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Nomophobia treatment. Biofeedback.

November 28, 2023

by Armine Zarayelyan with No Comment Uncategorized all

In the digital era, the pervasive phenomenon of Nomophobia, or the fear of being without one’s mobile phone, has given rise to a pressing need for effective interventions. Among the innovative approaches, Nomophobia treatment through biofeedback emerges as a promising solution. Biofeedback, leveraging advanced technology, offers a tailored and dynamic method to address the escalating concerns associated with smartphone dependency. This treatment modality allows individuals to gain insight into their physiological responses during moments of phone separation anxiety, fostering self-awareness and real-time control. By combining the power of biofeedback modalities technology with personalized interventions, Nomophobia treatment aims to empower individuals to manage and alleviate the adverse effects of smartphone-related stress, promoting a healthier and more balanced relationship with digital devices.

Table of Contents

What is nomophobia?

New technologies have become an integral part of our lives. Rapidly spreading all over the world, smartphones and their applications now play a key role in social connections, expression, information sharing, and achievement development. Smartphones have become essentials rather than accessories, due to their capacity to perform many tasks with features including advanced operating systems, touch screens, and internet access. Information is easily transmitted and received through text messages, phone calls, emails, faxes, games, movies, videos, and social media. Smartphones can also combine services, such as “commutainment” (entertainment and communication) and “edutainment” (education and entertainment). Like other modern technologies, many variables must be considered in evaluating their overall benefit and utility. For example, while smartphones provide ready, convenient access to the internet, and a sense of comfort and connection to others, they may also result in an unhealthy, negative psychological dependency, anxiety, and possible fear. Smartphones have countless impacts on our lives, potentially including problematic health issues that may develop as a consequence of overuse.

The increasingly symbiotic relationship between humans and their handheld devices has given rise to a new psychological phenomenon known as nomophobia, or the fear of being without one’s mobile phone. This modern malady underscores the profound impact of technology on our lives, raising questions about how it alters not only our behavior but also our very brains.

The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity (being out of contact with a mobile phone, having no mobile networks, or having insufficient balance or battery). The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labeled as a “phobia for particular/specific things”.

It’s not officially recognized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but it is often used informally to describe the emotional and psychological distress that can result from being separated from one’s mobile device. While it’s not an officially recognized phobia, it can have a real impact on a person’s daily life and mental well-being.

In contrast to other forms of addiction such as gaming or gambling addiction which has been categorized as a distinct disease entity according to the International Classification of Disease (ICD), excessive smartphone use is a more general behavioral addiction that has not been officially classified as a disorder. Compared with drug dependence, which affects structural and functional neural correlates through chemical pathways, changes associated with behavioral addiction are more likely through operant learning that involves rewards and punishments for behavioral impacts.

Common symptoms of nomophobia

The symptoms of nomophobia include anxiety, panic attacks, and agitation when the phone is not in one’s possession, physical symptoms like trembling, sweating, tachycardia, and disorientation when without the phone, and a persistent need to have the phone within reach at all times. These symptoms are often driven by a deep-seated fear of disconnection, isolation, or the inability to communicate and access information, aligning with the concept of nomophobia.

The below-mentioned signs and symptoms are observed in Nomophobia cases

• Anxiety
• Respiratory alterations
• Trembling
• Perspiration
• Agitation
• Disorientation
• Tachycardia.
• Irritability or restlessness when unable to use the phone.

Prevalence of nomophobia

Nomophobia has been found to occur in 18.5–73% of college students, depending on factors including age, gender, self-image, self-esteem, self-efficacy, impulsivity, and. People with nomophobia may never turn their phone off or stay away from it even at bedtime, and tend to carry an extra phone, battery, or charger as a precaution should they lose their phone, run out of battery life, or lose service connectivity.

One study showed that 95% used smartphones to watch YouTube, WhatsApp, or other media to induce sleep; 72% could not stay away from their smartphones, and usually kept their phones just five feet from them. The prevalence of nomophobia is similar between developed and developing countries; both show a prevalence of between 77 and 99% and highest among young adult populations.

Nomophobia is not limited to adults; children and adolescents are equally susceptible to this phenomenon. Defined as the fear or anxiety associated with being separated from one’s mobile phone, it often manifests as an intense reliance on smartphones for social validation, entertainment, and a sense of security. It can result in a range of behavioral and emotional changes in young individuals.

Causes and predisposition for nomophobia

Certain people are more susceptible to developing nomophobia. Factors that can accelerate chances of developing the condition are having:

• Pre-existing anxiety
• Low self-esteem
• Struggles with emotional regulation
• Insecure attachment styles
• A lack of personal relationships

Nomophobia can be influenced by a variety of predisposing factors. These factors can vary from person to person, and the development of nomophobia is often the result of a combination of multiple influences. Some common predisposing factors for nomophobia include:

1. Smartphone Dependency: Excessive smartphone use and reliance on the device for communication, entertainment, and information can predispose individuals to nomophobia. The more dependent one becomes on their smartphone, the more likely they are to experience anxiety when separated from it.

2. Attachment Style: People with anxious attachment styles, characterized by a strong need for emotional closeness and reassurance, may be more prone to nomophobia. The smartphone can serve as a means of seeking constant connection and reassurance.

3. Social Media Usage: Heavily engaging in social media and seeking social validation online can contribute to nomophobia. The constant need for likes, comments, and online interaction can intensify the fear of missing out and the desire to stay connected.

4. High Stress and Anxiety Levels: Individuals with high levels of stress and anxiety may be more vulnerable to developing nomophobia. The smartphone can become a source of distraction and a way to cope with anxiety, leading to a reliance on the device.

5. Low Self-Esteem: Individuals with low self-esteem may use their smartphones as a means of boosting their self-worth through social media validation. The fear of being without the device can be linked to a fear of losing this source of self-esteem.

6. Peer Pressure: Social pressures and peer influence can play a significant role in the development of nomophobia. If a person’s peers are constantly connected and expect them to be as well, it can create a fear of social exclusion.

7. FOMO (Fear of Missing Out): The fear of missing out on social events, news, or online interactions can be a powerful driver of nomophobia. Individuals who experience a strong FOMO are more likely to be anxious when not connected to their phones.

8. Previous Negative Experiences: Past negative experiences, such as missing important messages or events due to being without a phone, can contribute to the fear of being without one’s mobile device.

9. Family or Cultural Factors: Family dynamics and cultural norms can influence smartphone usage and the development of nomophobia. In some cultures, constant connectivity may be emphasized, leading to greater phone dependency.

10. Accessibility and Availability of Technology: The ease of access to smartphones and the constant availability of technology can make it more likely for individuals to become dependent on their devices.

11. Childhood Exposure: Early exposure to smartphones and mobile technology can impact a person’s attachment to these devices. Growing up with constant access to smartphones can contribute to a stronger dependency.

It’s important to note that these factors can interact and compound, leading to the development of nomophobia. Additionally, individual vulnerabilities and predispositions can vary, making the experience of nomophobia unique to each person. Understanding these predisposing factors can be helpful in addressing and managing nomophobia through awareness, self-regulation, and, if necessary, professional support.

What mental conditions can contribute to and potentially accelerate development of nomophobia

Several mental health conditions and psychological factors can contribute to and potentially accelerate the development of nomophobia (the fear of being without one’s mobile phone). It’s important to note that these conditions may not directly cause nomophobia but can increase the likelihood and severity of the condition. Some of these mental health conditions and factors include:

1. Generalized Anxiety Disorder (GAD): Individuals with GAD experience excessive and uncontrollable worry and anxiety about various aspects of their lives. This chronic anxiety can make people more susceptible to the fear and anxiety associated with being without their mobile phones.

2. Social Anxiety Disorder: Social anxiety often involves a fear of social interactions and judgment. Smartphones can serve as a means of coping with social anxiety by providing a distraction and a barrier to face-to-face interactions, contributing to increased phone reliance.

3. Obsessive-Compulsive Disorder (OCD): OCD is characterized by intrusive and distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). In some cases, checking and rechecking the smartphone for messages or notifications can become a compulsive behavior, intensifying the fear of being without the phone.

4. Depression: People with depression may turn to their smartphones as a source of distraction and emotional relief. Constant smartphone use can provide a temporary escape from negative emotions and may lead to dependency.

5. Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is associated with difficulties in impulse control and attention regulation. Individuals with ADHD may be more likely to use smartphones excessively, leading to a heightened risk of nomophobia.

6. Post-Traumatic Stress Disorder (PTSD): PTSD can lead to hypervigilance and heightened anxiety. The constant checking of the smartphone can be a way to stay prepared for potential threats, which can contribute to phone dependence.

7. Negative Body Image and Eating Disorders: Individuals with body image issues may use their phones for reassurance or distraction. The fear of being without a smartphone can be linked to the fear of facing negative body image thoughts without a distraction.

8. Substance Abuse Disorders: Individuals with substance abuse issues may use smartphones to connect with their support networks or to distract themselves from cravings or withdrawal symptoms. This can lead to a strong dependence on the phone.

9. Stress and Burnout: Chronic stress and burnout can lead to a desire for constant distraction and relief, making people more likely to turn to their smartphones excessively.

10. Cyberbullying: Experiences of cyberbullying can lead to increased phone reliance as individuals may want to stay informed about online threats or negative comments.

It’s essential to recognize that these mental health conditions can interact with individual vulnerabilities and other life circumstances to accelerate the development of nomophobia. Treating and managing the underlying mental health condition, along with addressing smartphone dependency, can be crucial in preventing or alleviating nomophobia. If you or someone you know is experiencing these mental health conditions and smartphone-related anxieties, seeking professional help is advisable.

Impact of nomophobia to the health

Nomophobia can have various effects on an individual’s health, encompassing both mental and physical well-being. Here are some ways in which nomophobia can impact health:

1. Increased Stress and Anxiety: The constant need to be connected and the fear of missing out can lead to heightened stress and anxiety levels. The anticipation of not having a mobile phone or being unable to check messages may induce a persistent state of anxiety.

2. Sleep Disturbances: Excessive use of mobile phones, especially before bedtime, can disrupt sleep patterns. The blue light emitted by screens can interfere with the production of melatonin, a hormone essential for sleep regulation, potentially leading to insomnia.

3. Impaired Cognitive Function: The constant checking of messages and notifications can contribute to cognitive overload. This continuous cognitive stimulation may affect concentration, memory, and overall cognitive function.

4. Social Isolation: Paradoxically, while mobile phones facilitate virtual connections, nomophobia can lead to social isolation. Individuals may withdraw from face-to-face interactions, relying more on digital communication, which can impact social skills and relationships.

5. Physical Health Issues: Constant use of smartphones can contribute to physical health problems, including eye strain, neck and back pain (text neck), and repetitive strain injuries from prolonged phone use.

6. Reduced Productivity: Nomophobia may lead to decreased productivity, as individuals may find it challenging to focus on tasks without the constant distraction of their phones. This can affect work and academic performance.

7. Negative Impact on Mental Health: Over time, the fear of being without a mobile phone can contribute to the development or exacerbation of mental health conditions such as depression and social anxiety. It may also lead to a diminished sense of well-being.

8. Compromised Personal Relationships: Excessive phone use and the fear of separation from one’s device can strain personal relationships. Individuals may prioritize their phones over face-to-face interactions, leading to misunderstandings and a sense of emotional distance.

It’s essential to recognize the potential health impacts of nomophobia and take proactive steps to foster a healthy relationship with technology.

What changes in behavior cause nomophobia

Nomophobia can lead to various changes in behavior. These behavioral changes can have a significant impact on an individual’s daily life, relationships, and overall well-being. Common behavioral changes associated with nomophobia include:

1. Excessive Smartphone Use: People with nomophobia tend to use their smartphones excessively, often checking their devices for messages, notifications, or updates even when it’s not necessary. This behavior can lead to reduced productivity and increased distraction.

2. Avoidance of Certain Situations: Individuals with nomophobia may avoid situations or places where they know they won’t have phone signals or access to their phones. This can affect their willingness to engage in social activities, travel, or attend events.

3. Reduced Face-to-Face Social Interaction: Excessive phone use can lead to decreased in-person social interactions. People with nomophobia may prioritize virtual connections over real-world relationships, impacting their ability to build and maintain meaningful connections with others.

4. Increased Anxiety and Stress: Constantly checking the phone for messages or updates can lead to heightened anxiety and stress levels. This behavior can be a response to the fear of missing out (FOMO) on important information or social interactions.

5. Sleep Disruption: The use of smartphones before bedtime, often associated with nomophobia, can disrupt sleep patterns. Blue light emitted by screens can interfere with the body’s production of melatonin, a hormone that regulates sleep, leading to insomnia or poor sleep quality.

6. Impaired Concentration and Productivity: Frequent phone checking and social media use can make it difficult for individuals to focus on tasks, whether at work or in school, leading to reduced productivity and concentration. There are some researches that found a strong association between academic performance and nomophobia and show weaker academic performance among students with severe nomophobia.

7. Distraction While Driving: Nomophobia can lead to dangerous behavior, such as using a smartphone while driving. Distracted driving is a significant safety concern and can lead to accidents.

8. Negative Impact on Mental Health: The constant need to be connected can contribute to feelings of loneliness, depression, and anxiety. This behavioral change can have long-term consequences for mental well-being.

9. Relationship Issues: Nomophobia can strain personal relationships, as partners or family members may feel neglected or frustrated when someone is more focused on their phone than on spending time with loved ones.

10. Difficulty Disconnecting: People with nomophobia often find it challenging to disconnect from their phones, even during vacations or leisure time. This can prevent them from fully enjoying moments of relaxation.

It’s important to recognize these behavioral changes associated with nomophobia, as they can have a negative impact on an individual’s quality of life.

What changes in brain and its function cause nomophobia

There is ongoing research into the specific changes in the brain that may be associated with nomophobia. However, some research suggests that the fear and anxiety associated with nomophobia may be linked to changes in brain activity and neurochemistry, similar to other forms of addiction or anxiety disorders. Here are some potential brain-related factors:

1. Dopamine Release: When individuals receive notifications or messages on their phones, the brain often releases dopamine, a neurotransmitter associated with pleasure and reward. Over time, excessive smartphone use can lead to alterations in the brain’s reward system, making people more dependent on their phones for these pleasurable experiences.

2. Cortisol Levels: The constant need to check and respond to messages, notifications, or social media updates can create a sense of pressure and stress, leading to increased levels of the stress hormone cortisol in the brain. Chronic stress can have negative effects on brain health.

3. Prefrontal Cortex Activity: The prefrontal cortex is involved in decision-making and impulse control. Excessive smartphone use may alter the functioning of this region, making it harder for individuals to resist the urge to check their phones constantly.

Moreover, some research has found atrophy (shrinkage or loss of tissue volume) in gray matter areas. Volume loss was also seen in the striatum, which is involved in reward pathways and the suppression of socially unacceptable impulses. A finding of particular concern was damage to an area known as the insula, which is involved in our capacity to develop empathy and compassion for others and our ability to integrate physical signals with emotion. Aside from the obvious link to violent behavior, these skills dictate the depth and quality of personal relationships.

4. Altered Sleep Patterns: Overuse of smartphones, especially at night, can disrupt sleep patterns due to the blue light emitted by screens. Sleep disruption can affect cognitive functions and mood regulation.

5. Neuroplasticity: The brain is highly adaptable and can rewire itself based on repeated behaviors. If a person is constantly engaged with their smartphone, the brain may reorganize its neural connections to prioritize this behavior, potentially at the expense of other important activities and interactions.

It’s important to note that these changes are not unique to nomophobia but are related to excessive smartphone use in general. The specific neural changes associated with nomophobia may vary from person to person, and more research is needed to fully understand the neurological aspects of this phenomenon. Additionally, the impact of excessive smartphone use on brain function and mental health can vary depending on the individual and the extent of their phone dependency.

Prevention of nomophobia development

Preventing or proactively addressing nomophobia (the fear of being without one’s mobile phone) involves a combination of awareness, self-regulation, and healthy technology habits. Here are some strategies for nomophobia prophylaxis:

1. Digital Detox Days: Designate regular “digital detox” days where you intentionally disconnect from your smartphone and other devices. This can help you become less reliant on your phone for entertainment and social interaction.

2. Set Boundaries: Establish clear boundaries for smartphone use. For example, avoid using your phone during meals, in the bedroom, or while engaging in other important activities. Stick to these boundaries to prevent excessive phone use.

3. Silent Hours: Designate certain hours of the day as “silent hours” where you turn off or silence your phone. This can provide a break from notifications and constant connectivity.

4. Selective Notifications: Customize your smartphone’s notification settings. Turn off non-essential notifications or set them to “Do Not Disturb” during specific hours to reduce constant interruptions.

5. Offline Activities: Engage in offline activities that you enjoy, such as hobbies, exercise, or face-to-face social interactions. These activities can help reduce the time spent on your phone.

6. Digital Well-Being Tools: Many smartphones offer digital well-being features that can help you track and manage your screen time. Use these tools to set daily limits on app usage.

7. Mindfulness and Relaxation: Practice mindfulness and relaxation techniques to manage stress and anxiety without relying on your phone. This can help reduce the need to constantly check your device.

8. Self-Awareness: Reflect on your smartphone usage and its impact on your daily life. Recognize the situations or emotions that trigger your nomophobia and work on addressing them.

9. Seek Support: If nomophobia is significantly affecting your life and well-being, consider seeking support from a mental health professional or a therapist. They can help you explore the root causes and develop coping strategies.

10. Parental Guidance: For children and adolescents, parents play a crucial role in preventing nomophobia. Set limits on their screen time, educate them about the potential negative effects of excessive smartphone use, and encourage a healthy balance between online and offline activities.

11. Education: Stay informed about the potential risks of excessive smartphone use and educate yourself about digital well-being. The more you know about the impact of technology on your life, the better equipped you are to make informed choices.

12. Role Modeling: Be a role model for responsible smartphone use. Children and adolescents often learn by observing the behavior of adults, so demonstrate a healthy relationship with your phone.

Prophylaxis for nomophobia is about creating a balanced and mindful approach to smartphone usage. It involves understanding the role of technology in your life, recognizing the signs of dependency, and actively taking steps to maintain control over your digital habits. By implementing these strategies, you can reduce the risk of developing nomophobia or mitigate its effects if you’re already experiencing it.

Preventing nomophobia in children

Preventing nomophobia in children and adolescents involves establishing healthy digital habits, fostering responsible technology use, and promoting a balanced relationship with smartphones and other devices. Here are some strategies for preventing nomophobia in young individuals:

1. Educate About Digital Well-Being:
Start by educating children and adolescents about the potential risks of excessive smartphone use, including the development of nomophobia. Teach them to recognize the signs of smartphone dependency.

2. Set Screen Time Limits:
Establish daily screen time limits for the recreational use of smartphones and other devices. Consider using parental control apps or built-in features to enforce these limits.

3. Create Tech-Free Zones:
Designate specific areas in the home where smartphone use is not allowed, such as the dinner table, bedrooms, and study areas. These zones promote face-to-face interactions and better sleep habits.

4. Encourage Outdoor Activities:
Promote outdoor activities, physical exercise, and hobbies that do not involve screens. Encourage children and adolescents to explore the real world and engage in physical play.

5. Model Responsible Behavior:
Be a positive role model by demonstrating responsible smartphone use. Show that you can disconnect from your phone when needed and prioritize in-person interactions.

6. Open Communication:
Create an open and non-judgmental environment where children and adolescents can discuss their feelings and experiences related to smartphone use. Encourage them to talk about any anxieties or insecurities they may have.

7. Teach Time Management:
Help children and adolescents develop effective time management skills. Teach them how to allocate time for homework, chores, relaxation, and digital entertainment.

8. Set Tech-Free Bedtime Rituals:
Establish tech-free bedtime rituals to help children and adolescents unwind and prepare for restful sleep. Encourage them to leave their phones outside the bedroom to avoid sleep disruption.

9. Monitor Online Activity:
Keep an eye on your child’s online activity, especially on social media platforms. Be aware of any cyberbullying or negative experiences that may contribute to anxiety.

10. Limit Social Media Comparison:
Discuss the potentially harmful effects of comparing oneself to others on social media. Teach children and adolescents to appreciate their uniqueness and self-worth.

11. Teach Digital Literacy:
Promote digital literacy and critical thinking skills. Help young individuals recognize and evaluate the credibility of online information.

12. Encourage Offline Social Interactions:
Foster opportunities for children and adolescents to interact with peers in person. Encourage group activities, playdates, and involvement in clubs or sports.

13. Reward Offline Achievements:
Recognize and reward offline achievements, such as academic success, sports accomplishments, or creative endeavors. Celebrate non-digital milestones.

14. Seek Professional Help if Necessary:
If you notice signs of nomophobia or severe smartphone dependency in a child or adolescent, seek the guidance of a mental health professional. They can provide specialized support and intervention.

Preventing nomophobia in children and adolescents requires a holistic approach that combines awareness, parental involvement, education, and the cultivation of a balanced digital lifestyle. By taking proactive steps and providing guidance, parents, and caregivers can help young individuals develop a healthy relationship with technology and reduce the risk of experiencing nomophobia

You can check if you have nomophobia by answering this questionnaire.

Nomophobia Questionnaire (NMP-Q).pdf

What is nomophobia treatment?

Treatment for nomophobia, like treatment for other technology-related behavioral issues, focuses on reducing dependency, managing anxiety, and establishing healthier habits around smartphone use. Here are some strategies and treatments that can be helpful in addressing nomophobia:

1. Cognitive-Behavioral Therapy (CBT): CBT is a common therapeutic approach for treating anxiety disorders. A therapist can work with individuals to identify and challenge irrational thoughts and behaviors related to their smartphone use and fear of being without it.

2. Exposure Therapy: This type of therapy involves gradually exposing individuals to situations where they would typically experience anxiety due to being without their phone. Over time, this can help desensitize them to the fear.

3. Mindfulness and Relaxation Techniques: Learning mindfulness and relaxation exercises can help individuals manage anxiety and stress associated with nomophobia. Breathing exercises, meditation, and yoga can be beneficial.

4. Coping Skills Training: Therapists can teach individuals healthy coping mechanisms to deal with the fear of being without their phone. This may include identifying alternative activities and strategies for managing anxiety.

5. Setting Boundaries: Establishing clear boundaries for smartphone use is essential. This can involve creating designated “phone-free” times or places, such as during meals or in the bedroom.

6. Digital Detox: Periodically disconnecting from the smartphone for an extended period can help break the cycle of dependency. Some individuals may benefit from technology-free weekends or vacations.

7. Support Groups: Joining support groups or seeking the support of friends and family who understand the issue can be beneficial. Sharing experiences and strategies for managing smartphone use can provide a sense of community and accountability.

8. Behavioral Interventions: Behavior modification techniques, such as reward systems for reducing smartphone use, can be effective. Positive reinforcement for meeting goals can help individuals gradually reduce their phone attachment.

9. Educational Workshops: Some organizations and mental health professionals offer workshops or educational sessions on digital well-being and smartphone addiction. These can provide information and tools to manage smartphone use effectively.

10. Self-Help Apps: Various smartphone apps are designed to help individuals track and manage their phone usage. These apps can provide insights into usage patterns and help set limits.

11. Consultation with a Mental Health Professional: If nomophobia is significantly impacting an individual’s life and well-being, it may be advisable to consult with a mental health professional, such as a psychologist or psychiatrist, for a personalized treatment plan.

Treatment for nomophobia should be tailored to the individual’s specific needs and the severity of the condition. It’s important to remember that addressing nomophobia is not about completely eliminating smartphone use but about finding a healthy balance and reducing the negative impact of excessive phone dependency on one’s life.

Biofeedback in nomophobia treatment

Biofeedback is a therapeutic technique that helps individuals gain awareness and control over physiological processes in their bodies, such as heart rate, muscle tension, and skin conductance. While biofeedback is not typically used as a direct treatment for nomophobia, it can be a valuable component of a broader treatment plan aimed at managing anxiety and stress, which are often associated with nomophobia. Here’s how biofeedback can be integrated into the treatment of nomophobia:

1. Stress Management: Nomophobia is often accompanied by stress and anxiety. Biofeedback can be used to teach individuals how to recognize and reduce the physiological signs of stress, such as increased heart rate and muscle tension. By learning to control these responses, individuals can better manage the anxiety that can trigger their dependence on their smartphones.

2. Self-Regulation: Biofeedback helps individuals develop self-regulation skills. By monitoring their physiological responses in real time, they can learn to consciously control these responses. This can be particularly useful for individuals who experience anxiety when separated from their phones.

3. Relaxation Techniques: Biofeedback training often involves teaching relaxation techniques, such as deep breathing and progressive muscle relaxation. These techniques can be used to counter the anxiety and restlessness associated with nomophobia.

4. Awareness: Biofeedback can enhance awareness of one’s physiological responses to stress, including the physical sensations that may accompany nomophobia. This increased awareness can help individuals recognize their anxiety triggers and develop strategies to cope with them.

5. Biofeedback Apps and Wearables: There are biofeedback apps and wearable devices available that can measure and provide real-time feedback on physiological parameters. These tools can help individuals track and manage their stress and anxiety, making it easier to address the emotional aspects of nomophobia.

6. Integration with Other Therapies: Biofeedback can be integrated into a broader treatment plan that includes cognitive-behavioral therapy (CBT) or exposure therapy, which are commonly used to address anxiety-related issues like nomophobia. Biofeedback can complement these therapies by helping individuals manage the physical symptoms of anxiety.

It’s important to note that biofeedback is not a standalone treatment for nomophobia but rather a component of a comprehensive approach. A mental health professional, such as a therapist or psychologist, can work with individuals to determine how best to integrate biofeedback into their treatment plan and address the psychological and emotional aspects of nomophobia. The goal is to help individuals manage their anxiety and stress in healthier ways, ultimately reducing their dependency on their smartphones.

What biofeedback modalities can be used for nomophobia treatment?

Various modalities of biofeedback can be used, and the choice of modality depends on the specific physiological factors contributing to an individual’s nomophobia. Here are some common biofeedback modalities and how they can be used:

1. Heart Rate Variability (HRV) Biofeedback:
• How it works: HRV biofeedback measures the variations in time between successive heartbeats. It reflects the balance between the sympathetic (fight or flight) and parasympathetic (rest and digest) branches of the autonomic nervous system.
• Relevance to nomophobia treatment: Many individuals with nomophobia experience increased heart rate and a “fight or flight” response when separated from their phones or experiencing phone-related anxiety. HRV biofeedback can help individuals learn to regulate their autonomic nervous system, reduce heart rate, and promote relaxation in these situations.

2. Electrodermal Activity (EDA) Biofeedback:
• How it works: EDA biofeedback measures skin conductance or sweat gland activity. It reflects the activity of the sympathetic nervous system, which is responsible for the body’s stress response.
• Relevance to nomophobia treatment: People with nomophobia often experience increased sweat gland activity when they are anxious about being without their phones. EDA biofeedback can help individuals recognize and control these physiological responses, leading to decreased anxiety and improved stress management.

3. Respiration Biofeedback:
• How it works: Respiration biofeedback involves monitoring and controlling one’s breathing patterns. It helps individuals achieve a balanced and controlled breathing rate.
• Relevance to nomophobia treatment: Anxiety often leads to shallow and rapid breathing. Respiration biofeedback can teach individuals to slow their breathing and engage in deep, diaphragmatic breathing, which triggers the body’s relaxation response. This can help counteract the stress response associated with nomophobia.

4. Temperature Biofeedback:
• How it works: Temperature biofeedback measures skin temperature, which is influenced by blood flow and circulation. It is linked to the body’s relaxation response.
• Relevance to nomophobia treatment: Stress and anxiety can lead to peripheral vasoconstriction (reduced blood flow to the extremities), resulting in cold hands and feet. Temperature biofeedback can help individuals increase peripheral blood flow and warm their extremities, promoting relaxation and reducing the physical symptoms of anxiety.

5. Muscle Electromyography (EMG) Biofeedback in nomophobia treatment:
• How it works: EMG biofeedback measures muscle tension and provides feedback on muscle activity.
• Relevance to nomophobia treatment: People with nomophobia may experience muscle tension and physical discomfort when separated from their phones or when they experience anxiety related to phone use. EMG biofeedback can help individuals recognize and reduce muscle tension, promoting physical relaxation.

The choice of biofeedback modality for the treatment of nomophobia should be based on an individual’s specific physiological responses and needs. In therapy, a trained professional can conduct an assessment to determine which modality would be most effective. The goal of using biofeedback is to increase self-awareness, develop self-regulation skills, and reduce the physiological markers of anxiety and stress, ultimately helping individuals manage their nomophobia-related symptoms more effectively.

EEG (Electroencephalography) biofeedback in nomophobia treatment

EEG (Electroencephalography) biofeedback, also known as neurofeedback, is a therapeutic technique that involves real-time monitoring of brainwave activity to provide individuals with information about their brain functioning. While the direct application of EEG biofeedback specifically for nomophobia is a relatively novel area, the general principles of neurofeedback can be explored for potential benefits in managing the underlying factors contributing to nomophobia.
Here’s how EEG biofeedback could be considered for the treatment of nomophobia:

Understanding Brain Activity in Nomophobia:

1. Identifying Stress Patterns:
• EEG biofeedback allows for the identification of specific brainwave patterns associated with stress and anxiety.
• Nomophobia often involves heightened stress responses when individuals are separated from their phones. EEG can pinpoint these stress-related brainwave patterns.

2. Neurological Correlates of Nomophobia:
• Research could be conducted to identify neurological correlates of nomophobia using EEG technology.
• Understanding how the brain responds during situations that trigger nomophobia could inform targeted neurofeedback interventions.

Potential Benefits of EEG Biofeedback in Nomophobia Treatment

1. Self-Regulation Training:
• EEG biofeedback enables individuals to learn how to regulate their own brain activity consciously.
• Nomophobia treatment can involve training individuals to self-regulate their stress responses by modulating specific brainwave patterns associated with anxiety.

2. Alpha-Theta Training:
• Alpha-theta neurofeedback has been used for anxiety and stress management.
• This type of biofeedback involves enhancing alpha brainwaves (associated with relaxation) and theta brainwaves (associated with deep relaxation and creativity). It could potentially help individuals achieve a calmer state, reducing nomophobia-related stress.

3. Cognitive Behavioral Therapy Enhancement:
• EEG biofeedback can complement traditional therapeutic approaches, such as Cognitive Behavioral Therapy (CBT).
• By incorporating neurofeedback, individuals may gain insights into the physiological aspects of their anxiety and enhance the effectiveness of cognitive strategies to manage nomophobia.

4. Real-Time Feedback during Exposure:
• Individuals can receive real-time feedback during exposure to situations that trigger nomophobia.
• The biofeedback process can help individuals understand and control their physiological responses, gradually reducing the anxiety associated with being without a mobile phone.

5. Individualized Treatment Plans:
• EEG biofeedback allows for individualized treatment plans based on the unique brainwave patterns of each person.
• Tailoring interventions to address specific neurological aspects contributing to nomophobia enhances the effectiveness of the treatment.

Neurofeedback Protocols for Nomophobia:

1. Alpha Training (Occipital Lobe – O1, O2):
• Aim: Increase alpha brainwave activity.
• Rationale: Alpha waves are associated with relaxation and a calm mental state. Training individuals to enhance alpha activity may help reduce overall stress and anxiety related to nomophobia.

2. Theta Training (Frontal Lobe – F3, F4):
• Aim: Increase theta brainwave activity.
• Rationale: Theta waves are associated with deep relaxation and creativity. By encouraging theta activity, individuals may experience a more tranquil mental state, potentially alleviating the anxiety associated with phone separation.

3. SMR (Sensory-Motor Rhythm) Training (Central Cortex – C3, C4):
• Aim: Increase SMR (12-15 Hz) brainwave activity.
• Rationale: SMR is associated with a calm and focused state. Enhancing SMR activity may contribute to better attention regulation and stress reduction.

4. Beta Training (Frontal Cortex – F3, F4):
• Aim: Normalize beta brainwave activity.
• Rationale: Abnormal beta activity has been associated with increased anxiety. Normalizing beta levels may help individuals maintain a more balanced and less anxious state.

Application Sites According to the 10-20 System

• O1 and O2: Occipital lobe electrodes for alpha training.
• F3 and F4: Frontal lobe electrodes for theta and beta training.
• C3 and C4: Central cortex electrodes for SMR training.

Challenges and Considerations

1. Research and Validation:
• Rigorous research is needed to establish the effectiveness of EEG biofeedback specifically for nomophobia.
• Validating the neurological correlates of nomophobia and developing targeted interventions require comprehensive studies.

2. Integration with Behavioral Therapy:
• Combining EEG biofeedback with behavioral therapy approaches is crucial for a comprehensive treatment plan.
• Neurofeedback should complement, not replace, traditional therapeutic methods.

3. Ethical Considerations:
• Ethical considerations, such as informed consent and ensuring the well-being of participants, are essential in utilizing neurofeedback for mental health applications.
In conclusion, while the direct application of EEG biofeedback for nomophobia is an evolving area, the potential lies in its ability to provide personalized insights into the neural mechanisms of stress and anxiety. Integrating neurofeedback with existing therapeutic strategies could offer a holistic approach to addressing the complex interplay of psychological and physiological factors associated with nomophobia.

Biofeedback devices that can be used in nomophobia treatment

eSense Biofeedback devices for various biofeedback modalities

Breathing Biofeedback home-use device

Temperature Biofeedback home-use device

Heart Rate Variability Biofeedback home-use device

Electrodermal Skin Activity Biofeedback home-use device

Biosignals Biofeedback devices with the combination of all biofeedback modalities in one device.

BioSignals Biofeedback 5 sensors Device

Biofeedback BioSignals Green Box 4 sensors

Biofeedback speech therapy for stuttering

October 18, 2023

by Armine Zarayelyan with No Comment Uncategorized all

Stuttering is an action-induced speech disorder with involuntary, audible, or silent repetitions or prolongations in the utterance of short speech elements (sounds, syllables) and words. Stuttering typically begins in childhood and may persist into adulthood. It can vary in severity, with some individuals experiencing only mild stuttering while others may have more pronounced difficulties speaking fluently. Treatment for stuttering often involves a combination of therapeutic approaches tailored to the individual’s specific needs and goals. Biofeedback speech therapy for stuttering is a therapeutic technique that can be used as part of the treatment to help individuals gain better control over physiological processes, such as muscle tension and stress that may effectively contribute to stuttering. Several modalities of biofeedback speech therapy for stuttering can be used for treatment to help individuals gain better control over physiological processes that may contribute to disfluency.

Table of Contents

What stuttering is?

Stuttering, or stammering, is a speech disorder characterized by disruptions or interruptions in the normal flow of speech. People who stutter may experience difficulty in the production of sounds, syllables, words, or phrases, which can manifest as repetitions of sounds or words, prolongations of sounds, or blocking where the person is unable to produce any sound for a brief period. These disruptions in speech can be accompanied by physical tension, such as facial grimaces or rapid eye blinking, as well as feelings of frustration and anxiety.

Stuttering typically begins in childhood and may persist into adulthood. It can vary in severity, with some individuals experiencing only mild stuttering while others may have more pronounced difficulties speaking fluently. The exact cause of stuttering is not fully understood, but it is believed to result from a combination of genetic, neurological, and environmental factors.

Treatment for stuttering often involves speech therapy, where a trained speech-language pathologist works with individuals to improve their fluency and reduce the frequency and severity of stuttering episodes. Therapists may use techniques such as speech modification, fluency shaping, and stuttering modification to help individuals manage their speech more effectively. Early intervention is crucial in helping children who stutter, as it can prevent the disorder from becoming more ingrained and severe.

It’s important to note that stuttering does not reflect a person’s intelligence or competence, and many individuals who stutter lead successful lives and careers with appropriate support and therapy. Supportive environments and understanding from family, friends, and peers can also play a significant role in helping individuals with stuttering feel more confident and comfortable in their communication.

Pathophysiology of stuttering

The pathophysiology of stuttering, or the underlying biological and neurological processes that contribute to the disorder, is not fully understood. Stuttering is believed to be a complex condition influenced by a combination of genetic, neurological, and environmental factors. While researchers continue to study the condition, there is no single, universally accepted theory that explains all aspects of stuttering. However, several theories have been proposed to shed light on the potential mechanisms involved:

1. Genetic Factors: There is evidence to suggest that stuttering may have a genetic component. Studies have shown that stuttering tends to run in families, and certain genetic variations may increase susceptibility to the disorder. However, no specific “stuttering gene” has been identified, and genetics alone cannot account for all cases of stuttering.

2. Neurological Factors: Stuttering is thought to involve abnormalities in the brain’s speech-processing areas and neural pathways. Some studies have identified differences in brain structure and function in individuals who stutter. For example, there may be variations in the size or activity of regions like the left inferior frontal gyrus, which is involved in speech production and language processing.

3. Neural Processing Differences: Stuttering may be associated with differences in how the brain processes speech and language. It is hypothesized that individuals who stutter may have difficulties with the timing and coordination of the neural circuits responsible for speech production, leading to disruptions in fluency.

4. Developmental Factors: Stuttering often begins in childhood during a period of rapid language and speech development. Some researchers suggest that developmental factors, such as the rate at which a child’s speech and language skills develop, may contribute to stuttering. Children who experience a rapid increase in speech demands without a corresponding increase in their abilities for motor control of speech may be more susceptible to stuttering.

5. Environmental and Psychological Factors: While genetic and neurological factors play a role, environmental and psychological factors can also influence the severity and persistence of stuttering. Stress, anxiety, and social pressure can exacerbate stuttering, while supportive and communicative environments can help individuals manage their stuttering more effectively.

It’s important to note that stuttering is a highly variable condition, and the pathophysiology may differ from one individual to another. Additionally, ongoing research continues to refine our understanding of the disorder, and new insights are regularly emerging. Speech-language pathologists and researchers work together to develop and refine therapies that address the specific needs of individuals who stutter, taking into account the complex interplay of genetic, neurological, and environmental factors.

Stuttering signs and symptoms

Stuttering signs and symptoms may include:

• Difficulty starting a word, phrase, or sentence,
• Prolonging a word or sounds within a word,
• Repetition of a sound, syllable, or word,
• Brief silence for certain syllables or words, or pauses within a word (broken word),
• Addition of extra words such as “um” if difficulty moving to the next word is anticipated,
• Excess tension, tightness, or movement of the face or upper body to produce a word,
• Anxiety about talking,
• Limited ability to effectively communicate.

Classification of stuttering

Stuttering can be classified into several categories or types based on various factors, including its characteristics and presentation. The classification of stuttering helps clinicians and researchers understand the nature of the disorder and tailor treatment approaches accordingly. Here are some common classifications of stuttering:

1. Developmental Stuttering:
• Developmental stuttering is the most common type and typically begins in childhood as a child is learning to speak.
• It often starts between the ages of 2 and 4 when language and speech skills are developing.
• Developmental stuttering can vary in severity, and many children naturally outgrow it with age or through speech therapy.

2. Neurogenic Stuttering:
• Neurogenic stuttering is associated with neurological conditions or injuries that affect the brain’s speech centers or motor control.
• It can result from conditions such as strokes, traumatic brain injuries, or other neurological disorders.
• Neurogenic stuttering may have a sudden onset and typically occurs in adulthood.

3. Psychogenic Stuttering:
• Psychogenic stuttering is thought to be related to psychological factors and is often a response to stress, anxiety, or psychological trauma.
• It can occur suddenly and may resolve with appropriate psychological therapy or intervention.

4. Cluttering:
• Cluttering is a speech disorder characterized by rapid and disorganized speech, which may include frequent interruptions, irregular pacing, and unclear articulation.
• Unlike stuttering, which involves disruptions in speech flow, cluttering often involves overly rapid and hasty speech.
• Treatment for cluttering focuses on slowing down speech and improving articulation.

5. Acquired Stuttering:
• Acquired stuttering refers to stuttering that develops later in life due to specific events, such as head injuries, illnesses, or psychological trauma.
• It can be associated with sudden and noticeable changes in speech fluency.

6. Persistency:
• This classification considers whether stuttering persists into adulthood or if it is outgrown during childhood.
• Some individuals continue to stutter into adulthood, while others naturally recover or see significant improvements.

7. Secondary Behaviors:
• Stuttering may also be classified based on the presence of secondary behaviors. These are physical or verbal reactions to stuttering, such as facial grimaces, eye blinking, or word substitutions, used to avoid stuttering.
• Stuttering with secondary behaviors can be more complex and challenging to treat.

8. Severity Levels:
• Stuttering can be classified by its severity, ranging from mild to severe. Severity is often determined by the frequency and duration of disfluencies, as well as the impact on communication.

It’s important to note that these classifications are not always mutually exclusive, and some individuals may exhibit characteristics of more than one type of stuttering. Additionally, the presentation and classification of stuttering can vary from person to person. Stuttering is a complex communication disorder, and assessment by a qualified speech-language pathologist is essential to determine the most appropriate treatment and management strategies for each individual.

Stuttering therapy

Treatment for stuttering often involves a combination of therapeutic approaches tailored to the individual’s specific needs and goals. Here is a list of some of the common therapeutic approaches used for the treatment of stuttering:

1. Speech Modification Techniques:

• Fluency Shaping: This approach focuses on teaching individuals who stutter to speak more fluently by modifying their speech patterns. Techniques may include slowing down speech rate, prolonging vowel sounds, and using gentle onsets (soft starts to words).
• Easy Onset: Encourages individuals to start words or sentences with gentle, easy starts instead of sudden or forceful starts, reducing tension and improving fluency.

2. Stuttering Modification Strategies:

• Cancellation: After a stuttering event occurs, individuals pause, acknowledge the stutter, and then repeat the word or phrase with reduced tension and increased fluency.
• Pull-Out: When stuttering starts, individuals pause and transition smoothly out of the stutter, correcting it mid-speech.
• Preparation: Individuals anticipate challenging words or situations and use techniques like stretching sounds or lightly tapping to reduce stuttering.

3. Cognitive-Behavioral Therapy (CBT):

CBT aims to address the emotional and psychological aspects of stuttering, such as anxiety, fear, and negative self-perceptions. It helps individuals develop coping strategies and improve their self-esteem.

4. Desensitization and Confidence-Building:

Therapy may involve desensitization techniques, such as voluntarily stuttering or speaking in challenging situations to reduce anxiety and build confidence.

5. Group Therapy:

Group therapy provides a supportive environment for individuals who stutter to practice fluency techniques, share experiences, and gain social confidence.

6. Parent/Caregiver Training:

Parents and caregivers can learn strategies to create a supportive communication environment for their child who stutters, helping them communicate more comfortably.

7. Stress and Anxiety Management:

Stress and anxiety can exacerbate stuttering. Techniques such as relaxation exercises, mindfulness, and stress reduction strategies can be integrated into therapy to manage emotional triggers.

8. Neurofeedback and Biofeedback:

Neurofeedback or biofeedback is used to gain better control over physiological responses associated with stuttering, such as muscle tension or stress.

9. Electronic Devices and Apps:

Speech therapy apps and devices may provide visual or auditory feedback to assist individuals in monitoring and improving their speech patterns.

10. Supportive Counseling:

Some individuals find it helpful to engage in counseling to discuss the emotional and psychological aspects of living with stuttering, such as self-acceptance and managing societal pressures.

It’s important to note that stuttering therapy should be personalized to meet the unique needs of each individual. A qualified and experienced speech-language pathologist (SLP) or therapist who specializes in stuttering can assess the specific challenges faced by the person who stutters and develop a tailored treatment plan. Early intervention is often crucial in helping children who stutter, but therapy can also be beneficial for teenagers and adults. The goal of therapy is to improve speech fluency, communication confidence, and overall quality of life.

Biofeedback speech therapy for stuttering

Biofeedback speech therapy for stuttering is a therapeutic technique that is used as part of the treatment of stuttering to help individuals gain better control over physiological processes, such as muscle tension and stress that may contribute to stuttering. While biofeedback is not a standalone treatment for stuttering, it can be a valuable component of a comprehensive therapy program. Here’s how biofeedback can be used in the treatment of stuttering:

1. Muscle Tension Monitoring:

Electromyographic (EMG) biofeedback speech therapy for stuttering can be used to monitor muscle tension, especially in the muscles associated with speech production (e.g., facial muscles, and neck muscles).

Individuals who stutter can learn to recognize patterns of excessive muscle tension during speech, which can contribute to disfluencies. Biofeedback provides real-time information about muscle activity, helping them become more aware of tension and relaxation in these muscles.

2. Relaxation Training:

Biofeedback can assist in teaching individuals relaxation techniques to reduce muscle tension and stress.

By seeing or hearing their physiological responses on a biofeedback monitor (e.g., muscle activity or skin conductance), individuals can practice relaxation exercises and learn to control their bodily responses.

3. Stress Reduction:

Stress and anxiety can exacerbate stuttering. Biofeedback can help individuals learn to manage stress and anxiety levels by providing feedback on physiological indicators of stress, such as heart rate variability or skin temperature.

With biofeedback, individuals can develop strategies to reduce stress and anxiety during speaking situations.

4. Breathing Control:

Breathing patterns play a significant role in speech production and fluency. Breathing biofeedback speech therapy for stuttering can be used to monitor and adjust breathing patterns during speech.

By providing feedback on respiratory rate and depth, individuals can learn to control their breath and reduce breath-related disfluencies.

5. Generalization and Self-Regulation:

The skills learned through biofeedback training can be applied in real-life speaking situations. Individuals can use the self-regulation techniques acquired during biofeedback therapy to improve their overall speech fluency.

6. Progress Monitoring:

Biofeedback sessions can track and record progress over time, allowing individuals and therapists to assess the effectiveness of relaxation and self-regulation strategies.
It’s important to note that biofeedback is typically used with other evidence-based stuttering therapy approaches, such as speech modification techniques, stuttering modification strategies, and cognitive-behavioral therapy. A qualified speech-language pathologist or therapist specializing in stuttering therapy can integrate biofeedback into an individualized treatment plan based on the specific needs and goals of the person who stutters.

The effectiveness of biofeedback in stuttering treatment can vary from person to person, and the choice to use biofeedback should be made in consultation with a qualified therapist. When integrated appropriately, biofeedback can help individuals become more aware of and better control the physiological factors contributing to stuttering, ultimately improving speech fluency and communication confidence.

What modalities of biofeedback speech therapy for stuttering can be used for effective treatment?

Several modalities of biofeedback can be used for stuttering treatment to help individuals gain better control over physiological processes that may contribute to disfluency. These modalities provide real-time feedback on specific physiological indicators, allowing individuals to monitor and adjust their responses. Here are some of the modalities of biofeedback that can be used in stuttering treatment:

1. Electromyographic (EMG) Biofeedback speech therapy for stuttering:

• EMG biofeedback measures muscle activity and tension by using electrodes placed on the skin’s surface or inside the mouth to monitor the activity of speech-related muscles.
• For stuttering treatment, EMG biofeedback can help individuals become aware of excessive tension in muscles involved in speech production (e.g., facial muscles, and neck muscles).
• By visualizing muscle activity in real-time, individuals can learn to relax these muscles during speech to reduce tension-related disfluencies.

2. Respiratory Biofeedback:

• Respiratory biofeedback focuses on monitoring and controlling breathing patterns, which are closely related to speech fluency.
• Individuals can use respiratory biofeedback to adjust their breathing rate, depth, and coordination during speech to reduce breath-related disfluencies.

3. Heart Rate Variability (HRV) Biofeedback:

• HRV biofeedback measures the variation in time between successive heartbeats, which reflects the body’s physiological response to stress and relaxation.
• It can help individuals learn to manage stress and anxiety levels, which can impact stuttering.
• By increasing heart rate variability, individuals can promote relaxation and reduce the physiological stress response during speaking situations.

4. Skin Conductance Biofeedback:

• Skin conductance biofeedback monitors the electrical conductance of the skin, which can indicate changes in emotional arousal and stress levels.
• Individuals can use skin conductance biofeedback to become aware of stress reactions and learn relaxation techniques to reduce stress-related disfluencies.

5. Temperature Biofeedback:

• Temperature biofeedback measures changes in skin temperature, which can be influenced by emotional and stress responses.
• It can help individuals learn to regulate their body’s temperature and reduce the physiological effects of stress on speech.

6. Neurofeedback or Brainwave (EEG) Biofeedback speech therapy for stuttering:

EEG biofeedback, also known as neurofeedback, monitors brainwave activity and provides feedback on brainwave patterns to help individuals regulate brain activity associated with speech production and anxiety.

7. Biofeedback Apps and Software:

• Various biofeedback apps and software programs are available for smartphones and computers.
• These apps may provide visual or auditory feedback on physiological indicators and can be used for self-regulation and practice outside of therapy sessions.

The choice of biofeedback modality depends on the specific needs and goals of the individual who stutters and should be determined in collaboration with a qualified speech-language pathologist or therapist who specializes in stuttering therapy. Biofeedback is often integrated into a comprehensive stuttering therapy program, along with other evidence-based therapeutic approaches, to help individuals improve speech fluency and communication confidence.

Role of EMG biofeedback in the treatment of stuttering

EMG (Electromyography) biofeedback is a therapeutic technique that can be used as a component of the treatment of stuttering. Its primary role is to assist individuals who stutter in gaining greater awareness and control over the muscle tension and coordination involved in speech production. Here’s how EMG biofeedback can be beneficial in the treatment of stuttering:

1. Muscle Tension Awareness: EMG biofeedback provides real-time feedback on the activity of specific muscles involved in speech production, such as the muscles around the mouth, lips, jaw, and throat. By monitoring muscle activity, individuals who stutter can become more aware of patterns of excessive tension and learn to recognize when they are tensing these muscles unnecessarily.

2. Tension Reduction: The visual or auditory feedback provided by EMG biofeedback can help individuals reduce excessive muscle tension during speech. When they see or hear that they are tensing their speech muscles, they can work to relax and release that tension, which can lead to smoother and more fluent speech.

3. Muscle Coordination: Stuttering often involves disruptions in the coordination of speech muscles. EMG biofeedback can assist in improving muscle coordination by helping individuals learn to activate and deactivate the relevant muscles at the right times during speech.

4. Biofeedback-Based Practice: EMG biofeedback allows individuals to practice speech with immediate feedback in a controlled environment. This practice can help them develop new, more fluent speech patterns while reducing tension-related behaviors.

5. Self-Regulation: Over time, individuals can learn to self-regulate their muscle tension and speech patterns without the need for continuous biofeedback. They can carry the skills and awareness gained from biofeedback sessions into their everyday communication.

6. Individualized Therapy: EMG biofeedback can be tailored to the specific needs of each person who stutters. Therapists can target specific muscle groups and patterns of tension that are unique to the individual’s speech difficulties.

It’s important to note that EMG biofeedback is often used as part of a comprehensive stuttering therapy program, which may include other therapeutic approaches such as speech modification techniques, stuttering modification strategies, and cognitive-behavioral therapy. The choice of therapy approaches and the inclusion of EMG biofeedback will depend on the individual’s specific needs and goals for improving their fluency and reducing stuttering.

As with any therapeutic intervention, the effectiveness of EMG biofeedback in stuttering treatment can vary from person to person. Therefore, it should be administered and supervised by a qualified speech-language pathologist or therapist who specializes in stuttering therapy and can tailor the treatment plan to the individual’s unique needs.

EMG electrode placement sites for biofeedback for stuttering

Electromyography (EMG) biofeedback involves placing electrodes on specific muscle groups associated with speech production and providing visual or auditory feedback to the individual about the activity of these muscles. This feedback can assist in reducing tension and improving muscle coordination during speech. Here are some common electrode placement sites for EMG biofeedback in stuttering therapy:

Head Muscles:

1. Orbicularis Oris Muscle: The orbicularis oris muscle is a circular muscle that surrounds the mouth and plays a significant role in speech production. This muscle controls lip movements during speech, and excessive tension in this muscle can lead to difficulties in articulation and fluency EMG electrodes can be placed on the corners of the mouth or along the upper and lower lips to monitor muscle activity. This can help individuals become aware of excessive muscle tension and facilitate relaxation.

2. Mentalis Muscle: The mentalis muscle is located in the chin area and can be involved in the lower lip and chin movements during speech. Excessive tension in this muscle can lead to difficulties in articulation and fluency. Electrodes can be placed on the chin to monitor this muscle’s activity and help individuals reduce unnecessary tension.

3. Frontalis Muscle: The frontalis muscle is located in the forehead and is involved in facial expressions. Although not directly related to speech, it can be monitored to assess overall muscle tension and relaxation.

4. Facial Muscles: Various facial muscles, including the frontalis (forehead) and corrugator supercilii (between the eyebrows), can become tense during stuttering moments, contributing to facial tension that may impact speech.

5. Buccinator Muscle: This muscle is located in the cheeks. It plays a role in controlling the oral cavity during speech. Tension in the buccinator muscle can influence articulation.

6. Temporalis Muscle: This muscle is located on the side of the head, it can influence jaw movement and tension.

7. Masseter Muscle: Masseter muscle is part of the jaw muscles, it can contribute to jaw tension during speech.

8. Palatal Muscles: These are muscles of the soft palate (velum), such as the palatoglossus and palatopharyngeus, which affect resonance and articulation.

Neck muscles

1. Suprahyoid Muscles: The suprahyoid muscles include muscles like the digastric and mylohyoid, which play a role in laryngeal control and swallowing. The suprahyoid muscles are located under the chin, and beneath the jaw, and are involved in jaw and tongue movement during speech, laryngeal control, and swallowing. Tension in these muscles can affect vocal control and fluency.
Electrodes may be placed along the neck or jawline to monitor the activity of these muscles.

2. Infrahyoid Muscles: The infrahyoid muscles (sternohyoid and omohyoid) are also located under the chin, below the suprahyoid muscles, can influence laryngeal control and voice production, and are also involved in speech-related movements. Monitoring and training these muscles can help reduce tension-related disfluencies.
Electrodes can be placed in the neck area to monitor these muscles.

3. Platysma Muscle: The platysma muscle is a thin sheet of muscle that covers the front of the neck. It can play a role in neck tension during speech. Electrodes may be placed along the neck to monitor platysma muscle activity.

4. Trapezius Muscle: The trapezius muscle is a large muscle that extends down the neck and upper back. Specifically, the upper portion of the trapezius muscle in the neck and upper back can become tense during stuttering and may contribute to neck and shoulder tension, affecting overall speech tension.

5. Sternocleidomastoid (SCM) Muscle: The sternocleidomastoid muscle runs from the base of the skull to the collarbone and sternum. Tension in the SCM can affect head and neck posture and potentially contribute to speech tension.

6. Scalene Muscles: The scalene muscles are located on the sides of the neck and play a role in neck movement and respiration. Tension in the scalenes can affect overall neck tension and posture during speech.

7. Longus Colli Muscle: This muscle is situated in the anterior (front) portion of the neck and contributes to neck flexion and head movement. Monitoring and training this muscle can help reduce tension in the front of the neck.

These muscles collectively contribute to the coordination, tension, and control involved in speech production. Monitoring and training them with EMG biofeedback can assist individuals who stutter in becoming more aware of and regulating muscle activity to improve speech fluency and reduce disfluencies.

The specific electrode placements may vary based on the individual’s unique speech patterns and muscle tension issues. The goal of EMG biofeedback is to help individuals become more aware of muscle tension patterns and learn to control and reduce tension during speech, ultimately improving fluency.

Role of Breathing Biofeedback in Stuttering Treatment

Breathing biofeedback can be a helpful component of stuttering therapy by assisting individuals in developing better control over their breathing patterns during speech. Proper breathing techniques can contribute to improved speech fluency and reduced stuttering. Here’s the role of breathing biofeedback in the treatment of stuttering and how it can be performed:

1. Increased Awareness: Breathing biofeedback helps individuals become more aware of their breathing patterns, such as shallow or irregular breathing, which can contribute to stuttering.

2. Controlled Breathing: It teaches individuals how to control their breath, allowing for more relaxed and controlled speech production.

3. Reduction of Tension: Proper breathing techniques can help reduce overall muscle tension, including tension in the speech muscles, which can enhance speech fluency.

4. Anxiety Management: Breath control techniques can also be beneficial for managing anxiety, which can exacerbate stuttering. Deep, slow breaths can promote relaxation and reduce anxiety-related tension.

Performing Breathing Biofeedback for Stuttering

Here are the general steps for Breathing biofeedback:

1. Assessment: The therapist will first assess the individual’s current breathing patterns and their impact on speech fluency. This may involve monitoring chest, diaphragmatic, or abdominal breathing, as well as the rate and depth of breaths.

2. Sensor Placement: Small sensors or electrodes may be attached to the individual’s chest, abdomen, or other relevant areas to monitor breathing patterns. These sensors are connected to a biofeedback device.

3. Feedback Display: The biofeedback device provides real-time visual or auditory feedback based on the individual’s breathing patterns. This feedback can be displayed on a computer screen or through audio cues.

4. Training: The therapist will guide the individual through exercises and techniques to improve their breathing patterns. This may include exercises to promote diaphragmatic breathing (deep belly breathing) and to control the rate and rhythm of breaths.

5. Practice: The individual practices these techniques while receiving feedback from the biofeedback device. They learn to make adjustments in their breathing to achieve smoother and more controlled speech.

6. Generalization: Over time, the goal is for the individual to apply these breathing techniques in their everyday communication, not just during therapy sessions. The therapist helps the individual transfer these skills to real-life situations.

7. Progress Monitoring: Progress is monitored throughout therapy to track improvements in breathing patterns and speech fluency. Adjustments to the treatment plan can be made as needed.

The effectiveness of Breathing biofeedback speech therapy for stuttering can vary from person to person, and it is essential to work with a qualified speech-language pathologist or therapist who can tailor the treatment to the individual’s specific needs and goals.

Role of Heart Rate Variability biofeedback speech therapy for stuttering

Heart Rate Variability (HRV) biofeedback is a therapeutic technique that can be used as part of the treatment of stuttering, particularly for managing stress and anxiety, which are known to exacerbate stuttering. HRV biofeedback focuses on regulating the variation in time between successive heartbeats, which reflects the body’s physiological response to stress and relaxation.

Here’s the role of HRV biofeedback in stuttering treatment and how it works:

1. Stress Reduction: Stuttering often occurs or worsens in stressful situations. HRV biofeedback helps individuals learn to manage stress by providing real-time feedback on their physiological responses, such as heart rate variability. By increasing HRV, individuals can promote relaxation and reduce the physiological stress response during speaking situations.

2. Anxiety Management: Anxiety is a common trigger for stuttering. HRV biofeedback can teach individuals to regulate their anxiety levels by monitoring changes in heart rate variability. As they become more skilled in HRV control, they can apply these techniques to reduce anxiety associated with speaking.

3. Emotional Regulation: Stuttering can lead to negative emotions, which, in turn, can exacerbate speech difficulties. HRV biofeedback can help individuals gain better control over their emotional responses by promoting emotional regulation and resilience.

4. Improved Self-Regulation: HRV biofeedback enhances an individual’s ability to self-regulate physiological responses. This can be especially valuable during moments of stuttering, as individuals can learn to stay calm and composed, reducing the likelihood of disfluencies caused by increased tension.

How HRV Biofeedback Works

1. Sensor Placement: HRV biofeedback typically involves the placement of sensors on the individual’s skin, often on the chest or wrists, to monitor heart rate variability.

2. Data Collection: The sensors continuously collect data on the time intervals between heartbeats (R-R intervals), which represent HRV.

3. Real-Time Feedback: The collected data are processed and displayed in real-time on a computer screen or through a mobile app. Individuals can see graphical representations of their HRV.

4. Breathing Techniques: HRV biofeedback often incorporates specific breathing techniques, such as slow, deep diaphragmatic breathing. The individual is guided to synchronize their breathing with the displayed HRV pattern.

5. Feedback and Practice: As individuals practice controlled breathing and see changes in their HRV patterns, they learn to associate specific breathing techniques with increased HRV and reduced stress. This reinforces relaxation and stress reduction skills.

6. Progress Monitoring: Over time, individuals can monitor their progress in increasing HRV and reducing stress and anxiety levels. They may see improvements in their ability to remain calm during speaking situations and experience fewer stuttering incidents.

7. Generalization: The self-regulation skills learned through HRV biofeedback can be applied in real-life speaking situations, helping individuals manage stress and anxiety while communicating.

HRV biofeedback, when integrated into a comprehensive stuttering therapy program, can be a valuable tool for individuals seeking to reduce the impact of stress and anxiety on their speech fluency. It empowers them with the skills to better regulate their physiological responses, ultimately contributing to improved speech confidence and fluency.

Role of acoustic biofeedback in stuttering treatment

Acoustic biofeedback is a therapeutic tool used in the treatment of stuttering to help individuals gain better control over their speech patterns and enhance their fluency. Acoustic biofeedback provides real-time auditory feedback on various aspects of speech, allowing individuals to monitor and adjust their speech production. Here’s the role of acoustic biofeedback in stuttering treatment:

1. Awareness of Stuttering Patterns: Acoustic biofeedback helps individuals who stutter become more aware of their stuttering patterns, including the frequency and severity of disfluencies (stuttering moments). By hearing their speech in real-time, individuals can identify specific problem areas and patterns.

2. Monitoring Speech Rate: Acoustic biofeedback can provide feedback on speech rate or speaking too quickly, which can contribute to stuttering. Individuals can learn to adjust their speaking rate to a more comfortable and controlled pace.

3. Smoothness and Fluency: Acoustic biofeedback can highlight moments of speech tension or disruptions in the flow of speech. By listening to their speech in real-time, individuals can work on producing smoother, more fluent speech patterns.

4. Pitch and Volume Control: Some acoustic biofeedback systems can provide feedback on pitch and volume variations in speech. This can help individuals achieve more consistent pitch and volume levels, which can contribute to fluency.

5. Delay or Altered Auditory Feedback: In some cases, acoustic biofeedback systems introduce a slight delay or alter the pitch of the individual’s voice. These alterations can create a “choral” effect, which may reduce stuttering and improve fluency for some individuals.

6. Practice and Self-Regulation: Acoustic biofeedback allows individuals to practice speech techniques and strategies while receiving immediate feedback. With guidance from a speech-language pathologist, they can develop self-regulation skills to adjust their speech in real-time.

7. Transfer to Everyday Communication: The goal of acoustic biofeedback therapy is to help individuals generalize the skills learned in therapy sessions to their everyday communication. They can apply the techniques and strategies to reduce stuttering and improve fluency in real-world situations.

8. Progress Tracking: Acoustic biofeedback sessions can track and record progress over time. This data can be used to evaluate the effectiveness of therapy and make adjustments to the treatment plan as needed.

The choice of therapy approaches and the inclusion of acoustic biofeedback will depend on the individual’s specific needs and goals for improving their fluency and reducing stuttering.

As with any therapeutic intervention, the effectiveness of acoustic biofeedback in stuttering treatment can vary from person to person. Therefore, it should be administered and supervised by a qualified speech-language pathologist or therapist who specializes in stuttering therapy and can tailor the treatment plan to the individual’s unique needs.

How to perform acoustic biofeedback for stuttering

Performing acoustic biofeedback for stuttering typically involves using specialized equipment and software under the guidance of a qualified speech-language pathologist or therapist who specializes in stuttering therapy.

Here’s a general overview of how acoustic biofeedback for stuttering can be performed:

1. Assessment and Evaluation:
• Before starting acoustic biofeedback therapy, the speech-language pathologist (SLP) will conduct a comprehensive assessment to evaluate the individual’s stuttering patterns, speech characteristics, and specific needs.
• The SLP will determine which aspects of speech (e.g., speech rate, fluency, pitch, volume) would benefit from acoustic biofeedback.

2. Selecting and Setting Up Equipment:
• The SLP will choose appropriate acoustic biofeedback equipment and software based on the individual’s therapy goals and needs. This may include software designed for speech therapy that provides real-time auditory feedback.
• The equipment typically includes a microphone to capture the individual’s speech and speakers or headphones to deliver the auditory feedback.

3. Baseline Recording:
• The initial session may involve recording the individual’s baseline speech patterns without any biofeedback. This helps establish a starting point for therapy and provides a reference for progress.

4. Biofeedback Sessions:
• During biofeedback sessions, the individual will speak into the microphone while the system provides real-time auditory feedback.
• The feedback may focus on specific aspects of speech that are problematic, such as speaking rate, pitch, or fluency. For example, the system might provide auditory cues when the individual speaks too quickly or stutters.
• The individual will work with the SLP to develop strategies for adjusting their speech based on the feedback provided. This may involve practicing speaking at a more controlled rate, producing smoother speech, or adjusting pitch and volume.
• The individual and SLP will review and discuss the feedback during the session, identifying areas for improvement and setting goals for future sessions.

5. Practice and Generalization:
• The individual will practice the techniques learned in biofeedback sessions and attempt to generalize them to real-world communication situations.
• The SLP will work with the individual to apply the strategies learned in therapy to everyday speaking scenarios, such as conversations with family, and friends, and in various social contexts.

6. Progress Tracking and Adjustments:
• Throughout the course of therapy, progress will be monitored and tracked using data collected during biofeedback sessions.
• The SLP will make adjustments to the treatment plan based on the individual’s progress, changing therapy goals as needed.

7. Termination and Maintenance:
• Therapy may continue until the individual achieves their therapy goals or experiences significant improvement in fluency and stuttering management.
• After therapy is completed, individuals may benefit from periodic follow-up sessions to maintain their progress and address any challenges that arise.

The SLP will tailor the treatment plan to the individual’s unique needs and provide guidance and support throughout the therapy process. Acoustic biofeedback is just one component of a comprehensive stuttering therapy program that may include other therapeutic approaches and techniques.

Use of the Forbrain audio-vocal biofeedback device in the treatment of stuttering

The Forbrain audio-vocal biofeedback device was marketed as a tool that combines bone conduction and auditory feedback to help individuals improve their speech and communication skills. It was primarily designed to assist with various speech and language challenges, including stuttering. Here’s how the Forbrain device is typically used and its potential role in the treatment of stuttering:

1. Auditory Feedback: The Forbrain device includes a microphone and bone conduction technology that delivers auditory feedback directly to the wearer’s ears. It enhances the perception of their own voice as they speak.

2. Voice Enhancement: Forbrain is designed to provide clearer and more resonant auditory feedback, which can help individuals become more aware of their speech patterns, including any stuttering or disfluencies.

3. Speech Practice: Users can practice speaking while wearing the device, and the device provides real-time auditory feedback, allowing individuals to monitor their speech.

4. Attention and Focus: Forbrain is also intended to help users improve their attention and concentration. By wearing the device during speech practice, individuals may become more focused on their speech, which can indirectly help reduce stuttering.

5. Neurological Training: The use of Forbrain may promote neuroplasticity, potentially leading to improved speech fluency and reduced stuttering over time.

Forbrain improves self-awareness which makes speech easier to correct. Forbrain helps correct the processing of sensory and auditory information and improves listening skills.

Role of neurofeedback in the treatment of stuttering. How to perform?

Stuttering has been linked to weakness in the fibers that carry nerve impulses among three regions: the thalamus, which relays sensory signals; the basal ganglia, which coordinates movements; and the cerebral cortex, which is involved in cognition and integration of sensory and motor signals.

There are many connections within and among these brain areas. In the cortex, a key fiber link is the arcuate fasciculus, which shows deficiencies in people who stutter. Other potentially poor connections are within the basal ganglia and in the network linking all areas, the cortico-basal ganglia-thalamocortical loop.

The International 10-20 System is a standardized method for electrode placement used in electroencephalography (EEG) to locate specific areas of the scalp relative to underlying brain regions. While the primary focus of the 10-20 system is on general brain activity monitoring, it can be adapted for speech neurofeedback by targeting regions of the brain associated with language and speech processing. Here are some electrode placement sites based on the 10-20 System that can be relevant for speech neurofeedback:

1. Frontal Electrodes:
F7 and F8: These electrodes are located over the left and right frontal lobes, respectively. They may be relevant for speech neurofeedback as the frontal lobes are involved in various aspects of language production and executive functions.

2. Temporal Electrodes:
T3 and T4: These electrodes are positioned over the left and right temporal lobes. The temporal lobes are crucial for language comprehension and auditory processing, which are integral to speech.

3. Central Electrodes:
C3 and C4: These electrodes are situated over the central region of the scalp and may be relevant for speech neurofeedback as they are associated with motor functions, including motor control of speech.

4. Parietal Electrodes:
P3 and P4: These electrodes are located over the left and right parietal lobes, which are involved in various aspects of language processing and sensory integration.

5. Frontocentral Electrodes:
FC5 and FC6: Positioned between the frontal and central regions, these electrodes may capture neural activity related to speech planning and execution.

6. Supplementary Motor Area (SMA):
FCz: Located at the midline of the scalp, FCz is associated with motor planning and may be relevant for speech motor control.

7. Broca’s Area (Left Hemisphere):
F5 and F3: These electrodes are located over the left frontal region and may be of particular interest in speech neurofeedback as Broca’s area is essential for language production and speech fluency.

8. Wernicke’s Area (Left Hemisphere):
T5: Positioned over the left temporal lobe, T5 may be associated with language comprehension and processing.

9. Angular Gyrus (Left Hemisphere):
P5: Over the left parietal lobe, P5 may play a role in language processing and comprehension.

Besides rewiring the brain in the specific brain area responsible for speech fluency neurofeedback can be effective also by regulating the conditions concomitant to stuttering.

1. Stress and Anxiety Management: Stuttering can often be exacerbated by stress and anxiety. Neurofeedback may help individuals learn to regulate their stress response and reduce anxiety levels, which can indirectly contribute to improved fluency by reducing tension associated with stuttering.

2. Attention and Concentration: Neurofeedback can be used to train individuals to enhance their attention and concentration abilities. Improved attention control may help individuals who stutter maintain focus on their speech and reduce the likelihood of stuttering interruptions.

3. Relaxation and Self-Regulation: Neurofeedback can teach individuals self-regulation skills, which may be beneficial for managing emotional responses and muscle tension during speech production.

It’s important to note that the choice of electrode placement should be guided by the specific objectives of the speech neurofeedback therapy and the individual’s unique needs. Electrode positions can be adjusted to target brain regions associated with speech production, language comprehension, and fluency. Additionally, a qualified clinician or therapist with expertise in neurofeedback for speech and language disorders should be consulted to determine the most appropriate electrode montage for achieving therapeutic goals.

The electronic devices that can be used for treatment of stuttering

Several electronic devices and technologies can be used to assist in the treatment and management of stuttering. These devices are often used in conjunction with traditional speech therapy techniques to provide real-time feedback and enhance therapy outcomes. Here is a list of some electronic devices and their descriptions:

1. SpeechEasy Device:
• SpeechEasy is a wearable electronic device that resembles a hearing aid. It uses delayed auditory feedback (DAF) or altered auditory feedback (AAF) to provide real-time auditory feedback to the individual who stutters.
• How It Works: When the person speaks, their voice is slightly delayed or altered in pitch, which can reduce stuttering frequency and severity.

2. VibroTactile Feedback Devices:
• These devices provide tactile (vibratory) feedback to help individuals monitor and control their speech rate and fluency.
• How They Work: VibroTactile feedback devices can be worn as wristbands or placed on the skin. They vibrate in response to specific speech patterns, providing a tactile cue to slow down or ease tension.

3. FluencyMaster Device:
• FluencyMaster is a handheld electronic device designed to assist individuals in practicing fluency-enhancing techniques.
• How It Works: The device generates a metronome-like beat that individuals can synchronize their speech with to achieve a more controlled and fluent speech pattern.

4. Apps and Software:
• Various smartphone and computer apps are available to support individuals in practicing speech techniques and monitoring their progress.
• Some apps provide visual or auditory feedback, such as fluency charts or metronome-like cues, to assist with speech modification and fluency shaping.

5. Voice Analysis Software:
• Specialized voice analysis software can be used to analyze speech patterns and provide visual feedback on pitch, intensity, and speech rate.
• This software can help individuals and therapists track progress and identify areas for improvement.

6. Biofeedback Devices:
• Biofeedback devices can monitor physiological indicators of stress and tension, which can be associated with stuttering.
• They may include sensors for measuring muscle tension, heart rate variability, or skin conductance. The data can help individuals learn to manage stress during speech.

7. Mobile Communication Devices:
• Mobile devices such as smartphones and tablets offer various apps and tools that can aid individuals in communication, including text-to-speech apps, speech synthesis software, and augmentative and alternative communication (AAC) apps.

It’s important to note that the effectiveness of electronic devices in stuttering treatment can vary from person to person. These devices are often used as adjuncts to traditional speech therapy techniques, and the selection of a specific device should be based on an individual’s needs, goals, and preferences. A qualified speech-language pathologist or therapist who specializes in stuttering therapy can help assess whether and how these devices may be beneficial and provide guidance on their use.

Conclusion

Biofeedback Speech Therapy for Stuttering represents a promising and innovative approach in the realm of stuttering treatment. This therapeutic method harnesses the power of real-time physiological feedback to empower individuals who stutter with tools for enhanced fluency and communication confidence. Through the precise monitoring and training of muscles, breathing patterns, and even neural activity, biofeedback speech therapy offers a holistic approach to address the multifaceted challenges associated with stuttering.

By delving into the principles, techniques, and potential benefits of biofeedback speech therapy for stuttering, we have uncovered a dynamic strategy that goes beyond traditional interventions. It equips individuals with the ability to gain better control over muscle tension, reduce stress and anxiety, and even modulate neural patterns related to speech production.

Biofeedback speech therapy for stuttering is a testament to the ongoing evolution of speech therapy practices, driven by a commitment to improving the lives of those affected by stuttering. This innovative approach reflects the interdisciplinary nature of stuttering therapy, drawing on insights from fields like psychology, physiology, and neurology to provide a comprehensive toolkit for clinicians and individuals alike.

As we look ahead, the continued research and application of biofeedback techniques in stuttering therapy hold the promise of even more personalized and effective treatments. The ability to tailor therapy plans to the unique needs of each individual, addressing their specific muscle tension patterns, emotional triggers, and neural responses, is a significant advancement in the field.

Biofeedback Speech Therapy for Stuttering reminds us that innovation, coupled with a deep understanding of the challenges faced by individuals who stutter, can lead to transformative results. As clinicians and researchers continue to explore the potential of biofeedback in stuttering therapy, we can anticipate brighter prospects for those seeking to unlock the fluent and confident communicators within themselves.

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Pelvic floor biofeedback and stim device for urinary incontinence

PELVIC FLOOR BIOFEEDBACK FOR URINARY INCONTINENCE

September 25, 2023

by Armine Zarayelyan with No Comment Uncategorized all

Urinary incontinence (UI), a prevalent condition affecting individuals across various age groups, can have a profound impact on one’s quality of life. The involuntary loss of bladder control can lead to not only physical discomfort but also emotional and social challenges. In the pursuit of innovative and effective solutions, medical research and treatment has turned its attention to the promising technique of biofeedback. Pelvic floor biofeedback for urinary incontinence offers a transformative path to regain control and confidence. Urinary incontinence, affecting countless lives, stems from multifaceted factors like muscle weakness and bladder overactivity. Pelvic floor biofeedback bridges this gap by facilitating real-time communication with the body. Through sensors and personalized cues, individuals learn to interpret and influence their physiological responses, targeting the root causes.

Table of Contents

What urinary incontinence is?

Urinary incontinence (UI) refers to the involuntary loss of bladder control, leading to the unintentional leakage of urine. It’s a common condition that can range in severity from occasional minor leaks to complete loss of bladder control. This loss of control can occur during activities such as coughing, sneezing, laughing, lifting, or even during moments of sudden urgency to urinate.
According to the World Health Organization, the prevalence of urinary incontinence reported in population-based studies ranges from 9.9% to 36.1% and is twice as high in older women as in older men. UI can occur at any age, but it is more common among women over 50. Urinary incontinence may be a temporary condition that results from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.
Urinary incontinence can be caused by various factors, including weakened pelvic floor muscles, overactive bladder muscles, nerve damage, hormonal changes, and certain medical conditions. It can affect people of all ages and genders, although it’s more prevalent among older adults and women, especially after childbirth or during menopause.

What are the four types of urinary incontinence?

There are four types of urinary incontinence: urgency, stress, overflow, and neurogenic incontinence.

Stress urinary incontinence is the most common type, concerns urine leakage associated with physical exertion, coughing, and sneezing. Weakness or damage to the pelvic floor muscles and tissues that support the bladder and urethra can result in stress incontinence.

During activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, or lifting, the pressure on the bladder exceeds the ability of the weakened muscles to keep the urethra closed. It is commonly seen in women, especially after childbirth, and may be related to weakened pelvic floor muscles or damaged urethral sphincters. This leads to leakage of urine. Stress incontinence is typically caused by weakened or stretched pelvic floor muscles and tissues that support the bladder and urethra. This weakening can be due to pregnancy, childbirth, obesity, hormonal changes, or aging.

Urgency urinary incontinence also known as overactive bladder (OAB) is characterized by a sudden and intense urge to urinate, often followed by involuntary urine leakage before reaching a restroom. Individuals with urgency incontinence may experience a frequent and uncontrollable need to urinate throughout the day and night. This type of incontinence is primarily caused by involuntary contractions of the bladder muscle (detrusor muscle) that create a sense of urgency. It can result from various factors, including neurological conditions, bladder irritation, certain medications, infections, or idiopathic (unknown) causes.

Overflow urinary incontinence is characterized by frequent or constant dribbling of urine from the bladder, often with the sensation of incomplete bladder emptying. Individuals may also experience difficulty initiating urination and a weak urinary stream. This type of incontinence is typically caused by an obstruction or blockage in the urinary tract, which prevents the bladder from emptying fully. Common causes include an enlarged prostate in men, urinary stones, constipation, or nerve damage that affects bladder contraction.

Neurogenic urinary incontinence occurs when there is a disruption in the normal communication between the nervous system and the bladder. It can manifest as either overactive or underactive bladder function, depending on which nerves are affected. Neurogenic incontinence can result from various neurological conditions or injuries, such as multiple sclerosis, Parkinson’s disease, spinal cord injuries, or stroke. These conditions can disrupt the coordination between the brain, spinal cord, and bladder, leading to either frequent and urgent voiding (overactive bladder) or an inability to empty the bladder completely (underactive bladder).

What are the causes of urinary incontinence?

Urinary incontinence can be caused by a variety of factors that affect the normal function of the urinary system. Some common causes include:

1. Weak Pelvic Floor Muscles

Weakened pelvic floor muscles, often due to childbirth, aging, or obesity, can lead to stress incontinence, where pressure on the bladder from activities like sneezing, laughing, or lifting causes urine leakage.

2. Overactive Bladder Muscles

When the muscles of the bladder contract involuntarily, creating a strong urge to urinate, it can result in urge incontinence or “overactive bladder.” This can be caused by various factors, including neurological conditions, infections, and certain medications.

3. Neurological Disorders

Conditions that affect the nervous system, such as multiple sclerosis, Parkinson’s disease, and stroke, can disrupt the signals between the brain and the bladder, leading to various types of incontinence.

4. Hormonal Changes

Hormonal fluctuations, especially in women during menopause, can lead to changes in the lining of the urethra and the bladder’s ability to store urine, contributing to incontinence.

5. Prostate Issues

In men, an enlarged prostate gland (benign prostatic hyperplasia) or prostate surgery can impact bladder control and lead to incontinence.

6. Urinary Tract Infections

Infections in the urinary tract can cause irritation and overactivity of the bladder, resulting in temporary incontinence.

7. Obstruction

An obstruction in the urinary tract, such as kidney stones or tumors, can disrupt the flow of urine and cause overflow incontinence.

8. Medications

Certain medications, like diuretics, sedatives, and alpha-blockers, can affect bladder function and contribute to incontinence.

9. Chronic Coughing

Conditions such as chronic bronchitis or smoking-related lung diseases can lead to chronic coughing, which can put stress on the pelvic muscles and lead to stress incontinence.

10. Physical Impairments

Mobility issues or physical disabilities that hinder a person’s ability to reach a restroom in time can contribute to functional incontinence.

11. Genetics

Some individuals may be genetically predisposed to developing weak pelvic floor muscles or other anatomical factors that increase the risk of incontinence.

12. Lifestyle Factors

Obesity, excessive caffeine or alcohol consumption, and inadequate fluid intake can exacerbate urinary incontinence symptoms.

Understanding the underlying cause of urinary incontinence is crucial for proper diagnosis and effective treatment.

The mechanism of urinary incontinence

The mechanism of urinary incontinence is closely tied to the role of pelvic floor muscles. Pelvic floor muscles are a group of skeletal muscles that form a sling-like structure at the base of the pelvis. These muscles are crucial for maintaining urinary continence. Here’s how they function:

1. Support: Pelvic floor muscles provide essential support to the bladder and other pelvic organs, keeping them in their proper position.

2. Sphincteric Function: The pelvic floor muscles encircle the urethra and the anal canal. They play a significant role in maintaining the closure of the urethra and preventing involuntary urine leakage. When these muscles contract, they compress the urethra, keeping it closed.

3. Voluntary Control: The external urethral sphincter, a part of the pelvic floor muscles, allows voluntary control over urination. When you choose to urinate, this muscle relaxes, allowing the release of urine. When you want to delay or stop urination, the external urethral sphincter contracts to close off the urethra.

The pelvic floor consists of layers of muscles and connective tissues connecting those muscles (ligaments) and wraps around the entirety of the pelvis. Two main muscles intertwine to form pelvic floor muscles:
• Levator ani composes the bulk of the pelvic floor muscles and consists of three separate muscle components:
– pubococcygeus,
– puborectalis and
– iliococcygeus.
• The coccygeus is the more minor muscle component in the pelvic floor muscles. It’s located toward the back of the pelvis.

Pelvic floor muscles can weaken as a result of injury or trauma, including childbirth and surgery. They can become stressed during pregnancy or from overuse (repeated heavy lifting, chronic coughing, constipation). They may grow weaker due to hormone changes during menopause and lose strength as a natural part of aging. Conditions like diabetes may also play a role in weakening pelvic floor muscles.

Understanding the role of pelvic floor muscles in maintaining continence and recognizing the factors that disrupt this balance is essential for diagnosing and effectively treating urinary incontinence. Strengthening these muscles through exercises like Kegel exercises can be a valuable part of managing certain types of incontinence, particularly stress incontinence. However, treatment approaches vary depending on the specific type and underlying causes of incontinence.

Common signs and symptoms of urinary incontinence include:

• Leaking urine when coughing, sneezing, laughing, or exercising.
• Feeling sudden, uncontrollable urges to urinate.
• Frequent urination.
• Waking up many times at night to urinate.
• Urinating during sleep.

Although pelvic floor muscles are hidden from view, they can be consciously controlled and therefore trained, much like arm, leg, or abdominal (tummy) muscles. Strengthening pelvic floor muscles will help to actively support and control the bladder. This reduces the likelihood of accidentally leaking from the bladder. Like other muscles in the body, pelvic floor muscles will become stronger with a regular exercise program. This is important for both men and women.

Treatment of urinary incontinence

The treatment of urinary incontinence varies based on the type and underlying causes of the condition. Here are some treatment approaches for different types of urinary incontinence:

1. Behavioral Interventions:
Behavioral interventions involve modifying habits and patterns that contribute to urinary incontinence. These can include bladder training, scheduled voiding, and fluid and diet management to reduce irritants and excessive urine production.

• Bladder Training: This technique involves gradually increasing the time between trips to the restroom to improve bladder capacity and reduce the frequency of urge incontinence.
• Scheduled Voiding: Establishing a regular schedule for emptying the bladder can help manage both urge and overflow incontinence by preventing overfilling or constant dribbling.
• Fluid and Diet Management: Adjusting fluid intake, particularly reducing caffeine and alcohol consumption, can help decrease bladder irritability and excessive urine production.

2. Pelvic Floor Muscle Exercises (Kegel Exercises):
Kegel exercises focus on strengthening the pelvic floor muscles that support the bladder and urethra. They are effective for both stress and urge incontinence by improving muscle tone and control.

• Stress Incontinence: Strengthening the pelvic floor muscles through Kegel exercises can provide better support to the bladder and reduce stress incontinence episodes.
• Urge Incontinence: Kegel exercises can also help individuals gain better control over their bladder and reduce urgency.

3. Medications:
Medications can help manage urinary incontinence by reducing overactive bladder contractions or relaxing bladder muscles. Anticholinergics and beta-3 adrenergic agonists are commonly prescribed for urge incontinence.

• Anticholinergics: These medications relax the bladder muscles and reduce spasms, making them useful for treating urge incontinence. Examples include oxybutynin, tolterodine, and solifenacin.
• Beta-3 Adrenergic Agonists: Some medications like mirabegron can increase bladder capacity and decrease the frequency of contractions, helping with both urgency and frequency.

4. Medical Devices:
Medical devices such as pessaries, which support the bladder and urethra, and urethral inserts that prevent leakage during specific activities can provide temporary relief for stress incontinence.

• Pessaries: A pessary is a device inserted into the vagina to provide support to the urethra and bladder, helping manage stress incontinence.
• Urethral Inserts: These are tampon-like disposable devices that can be inserted into the urethra to prevent leakage during specific activities.

5. Incontinence Pads and Products:

• Absorbent pads and adult diapers can provide temporary relief and increased confidence, especially for individuals with more severe incontinence.

6. Surgery:
Surgical options are considered for more severe cases of urinary incontinence. Procedures like sling placement or bladder neck suspension can provide additional support to the urethra for stress incontinence.

• Sling Procedures: Surgical placement of a sling under the urethra or bladder neck can provide additional support to prevent stress incontinence.
• Bladder Neck Suspension: A surgical procedure that supports the bladder neck and urethra to treat stress incontinence.
• Artificial Urinary Sphincter: For severe cases of stress incontinence, an artificial urinary sphincter can be implanted to provide manual control over the urethral opening.

7. Pelvic floor biofeedback:
Pelvic floor biofeedback is a non-invasive technique that uses sensors to provide real-time feedback about muscle activity and bladder function. For urinary incontinence, pelvic floor biofeedback assists in training individuals to strengthen pelvic floor muscles for stress incontinence and gain control over bladder contractions for urge incontinence.

• Pelvic floor biofeedback for urinary incontinence for pelvic floor muscle retraining is a treatment to help patients learn to strengthen or relax their pelvic floor muscles in order to improve bowel or bladder function and decrease some types of pelvic floor pain.
• Auxiliar muscles biofeedback: In addition to pelvic floor muscles, several other muscle groups such as abdominal, gluteal, quadriceps, etc. can play a role in managing urinary incontinence, depending on the type and underlying causes of the condition. EMG pelvic floor biofeedback is a valuable therapeutic technique used to target and train various muscle groups beyond the pelvic floor muscles in managing urinary incontinence, depending on the specific type and causes of the condition.

8. Neuromodulation:
• Sacral Nerve Stimulation: Electrical stimulation of the sacral nerves can help regulate bladder function and treat urge incontinence.

9. Botox Injections:
• Botox injections into the bladder muscle can help control overactive bladder symptoms by temporarily relaxing the muscle and reducing spasms.

10. Lifestyle Modifications:
• Maintaining a healthy weight, avoiding constipation, practicing good hygiene, and managing chronic cough can help alleviate urinary incontinence symptoms.

It’s important to note that the appropriate treatment depends on a thorough evaluation by a healthcare professional, who will consider factors such as the type and severity of incontinence, its underlying causes, the individual’s overall health, and their preferences. A comprehensive treatment plan may involve a combination of approaches, with pelvic floor biofeedback playing a pivotal role in empowering individuals to gain control over their bodily functions and improve their quality of life.

Pelvic Floor Muscle Exercises (Kegel Exercises)

In the context of urinary incontinence, particularly stress incontinence and some forms of urge incontinence, it’s essential to target and strengthen the pelvic floor muscles. These muscles play a crucial role in supporting the bladder, urethra, and other pelvic organs, and they are directly involved in urinary control. Strengthening these muscles can improve their ability to contract and relax appropriately, helping to prevent leakage and improve bladder control.

1. Support: Pelvic floor muscles provide support to the bladder, helping to keep it in its proper position.
2. Sphincteric Function: These muscles help maintain closure of the urethra, preventing urine leakage when there is increased abdominal pressure (as in stress incontinence).
3. Urge Control: Strong pelvic floor muscles can also help suppress sudden urges to urinate (as in some forms of urge incontinence) by providing better voluntary control.

Pelvic floor muscle exercises, often referred to as Kegel exercises, are designed to target and strengthen these muscles. When done correctly and regularly, Kegel exercises can be effective in reducing urinary incontinence episodes and improving overall bladder control.

To perform Kegel exercises:

1. Locate the Muscles: Identify the pelvic floor muscles by trying to stop the flow of urine during urination. The muscles you engage to do this are the ones you’ll be working on during Kegel exercises.

2. Isolate the Muscles: Once you’ve identified the muscles, practice contracting and relaxing them without using other muscles like the abdomen or buttocks.

3. Start Slowly: Begin with short contractions, holding for a few seconds, and then relax. Gradually increase the duration and intensity of the contractions as you become more comfortable.

4. Be Consistent: Perform these exercises regularly. It’s often recommended to aim for several sets of 10 repetitions throughout the day.

Remember that it’s crucial to perform Kegel exercises correctly to avoid straining other muscles and to ensure you’re targeting the pelvic floor muscles effectively. If you’re uncertain about how to do Kegel exercises properly, consider consulting a healthcare professional or a pelvic floor physical therapist who can provide guidance and personalized instructions. Additionally, pelvic floor biofeedback techniques can assist in ensuring that you’re engaging the right muscles during pelvic floor exercises, enhancing their effectiveness in managing urinary incontinence.

Auxiliary muscles exercise in urinary incontinence

In addition to pelvic floor muscles, several other muscle groups can play a role in managing urinary incontinence, depending on the type and underlying causes of the condition. Here are some of the muscles and muscle groups that may be involved in the treatment of urinary incontinence:

1. Abdominal Muscles (Transverse Abdominis): Strengthening the transverse abdominis, which is the deepest layer of abdominal muscles, can help provide additional support to the pelvic organs and reduce pressure on the bladder. This is particularly relevant for stress incontinence.

2. Oblique Abdominal Muscles: The oblique muscles, both internal and external, can help stabilize the trunk and provide support to the pelvic area. Exercises that engage these muscles can assist in managing stress incontinence.

3. Gluteal Muscles: The gluteal muscles (buttocks) play a role in pelvic stability and posture. Strengthening these muscles can help maintain proper alignment of the pelvis and contribute to better overall pelvic health.

4. Thigh Muscles (Quadriceps and Hamstrings): Strong thigh muscles can assist in activities like rising from a seated position and maintaining balance, which can reduce the risk of falls and related stress incontinence.

5. Lower Back Muscles (Erector Spinae): Strengthening the lower back muscles can help support the spine and maintain proper posture, indirectly contributing to pelvic health.

6. Diaphragm: The diaphragm, the primary muscle used in breathing, is connected to the pelvic floor through the core muscles. Learning to engage and coordinate the diaphragm with the pelvic floor can assist in overall core stability and urinary control.

7. Hip Adductors and Abductors: The muscles responsible for moving the thighs toward or away from the midline of the body can impact pelvic stability and balance.

It’s important to note that while these muscle groups can indirectly influence urinary continence, the primary focus for addressing urinary incontinence remains the pelvic floor muscles. Strengthening the pelvic floor muscles through exercises like Kegel exercises is usually the first-line approach for treating stress incontinence and some forms of urge incontinence.

However, a comprehensive approach to managing urinary incontinence may include exercises that engage these other muscle groups as part of a broader physical therapy or rehabilitation program. Additionally, maintaining overall physical fitness, which involves working on various muscle groups, can contribute to improved pelvic health and better urinary control. Consultation with a healthcare professional or a pelvic floor physical therapist can help design a personalized exercise regimen tailored to your specific needs and condition.

EMG Pelvic floor biofeedback for urinary incontinence

What pelvic floor biofeedback muscle retraining is?

Pelvic floor biofeedback muscle retraining is a treatment to help patients learn to strengthen or relax their pelvic floor muscles in order to improve bowel or bladder function. It is a painless process that uses special sensors and a computer or mobile phone monitor to display information about muscle activity. This information or “feedback” is used to gain sensitivity, and with practice, control over pelvic floor muscle function. An important part of pelvic floor biofeedback therapy is the consistent practice of pelvic floor muscle exercises at home. With pelvic floor biofeedback, an individual can learn to stop using the incorrect muscles and start using the correct ones.

Pelvic floor biofeedback has shown promising effectiveness in the management of urinary incontinence, particularly for conditions like stress incontinence and urge incontinence. This non-invasive technique utilizes real-time physiological data to help individuals gain awareness and control over their pelvic floor muscles and bladder function. Here’s how pelvic floor biofeedback proves effective:

Stress Incontinence: Pelvic floor biofeedback helps individuals strengthen their pelvic floor muscles, which are crucial for supporting the bladder and preventing leakage during activities that increase intra-abdominal pressure. By providing visual or auditory cues that indicate when the correct muscles are being contracted, individuals can learn proper muscle engagement techniques. Over time, consistent practice guided by pelvic floor biofeedback can lead to improved muscle strength and endurance, resulting in reduced or eliminated episodes of stress incontinence.

Urge Incontinence (Overactive Bladder): Pelvic floor biofeedback assists in training individuals to recognize the early signs of an impending urge to urinate. By monitoring bladder contractions and providing feedback when the bladder muscles start to contract involuntarily, individuals can learn to control these contractions and suppress the urge. This technique essentially empowers individuals to retrain their bladder and enhance their ability to delay urination until an appropriate time and place.

Efficacy and Benefits of pelvic floor biofeedback

Numerous clinical studies have demonstrated the effectiveness of pelvic floor biofeedback in reducing urinary incontinence episodes and improving overall bladder control. It offers several benefits, including:

1. Personalized Training: Pelvic floor biofeedback tailors training to an individual’s specific needs, adapting to their progress and challenges.
2. Non-Invasive: Unlike surgical interventions, pelvic floor biofeedback is non-invasive and carries minimal risks or side effects.
3. Empowerment: By providing real-time feedback, individuals feel empowered and engaged in their treatment process.
4. Holistic Approach: Pelvic floor biofeedback complements other treatment options, such as pelvic floor exercises and lifestyle modifications.
5. Psychological Well-being: Gaining control over bladder function often leads to improved self-esteem, confidence, and emotional well-being.
6. Long-Term Benefits: Consistent pelvic floor biofeedback training can lead to sustainable improvements, reducing the need for medication or more invasive procedures.

While pelvic floor biofeedback offers promising outcomes, its effectiveness can vary based on factors like individual commitment, the severity of incontinence, and the guidance of skilled healthcare professionals. Combining pelvic floor biofeedback with other strategies, such as pelvic floor exercises and behavioral modifications, can enhance its overall impact. As technology advances and research continues, biofeedback holds the potential to play an increasingly significant

Electromyographic (EMG) biofeedback for auxiliary muscles in UI

Electromyographic (EMG) biofeedback is a valuable therapeutic technique used to target and train various muscle groups beyond the pelvic floor muscles in managing urinary incontinence, depending on the specific type and causes of the condition.

Here’s how EMG auxiliary muscle biofeedback can be employed for these purposes:
1. Abdominal Muscles (Transverse Abdominis and Obliques):
• Purpose: Strengthening the transverse abdominis and oblique abdominal muscles can provide additional support to the pelvic area, reducing pressure on the bladder and assisting in the management of stress incontinence.
• EMG sensors can be placed on the abdominal muscles to monitor their activity during specific exercises. Patients can visualize this activity on a screen or receive auditory cues, helping them learn to engage and strengthen these muscles effectively.

2. Lower Back Muscles (Erector Spinae):
• Purpose: Strengthening the erector spinae muscles can contribute to better spinal stability and posture, indirectly influencing pelvic health and urinary control.
• EMG sensors can be positioned on the lower back muscles, allowing patients to monitor muscle engagement and ensure that they are targeting the correct muscles during exercises.

3. Hip Muscles (Adductors and Abductors):
• Purpose: The hip adductors and abductors play a role in pelvic stability and balance, which can affect urinary control.
• EMG biofeedback can be used to assess the activity of these hip muscles during specific movements or exercises, helping individuals focus on improving their strength and coordination in this area.

4. Diaphragm:
• Purpose: Coordinating the diaphragm with pelvic floor muscles and other core muscles can enhance overall core stability and control, indirectly impacting urinary continence.
• EMG sensors placed on the diaphragm can assist individuals in learning to coordinate its activity with the pelvic floor and other muscle groups during exercises aimed at improving core strength and stability.

How EMG biofeedback for auxiliary muscles works

• EMG biofeedback involves the placement of sensors or electrodes on the targeted muscle groups. These sensors detect and record the electrical activity generated by muscle contractions.
• The EMG signals are then transmitted to a monitoring device, which can be a computer screen or an auditory feedback system.
• Patients receive real-time visual or auditory cues based on their muscle activity. This feedback allows them to observe and adjust their muscle engagement, ensuring they are targeting the right muscles and using proper techniques during exercises.
• Over time, patients can learn to control and strengthen these muscle groups effectively, which can contribute to improved bladder control and the management of urinary incontinence.

EMG biofeedback can be particularly beneficial when working on specific muscle groups to complement other treatment approaches, such as pelvic floor exercises. It helps individuals gain awareness of muscle activity and ensures that exercises are performed correctly, ultimately enhancing the effectiveness of the overall incontinence management plan.

Sacral Area Biofeedback

Sacral area biofeedback and stimulation are therapeutic approaches used in the treatment of urinary incontinence, particularly for certain types of incontinence like overactive bladder (urge incontinence) and some cases of mixed incontinence.

Sacral area biofeedback involves the use of sensors or electrodes placed on or near the sacral area, which is the region at the base of the spine near the tailbone. These sensors detect electrical or muscular activity in the pelvic floor and bladder muscles. Here’s an overview of these techniques:

• Mechanism: During biofeedback sessions, the sensors provide real-time information on the activity of the pelvic floor muscles and the bladder. Patients can see this feedback on a monitor, allowing them to gain awareness of muscle contractions and bladder function.
• Benefits: Sacral area biofeedback helps individuals learn to control pelvic floor muscles more effectively, improve coordination, and increase the ability to suppress unwanted contractions. It can also enhance the relaxation of the bladder muscles when needed.
• Training: Biofeedback sessions are often conducted by trained healthcare professionals, such as pelvic floor physical therapists. These sessions guide patients in practicing muscle control techniques while monitoring their progress on the biofeedback display.
• Effectiveness: Sacral area biofeedback is particularly useful for people with urge incontinence or overactive bladder. It assists in training individuals to gain better control over bladder contractions, reduce urgency, and improve bladder capacity.

Sacral Nerve Stimulation (SNS)

Sacral nerve stimulation, also known as neuromodulation, involves the implantation of a device that sends electrical impulses to the sacral nerves, which are involved in bladder control.

• Mechanism: The implanted device delivers controlled electrical stimulation to the sacral nerves, modulating their activity. This neuromodulation affects the communication between the brain, spinal cord, and bladder, helping to regulate bladder function.
• Benefits: SNS is typically recommended for individuals with overactive bladder symptoms who have not responded to conservative treatments. It can reduce urgency, frequency, and incontinence episodes.
• Procedure: The SNS device is surgically implanted, and its settings can be adjusted externally by a healthcare professional. It is a reversible procedure, and if the individual does not experience relief or encounters side effects, the device can be turned off or removed.
• Effectiveness: SNS has shown promising results in the treatment of overactive bladder, improving urinary symptoms and quality of life for many patients.

Both sacral area biofeedback and sacral nerve stimulation are typically considered after conservative treatments like pelvic floor exercises and medications have been tried without success. They offer alternative options for individuals who are seeking additional interventions to manage urinary incontinence, particularly when it is related to overactive bladder or neurological factors. These treatments are usually recommended and managed by urologists or healthcare providers with expertise in incontinence management.

It’s important to note that the effectiveness of biofeedback for urinary incontinence can vary based on factors such as the individual’s dedication to the therapy, the severity of their condition, the guidance of a skilled healthcare professional, and the consistency of practice.

Clinical studies have generally reported success rates ranging from around 60% to 90% in terms of improvement in symptoms and quality of life. However, these success rates can vary widely depending on the study population, methodology, and duration of treatment.

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Neurofeedback for Tourette Syndrome

August 20, 2020

by Armine Zarayelyan with No Comment Neurofeedback Uncategorized all

Tics are irregular, uncontrollable, unwanted, and repetitive movements of muscles that can occur in any part of the body. Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics. Tourette’s syndrome (TS) is a complex neurological disorder. It is characterized by multiple tics – both motor and vocal. It is the most severe and least common tic disorder. This disorder is related to multiple neuroanatomical and neurophysiological deviations, primarily reduced sensorimotor rhythm (SMR) and excessive fronto-central Theta activity. Recent research has proposed neurofeedback for Tourette Syndrome and Tic Disorders as a promising treatment option, particularly in terms of helping patients control their tics and treat the cognitive dysfunctions commonly associated with TS.

Table of Contents

Tic disorders can usually be classified as motor, vocal, or Tourette’s syndrome, which is a combination of both. Motor and vocal tics can be short-lived (transient) or chronic. Tourette’s is considered to be a chronic tic disorder.

Children with transient tic disorder will present with one or more tics for at least 1 month, but for less than 12 consecutive months. The onset of the tics must have been before the individual turned 18 years of age. Motor tics are more commonly seen in cases of transient tic disorder than vocal tics. Tics may vary in type and severity over time. According to the American Academy of Child and Adolescent Psychiatry, a transient tic disorder, or provisional tic disorder affects up to 10% of children during their early school years.

Tics that appear before the age of 18 and last for 1 year or more may be classified as a chronic tic disorder. These tics can be either motor or vocal, but not both. A chronic tic disorder is less common than transient tic disorder, with less than 1% of children affected.

If the child is younger at the onset of a chronic motor or vocal tic disorder, they have a greater chance of recovery, with tics usually disappearing within 6 years. People who continue to experience symptoms beyond age 18 are less likely to see their symptoms resolved.

Some research suggests that tics are more common among children with learning disabilities and are seen more in special education classrooms. Children within the autism spectrum are also more likely to have tics.

Neurofeedback for Tourette Syndrome - Motor tics

Neurofeedback for Tourette Syndrome - Motor & vocal tics

Neurofeedback for Tourette Syndrome - Newborn with tics

Neurofeedback for Tourette Syndrome - Schoolchild tics

Tourette’s syndrome (TS) is the most severe and least common tic disorder. The Centers for Disease Control and Prevention (CDC) report that the exact number of people with TS is unknown. CDC research suggests that half of all children with the condition are not diagnosed. Currently, 0.3% of children aged 6 to 17 in the US have been diagnosed with TS. Symptoms of TS vary in their severity over time. For many people, symptoms improve with age. TS is often accompanied by other conditions, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

Tourette Syndrome is a neurodevelopmental disorder characterized by persistent, chronic, and involuntary tics. These tics manifest as either motor or phonic (vocalizations) and can range from simple tics such as blinking, sniffing, and head twitching to more complex such as repetitive swearing, spinning around, and jumping. The cause of Tourette’s is unknown but it is likely that both hereditary and nongenetic factors contribute to its development.

The onset of Tourette syndrome is usually in childhood between the ages of 2 and 21 years. The disorder affects more males than females with a ratio of approximately 3 males to every 1 female diagnosed. Tourette’s is a highly individualistic disorder with differing levels of severity, frequency, and impairment.

Whilst the exact cause of Tourette Syndrome is unknown, it is believed that the presence of tics is associated with abnormalities in the brain. In particular, it is suggested there is a distribution in the circuits which link the basal ganglia (the site which controls voluntary motor movements, eye movements, and emotion) to the frontal cortex.

Individuals with Tourette Syndrome display impaired performance in cognitive tasks in terms of memory, attention, reading, and writing. These impairments are often more severe in individuals diagnosed with comorbid ADHD who also display less cognitive flexibility. It is estimated that 70% of patients with Tourette Syndrome exhibit ADHD type behaviors and as such, Tourette Syndrome can be a debilitating diagnosis for many people.

If someone has tics, it doesn’t mean that this person has Tourette’s syndrome. Tics have to be present for at least one year to be classified as Tourette’s syndrome and at least one of tics has to be vocal.

Symptoms of Tic Disorder

The defining symptom of tic disorders is the presence of one or more tics. These tics can be classified as:

Motor tics: These include tics, such as head and shoulder movements, jerking of the head, twisting the neck, rolling the eyes, blinking, jerking, banging, clicking fingers, or touching things or other people. Motor tics tend to appear before vocal tics, although this is not always the case.
Vocal tics: These are sounds, such as coughing, blowing, throat clearing or grunting, or repeating words or phrases.

Tics can also be divided into the following categories:

Simple tics: These are sudden and fleeting tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing.
Complex tics: These involve coordinated movements using several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases.

Tics are usually preceded by an uncomfortable urge, such as an itch or tingle. While it is possible to hold back from carrying out the tic, this requires a great deal of effort and often causes tension and stress. Relief from these sensations is experienced upon carrying out the tic.

The symptoms of tic disorders may:
• worsen with emotions, such as anxiety, excitement, anger, and fatigue,
• worsen during periods of illness,
• worsen with extreme temperatures,
• occur during sleep,
• vary over time,
• vary in type and severity,
• improve over time.

Causes and risk factors for Tourette's syndrome and Tic Disorders

The exact cause of tic disorders is unknown. Within Tourette’s research, recent studies have identified some specific gene mutations that may have a role. Brain chemistry also seems to be important, especially the brain chemicals glutamate, serotonin, and dopamine.

Tics that have a direct cause fit into a different category of diagnosis. These include tics due to:
• head injuries,
• stroke,
• infections,
• poisons,
• surgery,
• other injuries.

In addition, tics can be associated with more serious medical disorders, such as Huntington’s disease or Creutzfeldt-Jakob disease.

Risk factors for tic disorders include:
• Genetics: Tics tend to run in families, so there may be a genetic basis to these disorders.
• Sex: Men are more likely to be affected by tic disorders than women.

Conditions associated with tic disorders

Conditions associated with tic disorders, especially in children with TS, include:

• anxiety
• ADHD
• depression
• autic spectrum disorder
• learning difficulties
• OCD
• speech and language difficulties
• sleep difficulties

Other conditions associated with tic disorders are related to the effect of the tics on self-esteem and self-image. Some research has found that children with TS or any chronic tic disorder experience a lower quality of life and lower self-esteem than those without one of these conditions.

In addition, the Tourette Association of America says that people with TS often experience difficulties with social functioning due to their tics and associated conditions, such as ADHD or anxiety.

Brain changes in Tourette's Syndrome and Tic Disorders

The frequent comorbidity of TS and ADHD may reflect a common underlying neurobiological substrate, and studies confirm the hypothesized involvement of fronto-striatal circuits in both TS and ADHD. However, poor inhibitory control and volumetric reductions in fronto-striatal circuits appear to be core features of ADHD, whereas reduced volumes of the caudate nucleus, together with activation and hypertrophy of prefrontal regions that likely help to suppress tics, seem to be core features of TS. (Neuroimaging of tic disorders with co-existing attention-deficit/hyperactivity disorder – Kerstin J. Plessen, M.D., Jason M. Royal, D.M.A., and Bradley S. Peterson, M.D.)

Activity in a region of the brain called the supplementary motor area (SMA) has been associated with tics. The investigators put tic patients into the MRI scanner and had a real-time functional magnetic resonance imaging neurofeedback session. The patients could see the SMA light up and they could try to control that area by focusing their thoughts on it. The patients who received the real neurofeedback had a greater reduction of tics on the Yale Global Tic Severity Scale as compared with the sham control.

Neurofeedback for Tourette Syndrome - Basal ganglia

Neurofeedback for Tourette Syndrome - Suplementary motor area

Neurofeedback for Tourette Syndrome - Brain region involved in tics

Neurofeedback for Tourette Syndrome - Tourette Brain

Researchers at Washington University School of Medicine in St. Louis have identified areas in the brains of children with Tourette’s syndrome that appear markedly different from the same areas in brains of children who don’t have the disorder.

In kids with Tourette’s, the researchers also found less white matter around the orbital prefrontal cortex, just above the eyes, and in the medial prefrontal cortex, also near the front, than in kids without the condition.

White matter acts like the brain’s wiring. It consists of axons that — unlike the axons in gray matter — are coated with myelin and transmit signals to the gray matter. Less white matter could mean less efficient transmission of sensations, whereas extra gray matter could mean nerve cells are sending extra signals.

In a scan of a child with Tourette’s, yellow indicates an area with less white matter than in the same brain region in kids who don’t have the disorder. The scans also revealed areas in the brains of kids with Tourette’s that have more gray matter (posterior thalamus, hypothalamus, and midbrain) than in children without the condition.

Deficits in executive functioning which contribute to ADHD symptoms also appear in TS, with the same losses of structural integrity in the cortico-striatal and cortico-thalamic pathways common to both disorders. Neurophysiological processes governing these deficits in executive functioning have proven modifiable by neurofeedback.

Clinical researchers Chuanjun Zhuo & Li Li (2014) found that neurofeedback training improved motor and vocal tic symptoms (e.g. a reduction in the frequency and intensity of tics) in adolescents with refractory Tourette syndrome.

Simone Messerotti Benvenuti et al. (2011) SMR up-training/Theta down-training schedule was utilized for sixteen sessions, followed by a further six purely using SMR up-training. SMR increase was better obtained when SMR up-training was administered alone, Whereas Theta decrease was observed after both types of trainings.

After 40 sessions of SMR training, 75% of patients demonstrated an increase in the production of SMR and a positive change in theta/beta ratio.

It was therefore hypothesized that this training of the sensorimotor cortex results in increased voluntary muscle control and elimination of tics.

Neurofeedback for Tourette syndrome and Tic Disorders

Neurofeedback training is a self-regulation strategy. The brain is trained at the point where the tics are to reduce or eliminate them. In a brain with TS there is over-arousal. There is a high degree of excitability of the motor system. The overarching need is for this brain to experience calming, both in general and specifically in regard to motor circuits. When such calming is achieved tics (motor and vocal) may be reduced.

With the right approach, Neurofeedback practitioners have seen significant improvement in symptoms in the vast majority of cases. Nonetheless every case is different and sometimes you may not experience the reduction of tics but overall you should feel more relaxed and you should notice a better quality of sleep. This is a condition that appears to benefit from long-term training.

Presently, medications used to treat tics can cause unforeseen side effects, whereas neurofeedback therapy can be tailored to more accurately target the area of the brain that needs changing.

By Dr. Clare Albright – “Neurofeedback – Transforming Your Life With Brain Biofeedback” – www.neurofeedbackbook.com

Neurofeedback for Tourette Syndrome - Protocols

1. Sensor Placement:

Neurofeedback for Tourette syndrome typically involves the application of electrodes to specific sites on the scalp according to the 10-20 system, a standardized method for locating and measuring EEG electrode placements.

Common electrode sites include Cz (vertex), Fz (midline frontal), C3/C4 (left and right central), and Pz (midline parietal).

2. Frequency Bands:

Neurofeedback protocols often target specific frequency bands associated with neurological functioning. For TS, protocols may focus on training specific frequencies like the sensorimotor rhythm (SMR) and beta waves. SMR is associated with motor control and inhibition and is often implicated in TS symptomatology.

3. Operant Conditioning:

The neurofeedback for Tourette Syndrome involves operant conditioning, where individuals learn to regulate their brain activity in response to visual or auditory feedback. In the case of TS, patients might receive positive feedback when their brain activity corresponds to a desired state (e.g., reduced hyperactivity in certain brain regions).

Electrode Application Sites According to 10-20 System

1. Cz (Vertex): Often associated with overall brain regulation.
2. Fz (Midline Frontal): May target prefrontal areas associated with impulse control.
3. C3/C4 (Left and Right Central): Relevant for sensorimotor rhythm and motor control.
4. Pz (Midline Parietal): Associated with sensory processing and integration.

Effectiveness of Neurofeedback for Tourette Syndrome

Research on neurofeedback for Tourette syndrome is still in its early stages, and findings vary. Some studies suggest positive outcomes, such as reduced tic severity and improved impulse control, while others report mixed or inconclusive results.

Studies Supporting Effectiveness:

1. A study by Sokhadze et al. (2010) found that neurofeedback training led to a significant reduction in tic frequency and improved behavioral measures in TS patients.
2. Gevensleben et al. (2014) reported positive effects of neurofeedback on tic reduction and attentional control in children with TS.

Studies with Mixed Results:

1. Dehghani-Arani et al. (2013) found improvements in tic severity and cognitive performance but reported variability in individual responses.
2. Holtmann et al. (2011) observed improvement in tic severity but did not find significant effects on comorbid symptoms.

Challenges and Considerations:

• The heterogeneity of Tourette syndrome poses a challenge, as individuals may respond differently to neurofeedback.
• Lack of standardized protocols across studies makes it difficult to draw consistent conclusions.
• Larger, well-controlled studies with long-term follow-up are needed to establish the efficacy and generalizability of neurofeedback for TS.

In conclusion, while there is some promising evidence supporting the effectiveness of neurofeedback for Tourette syndrome, further research is necessary to establish standardized protocols, determine optimal electrode placements, and address the variability in treatment outcomes. Neurofeedback for Tourette syndrome holds potential as a complementary

Learn, why Neurofeedback management of the Migraine is so effective, what neurofeedback protocol to use. Get rid of migraine headache.

Neurofeedback for Migraines. Neurofeedback Protocols.

November 21, 2019

by Armine Zarayelyan with One Comment Neurofeedback Psycho-Emotional States and Disorders Uncategorized all

Migraine is a debilitating illness with long term consequences for the brain. Researches had explored the origins of migraine and suggest that it is an electrical phenomenon initiated in the occipital cortex. Assessments of the brain using the EEG have found abnormal electrical activity supporting this idea. Neurofeedback for migraines is a treatment targeting electrical firing patterns in the brain. Many research data had shown that NFB training/treatment successfully suppresses abnormal brain wave activity leading to a significant decrease in migraine frequency and improvement in associated psychoneurological states such as anxiety, depression, and sleep.

Table of Contents

WHAT IS MIGRAINE? CAUSES, SYMPTOMS, AND PATHOPHYSIOLOGY.

Migraine is a severe health problem which is the second most common one among the primary headaches, which affects 3-10 to 30-38% of the world’s population and which affects the quality of life negatively. Migraine is a disabling neurological condition characterized by episodic attacks of usually unilateral headache, with pulsating character and light and sound intolerance, associated with nausea and vomiting.

The tendency to suffer from migraine has a genetic component, but attacks can be triggered by a series of internal and external factors.

Migraine is a disease with many faces. The most common form is migraine without aura, occurring in about 80% of patients, while migraine with aura occurs in about 20% of the patients.

The annual costs of migraines such as diagnosis, treatment, reduced productivity, and absence from work is estimated to be 5 billion euros in the European Union and about 29 billion in the USA.

The incidence of migraine before puberty is greater in boys than in girls. It grows up to 12 years in both sexes and is the highest in the age range of 30–40 years. After puberty, the ratio changes and increases in favor of women and with 40 are 3.5:1. After 40 years, the strength of the symptoms is reduced (except for women in perimenopause), and the beginning of migraine headaches in the fifties is rare.

Migraine trigger checklist

The main symptom of migraine is recurring, severe, most often localized in one half of the head (hemicrania), throbbing headache, which can last from 4 to 72 hours. It usually begins in the temporal region, in the eyeballs or in the frontal region. Pain may also occur in the face, neck. During a migraine attack, visual disturbances, increased sensitivity in the hands, dizziness, tinnitus, and increased sensitivity to light or noise may be observed. At the end of an attack, nausea and vomiting may occur.

There are migraines with and without aura. Aura is a complex of neuropsychological symptoms that anticipate the onset of pain, become the first signs of a migraine, or develop simultaneously with a headache. They are caused by a spasm of cerebral vessels, which occurs at the initial stage of an attack.

Symptoms associated with Migraine are:

Severe pain in the head or eyes;
Being worse on one side of the head;
Nausea
Vomiting;
Dizziness ;
Perceiving an aura;
Blurred or tunnel vision;
Seeing auras;
Photophobia (sensitivity to light);
Phonophobia (sensitivity to sound);
Osmophobia (sensitivity to smells);
Poor concentration;
Ringing in the ears;
Sweating;
Feeling very hot or very cold;
Abdominal pain (which can sometimes cause diarrhea);
A frequent need to urinate.

The pathogenesis of migraine

The pathogenesis of migraine has long been a subject of discussion among scientists. It has been considered that typical headaches are caused by intracranial vasodilation preceded by vasoconstriction causing aura—vascular theory. Today it is known that this is not the case, and although new findings have emerged, the exact mechanism and genetic determinants are not yet fully clarified.

For a long time, it was thought that the cause of the aura, which precedes headaches, is cerebral vasoconstriction. Today, this theory is denied, and the aura is explained by neural dysfunction rather than ischemia due to vasoconstriction.

The frequency with which migraine attacks occur may vary from once in a lifetime to almost daily, an indication that the degree of migraine predisposition varies individually. It is necessary to consider both the factors that influence the threshold of a person’s susceptibility to a migraine attack and also the mechanisms that trigger the attack and the associated symptoms.

Acute migraine attacks occur in the context of an individual’s inherent level of vulnerability. The greater the vulnerability/lower the threshold, the more frequent attacks occur. Attacks are initiated when internal or environmental triggers are of sufficient intensity to activate a series of events that culminate in the generation of a migraine headache. Many migraineurs experience vague vegetative or affective symptoms as much as 24 hours prior to the onset of a migraine attack. This phase is called the prodrome and should not be confused with the aura phase.

The aura phase consists of focal neurological symptoms that persist up to one hour. Symptoms may include visual, sensory, or language disturbance, as well as symptoms, localizing to the brainstem.

Within an hour of resolution of the aura symptoms, the typical migraine headache usually appears with its unilateral throbbing pain and associated nausea, vomiting, photophobia, or phonophobia. Without treatment, the headache may persist for up to 72 hours before ending in a resolution phase often characterized by deep sleep.

For up to twenty-four hours after the spontaneous throbbing has resolved, many patients may experience malaise, fatigue, and transient return of the head pain in a similar location for a few seconds or minutes following coughing, sudden head movement, or Valsalva movements. This phase is sometimes called the migraine hangover (postdrome).

It is becoming increasingly clear that much of the vulnerability to migraine is inherited.

Migraine is, in essence, a familial episodic disorder whose key marker is a headache, with certain associated features. One of the most important aspects of the pathophysiology of migraine is the inherited nature of the disorder. It is clear from clinical practice that many patients have first-degree relatives who also suffer from migraines. Transmission of migraines from parents to children has been reported as early as the seventeenth century, and numerous published studies have reported a positive family history.

In approximately 50% of the reported families, Familial hemiplegic migraine (FHM) has been assigned to chromosome 19p13. The biological basis for the linkage to chromosome 19 is mutations involving the Ca 2.1 (P/Q) type voltage-gated calcium channel CACNA1A gene. Dysfunction of these channels might impair serotonin release and predispose patients to migraine or impair their self-aborting mechanism.

Migraine aura

Migraine aura is defined as a focal neurological disturbance manifest as visual, sensory or motor symptoms. It is seen in about 30% of patients, and it is clearly neurally driven. Visual aura has been described as affecting the visual field, suggesting the visual cortex, and it starts at the center of the visual field, propagating to the periphery at a speed of 3 mm/min. Blood flow studies in patients have also shown that a focal hyperemia tends to precede the spreading oligemia. However some researchers conclude that migraine aura is evoked by aberrant firing of neurons.

Shown is the entire hemisphere, from a posterior-medial view. The aura-related changes appeared first in extrastriata cortex. The spread of the aura began and was most systematic in the representation of the lower visual field, becoming less regular as it progressed into the representation of the upper visual field.

WHAT KIND OF CHANGES IN THE BRAIN CAUSE THE MIGRAINE?

The study of anatomy and physiology of pain-producing structures in the cranium and the central nervous system modulation of the input have led to the conclusion that migraine involves alterations in the subcortical aminergic sensory modulatory systems that influence the brain widely.

Available research data had shown that no structural differences have been found in individuals with migraine compared to individuals without migraine. This research suggests that migraine is an electrical phenomenon initiated within the cortex of the brain. This phenomenon is known as Cortical Spreading Depression (CSD) referring to a wave of electrophysiological hyperactivity that spreads through the brain from the occipital lobes forward. This wave affects the cortex in several ways: altering the electrical polarity of neurons, decreasing blood flow and associated levels of oxygen in the cortex and altering the degree of vasodilation within the vascular system of the cortex. These changes release of nerve irritating chemicals into the brain. These chemicals irritate the pain transmitting the “trigeminal” nerve system in the meninges, the sensitive membranes that cover the brain. The result is severe blinding pain.

Consequences of migraine to the brain are:

impaired ability in tests of short and long term memory,
small areas of stroke-like damage to the brain,
with a high frequency of Migraine (more than three attacks per month) show significantly more areas of damage than those with fewer attacks,
with a history of Migraines longer than 15 years were found to have more changes in the brain than those with a shorter history,
higher frequency migraines show abnormalities in both white and gray matter of the brain,
people with migraine are more at risk for future strokes,
show a predilection toward damage in the following sites:
– frontal lobe
– limbic system
– parietal lobes
– brainstem
– cerebellum

Chronic migraine comorbidities

WHAT EEG CHANGES CAN BE OBSERVED IN PEOPLE WITH MIGRAINES?

There are two ways in which anomalies in the EEG have been associated with migraine: via the relationship of migraine to seizure activity and as a function of slow brain waves found elsewhere in the brain. Migraine and epilepsy frequently coexist and are often difficult to differentiate. Both migraine and seizure prone individuals show abnormal occipital discharges that are typically high voltage (200–300 mV), with a diphasic morphology, and a unilateral or bilateral occipital and postero-temporal distribution.

Migraine has been associated with abnormal EEG activity elsewhere in the brain. Both unilateral and bilateral increased delta wave activity has been recorded during a hemiplegic migraine and during attacks of migraine with disturbed consciousness. It is shown that in the waking, non-migraine state there are slow waves in the theta range (48 hertz). Neurofeedback for migraines has been used to target and suppress this slow-wave activity in both adults and children with a concomitant reduction in frequency and intensity of migraine. Some research has shown that neurofeedback blood flows up training in the frontal cortex results in a 70% reduction in the frequency of migraines compared with 50% reduction using medication alone. NFB training is also associated with decreases in anxiety, depression and improved sleep, each of which has been associated with migraines.

Newer methods, i.e. EEG frequency analysis and topographic brain mapping, are promising tools in this field. So far, mostly small studies have been published with somewhat inconsistent results. A pattern of increased alpha rhythm variability (and/or asymmetry) in the headache-free phase seems to emerge, however. Significant asymmetry of alpha and theta during headache has been reported in topographic brain mapping study.

The EEG patterns observed in migraine patients seem to suggest a possible physiological connection between sleep, hyperventilation, and migraine.

EEG activity seems to change shortly before the attack. This suggests that migraineurs are most susceptible to attack when anterior QEEG delta power and posterior alpha asymmetry values are high.
Occipitoparietal and temporal alpha power were more asymmetric before the attack compared with the interictal baseline

Different research had found the increased power in 19 cortical areas in delta (1.5-3.5 Hz), theta (4.0-7.5 Hz) and high-frequency beta (21-30 Hz) bands. Multiple types of research had shown significant abnormalities in the high-frequency beta band (21-30 Hz) in parietal, central and frontal regions.

How Neurofeedback Training Manage Migraines? Migraine Neurofeedback Protocols.

Despite a large number of medications are used to treat migraine today, only 20% of patients report their effectiveness. Many develop resistance to medications, and therefore the dose of the drug is gradually increasing, which is required to achieve the effect of relieving headache. Often the medication is accompanied by side effects.

In patients with migraine, changes in the biological parameters of brain activity, brain waves, are often recorded. Neurofeedback is recently developed technologies for treating migraines are based on recording these changes in brain wave activity and transmitting information about their condition in the form of audio and video signals to the patient. Based on these audio and video signals, the patient learns how to manage his condition so as to regulate brain wave activity and normalize it. Normalization of wave activity leads to a significant decrease in both the frequency and intensity of headaches. At first, these changes are not stable but gradually become stable and permanent. It becomes possible (after about 10 sessions of treatment) to manage the condition without the support of special equipment and computer program.

Migraine research points to electrophysiological anomalies in the brain as correlates of migraine headaches. Neurofeedback, as a therapy, is specifically designed to target dysregulated firing patterns in the brain. Research has demonstrated the ability of NFB to successfully treat anomalous brainwave patterns in a variety of conditions and most specifically with migraines.

After performing diagnostic scanning and getting brain mapping pattern of the patients with migraine some clinicians provide neurofeedback training with an increase of SMR and low beta 12-15 Hz and decrease theta (4-7Hz) and high beta (21-30 Hz) at each affected site in a number of 5 sessions for each affected site.

qEEG Before and after Neurofeedback for Migraines

More frequently are used the Neurofeedback Protocol for migraine management as follow:

Left-sided headaches – at C3 (T3)
down-trained: 2-7 Hz and high-frequency beta
up-trained: 15-18 Hz

Right-sided headaches – at C4 (T4)
down-trained: 2-7 Hz and high-frequency beta
up-trained: 12-15 Hz

An average number of neurofeedback sessions to get a significant change to occur are around 20-30 sessions. A person can get a neurofeedback session as much as twice a day with at least a two-hour break in between. It is recommended that a person try to do neurofeedback at least two or three times a week until the sessions are completed. Results appear to solidify and happen faster when done more frequently.

How effective is neurofeedback for migraines?

Neurofeedback for migraines can help with dysfunctions in the central nervous system, such as the increased excitability of the cerebral cortex. Because of working directly with the central nervous system, Neurofeedback training can be very effective in stabilizing the excitability of the cerebral cortex what will result in reduced headaches, less sensitivity, and improvements in other symptoms associated with Migraine.
The researchers concluded, “Neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine”.

Walker (Walker, J. E. (2011). QEEG‐Guided Neurofeedback for Recurrent Migraine Headaches. Clinical EEG and Neuroscience, 42(1), 59‐61. doi:10.1177/155005941104200112) examined the effects of neurofeedback therapy versus drug therapy in 71 patients with recurrent migraine headaches. After completion of a quantitative electroencephalogram (QEEG) procedure, all results indicated an excess of high-frequency beta activity (21‐30 Hz). Twenty‐five patients chose to continue with drug therapy for their recurring migraines, whilst 46 of the 71 patients selected neurofeedback training. Of those who chose neurofeedback therapy, the majority (54%) reported complete abolishment of their migraines, 39% experienced a significant reduction in migraine frequency of greater than 50%, and 4% experienced a decrease in the frequency of less than 50%. Only one patient did not report a reduction in headache frequency. The control group of participants who opted to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). Overall, the study demonstrates that neurofeedback is significantly effective in abolishing or substantially reducing the frequency of headaches in patients with recurrent migraines.

Effectiveness of Neurofeedback vs. Drug Management of the Migraine

Effectiveness of Neurofeedback for Migraines

Complete abolishment of the migraines

54%

Significant reduction in migraine frequency of greater than 50%

39%

Decrease in migraine frequency of less than 50%

No change in migraine frequency

Web Designer 0.5%

Effectiveness of Drug Therapy for Migrains

Complete abolishment of the migraines

Web Designer 0%

Significant reduction in migraine frequency of greater than 50%

Decrease in migraine frequency of less than 50%

20%

No change in migraine frequency

68%

After Neurofeedback for migraines the reduction of frequency and intensity of headaches usually was sustained at the 14.5 months follow‐up assessment.

Some of the benefits of neurofeedback for migraines:

It helps to retrain the brain and or optimize the functioning of the entire brain by removing barriers and improving the connections and brainwave activity in a certain region of the brain or among different regions of the brain.
It releases the old stuck or abnormal patterns to create new and more effective, stronger and organized patterns.
Training protocols are generated from the initial QEEG brain mapping. Training involves audiovisual feedback that INVOLUNTARILY teaches the individual to self-regulate the abnormal brain wave patterns that are presented to them on a computer screen in a number of ways.
There are no contraindications or side effects of neurofeedback for migraines.