory EMG training, and the relaxation group received modified PMR and imagery exercises. Subjects in the two experimental groups were given eight twice-weekly 10-minute sessions and then were retested for flexibility. Retention of flexibility was reassessed 2 and 4 weeks later. Sprint performance improved for all groups. EMG biofeedback and relaxation treatment methods were no more effective than stretching exercises used by the control group for improving flexibility during the treatment period, but they did produce evidence of superior flexibility gains in the retention period. This may be important as flexibility has been reported to be related to the incidence of injuries.     

Parasympathetic rebound following EMG biofeedback training: A case study

The self-regulation literature contains very few reports of negative side-effects stemming from biofeedback training. Nevertheless, the case reported here is unique in that immediately following each of several early EMG feedback sessions, an otherwise headache-free patient reported an acute attack of headache and nausea. These attacks, the conditions under which they appeared, and the conditions leading to their remission will be described. Discussion will focus on the possible physiological mechanisms involved.     

Parasympathetic rebound following EMG biofeedback training: a case study

The self-regulation literature contains very few reports of negative side-effects stemming from biofeedback training. Nevertheless, the case reported here is unique in that immediately following each of several early EMG feedback sessions, an otherwise headache-free patient reported an acute attack of headache and nausea. These attacks, the conditions under which they appeared, and the conditions leading to their remission will be described. Discussion will focus on the possible physiological mechanisms involved.     

The effectiveness of EMG biofeedback training in low back pain.

Eighteen patients with chronic low back pain (lbp) of muscle tension origin were given an EMG biofeedback training. Compared to seven controls they showed a significant decrease during training in muscle tension and subsequently in pain. However, at follow-up EMG levels dropped to the initial (high) level. Pain scores of patients with high pain decrements during training showed further improvement during follow-up, which was not the case with patients showing less substantial improvement. The importance of cognitions was discussed.     

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.     

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.     

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.     

Effectiveness of EMG biofeedback training for controlling arousal in subsequent stressful situations

Thirty-five subjects participated in (1) a pretreatment session during which arousal was measured while subjects anticipated and then viewed a stressful film; (2) four 20-min treatment sessions during which subjects received either contingent EMG biofeedback (biofeedback treatment), instructions to attend to a variable pitch tone (attention-placebo control), instructions to relax as much as possible (instructions-only control), or instructions to sit quietly (no-treatment control); and (3) a posttreatment session that was identical to the pretreatment session. Results indicate that when compared to the subjects in the control conditions, subjects who received EMG biofeedback were not effective in reducing frontalis EMG levels during treatment or while viewing the stressful film, but they were effective in reducing frontalis EMG levels while anticipating the stressful film. There was no evidence that EMG biofeedback influenced either skin conductance or self-reports of arousal.This research was supported in part by Bio-Medical and General Research Fund grants from the University of Kansas to David S. Holmes. Appreciation is due to B. Kent Houston, Edward F. Morrow, and Charles A. Hallenbeck for their contributions to the project.     

Cognitive skills training versus EMG biofeedback in the treatment of tension headaches

In an effort to study the role of cognitive skills training in the treatment of psychosomatic disorders, two single-case design experiments were conducted to assess the relative effectiveness of biofeedback procedures and cognitive coping techniques in the alleviation of tension headaches. For both subjects, biofeedback training influenced mean frontalis EMG levels, although such changes were not associated with concomitant reductions in headache activity. It was the presence or absence of cognitive skills training, however, that determined whether each subject reported changes in headache levels. These results suggest that a more efficient treatment approach for tension headaches would involve an increased emphasis on the modification of maladaptive cognitive activity. The present findings support the general view that a comprehensive approach in the treatment of stress-related disorders requires a concomitant focus on the cognitive, behavioral, and affective dimensions of the symptom. It was also suggested that biofeedback technology may be a useful tool for studying the physiological consequences of particular cognitive processes and in identifying particular cognitions with anxiety-provoking properties.     

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.     

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.     

The role of EMG awareness in EMG biofeedback learning

Underlying most research on biofeedback learning is a theoretical model of the processes involved. The current study tested a prediction from the Awareness Model: High initial EMG awareness should facilitate response control during EMG biofeedback training. Seventy-two undergraduates were assessed for forehead EMG awareness by asking them to produce target responses from 1.0 to 5.0 µV every 15 s for 16 trials. Based on this assessment, two groups (high and low awareness) were trained for 64 trials to produce these target levels with either EMG biofeedback, practice (no feedback), or noncontingent EMG feedback. A transfer task was identical to the initial assessment. During training, the biofeedback group deviated less from target than the practice and noncontingent groups. The biofeedback group was the only group to improve from initial EMG awareness activity. During transfer, only the low awareness biofeedback group remained below initial EMG awareness level. These findings can be interpreted in terms of the Two-Process Model.     

A comparison of frontal EMG biofeedback and neck EMG biofeedback in the treatment of muscle-contraction headache

EMG biofeedback from the frontal area (FFB) was compared to EMG biofeedback from the neck (NFB) in the treatment of chronic muscle-contraction headache. Both treatment groups (N=10) evidenced significant decreases in reported headache activity, with the NFB group also significantly reducing medication consumption. An analysis of EMG changes suggested that subjects were able to produce large within-session changes in EMG activity during initial sessions, with the major effect of additional training being an increase in speed with which these changes occurred. In neither group, however, did changes in EMG activity correspond closely to changes in reported headache activity.     

Effects of EMG biofeedback on diabetes

A case is described in which a juvenile-onset insulin-requiring diabetic was given frontalis EMG biofeedback. For 6 years prior to biofeedback training, the subject had been healthy and stable on 22–24 units regular insulin injected once daily. During 8 weeks of standard feedback training for relaxation of frontalis muscle activity, the subject twice reduced her daily insulin dosages. At the end of 8 weeks, the subject was receiving 17–18 units regular insulin daily but was still unstable, sometimes being hyperglycemic, sometimes hypoglycemic. Because of disturbing symptoms associated with this instability, biofeedback was discontinued for 6 months, at which time the subject was again healthy and stable on the equivalent of 18–19 units regular insulin daily. After this period, biofeedback was again given for 1 week, but the subject again became highly unstable and biofeedback was permanently stopped. Caution is suggested when dealing with diabetic patients.     

Finger pulse amplitude and frontalis EMG biofeedback effects of single- and two-system training.

The relationship between finger pulse amplitude (PA) and frontalis EMG was studied first by looking at general physiological changes accompanying successful bidirectional PA control. Seven successful subjects were then asked to produce two patterns of PA and EMG (PAincEMGdec and PAdecEMGdec) while receiving both PA and frontalis EMG biofeedback. Results indicate subjects can easily produce the differentiation pattern of PAdecEMGdec but cannot produce the integration pattern of PAincEMGdec. These rather paradoxical results may indicate subjects were using an "attentional" rather than "arousal" strategy for controlling PA and have implications for the use of peripheral vasomotor training as a general relaxation technique.     

EMG biofeedback and discriminative muscle control

The awareness model of biofeedback suggests that training teaches new skills or enhances performance at old skills, while the cognitive or feed-forward models suggest that biofeedback brings attention to the response of interest but does not actually increase task skill. In a test of the predictions made by these models, subjects were tested on one or more cross-modal matching tasks, provided brief training, and retested on the task(s). Thirty subjects participated in integer-matching tasks in which they were instructed to produce various levels of frontalis activity corresponding to the levels of a ratio scale. Forty-five subjects participated in a tone-matching task in which they tried to match their frontalis tension to the pitch of a tone. The results indicated that the groups receiving biofeedback training improved at the more difficult integer task and at the tone task. Subjects performed better on the integer tasks than at the tone task. Our findings suggest that an awareness model accounts for changes occurring during biofeedback training. However, an awareness model may be applicable only for tasks of moderate difficulty; for relatively easy tasks, a feed-forward model may be more appropriate. The clinical utility of cross-modal matching tasks is also described.This paper is based on a thesis conducted by the second author under the direction of the first author. Portions of this paper were presented at the annual meeting of the Association for Applied Psychophysiology and Biofeedback, March 1989, San Diego.     

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.     

EMG biofeedback and discriminative muscle control

The awareness model of biofeedback suggests that training teaches new skills or enhances performance at old skills, while the cognitive or feed-forward models suggest that biofeedback brings attention to the response of interest but does not actually increase task skill. In a test of the predictions made by these models, subjects were tested on one or more cross-modal matching tasks, provided brief training, and retested on the task(s). Thirty subjects participated in integer-matching tasks in which they were instructed to produce various levels of frontalis activity corresponding to the levels of a ratio scale. Forty-five subjects participated in a tone-matching task in which they tried to match their frontalis tension to the pitch of a tone. The results indicated that the groups receiving biofeedback training improved at the more difficult integer task and at the tone task. Subjects performed better on the integer tasks than at the tone task. Our findings suggest that an awareness model accounts for changes occurring during biofeedback training. However, an awareness model may be applicable only for tasks of moderate difficulty; for relatively easy tasks, a feed-forward model may be more appropriate. The clinical utility of cross-modal matching tasks is also described.     

Cognitive self-control factors in EMG biofeedback

This study investigated the efficacy of manipulation of cognitive self-control expectancy in EMG biofeedback training. It was predicted that a treatment procedure, which includes a positive-cognitive stage that establishes and reinforces a positive self-control belief system and also includes a training stage in EMG biofeedback, will be more effective in achieving a reduction in EMG activity than a treatment procedure which includes a negative-cognitive stage and which also includes ambiguous features prior to training and a treatment approach solely concerned with training. The study consisted of four groups with 10 subjects in each. In one group, expectation for inner control ability was created prior to actual training in reducing EMG activity. In the second group, expectation for negative self-control ability was created prior to EMG training. The third group only underwent the actual training in EMG. The fourth group served as a control group. The results show that the positive-cognitive self-control group was significantly more effective in reducing muscle activity than the other groups.