Biofeedback Flashcards
what are the 2 main categories of BF used in rehab?
biomechanical
physiological
what is the biomechanical BF used for detecting?
movt, postural control, and force
what is the physiological BF used for detecting?
neuromuscular, CV, and resp fxn
what are inertial sensors?
accelerometers,gyroscopes (3D info of a body segment)
are inertial sensors biomechanical or physiological BF?
biomechanical BF
what are force plates?
ground rxn forces generated by the body gives us info on balance, movt, and gait
are force plates biomechanical or physiological BF?
biomechanical BF
what are electrogoniometers?
record info on the kinematics of jt change during movt and fxnal tasks
are electrogoniometers biomechanical or physiological BF?
biomechanical BF
what are pressure biofeedback units?
stabilizer cuffs used to aid in retraining of ms activity (ie TA activation)
are pressure biofeedback unit biomechanical or physiological BF?
biomechanical BF
what are camera based systems?
a way to capture quantitative 3D movt analysis with markers placed on anatomic landmarks
are camera based systems biomechanical or physiological BF?
biomechanical BF
what is real time US imaging (RTUS) BF?
US reflections from tissues, images of internal structures, real time visual feedback of ms activity used to see CSA, edema, and correct ms activation
is RTUS BF biomechanical or physiological BF?
physiological BF
what is measured in CV BF?
HR, HR variability (HRV)
what is HRV (HR variability)?
the variability bw heartbeats
what is respiratory BF?
teaching diaphragmatic breathing
is respiratory BF biomechanical or physiological BF?
physiological BF
what is EMG BF?
the conversion of myoelectrical signals in ms to visual and auditory signals for monitoring, detection, or assessment of skeletal ms activity so that the info gained can be used by the pt and clinician to influence activity of skeletal ms (inhibition/facilitation)
is EMG BF diagnostic?
NO!!!
what is the purpose of EMG BF?
to improve fxn and decrease pain (through awareness of inappropriate ms recruitment)
is EMG BF biomechanical or physiological BF?
physiological BF
is electrical current delivered to the pt in EMG BF?
nope
t/f: EMG BF detects ms activity and we use it for therapeutic purposes
true
why is EMG BF considered part of the ES category is no electrical current is delivered to the pt?
bc it monitors electrical activity of the pt’s ms
electrical activity in EMG BF is associated with what?
skeletal ms contractions
what are the uses of EMG BF?
to either facilitate or inhibit a Ms contraction
what kind of electrodes are used in EMG BF? (Ava I’m looking at you, don’t over think this one)
surface electrodes
t/f: EMG-BF can be used in both MSK and neuro rehab
true
what biophysical agent can we use when a pt is apprehensive about NMES? why?
EMG BF bc the pt doesn’t feel anything with it
t/f: we use EMG BF when other biophysical agents are contraindicated
true
what does EMG BF facilitation do?
increases volitional ms contraction
would we use EMG BF for facilitation or inhibition when is pt is post-op?
facilitation
does EMG BF for facilitation or inhibition normalize contraction at a jt where one of the 2 ms groups may be weaker?
facilitation
t/f: EMG BF can be used to increase volitional control following CNS dysfxn
true
how can we use EMG BF for pelvic floor rehab or urinary incontinence?
use it to facilitate volitional control of the pelvic floor
what does EMG BF inhibition do?
decrease activity in a ms
when can we use inhibition in EMG BF?
to decrease spasticity in CNS dysfxn
to decrease ms activity caused by postural stress or anxiety
to decrease ms activity associated with chronic pain
what does the literature say on BF for LE fxn in hemiplegic pts?
it produced significant clinical and fxnal parameter improvements with use of EMG BF compared to control
what does the literature say on EMG BF for chronic LBP?
40-45 min with electrodes on the traps, lats, and lower paraspinals for 8 wks can significantly reduce pain intensity, disability, and ms tension in pts with CLBP
how does EMG BF work?
it detects and records electrical ms activity and transduces it into visual or audio feedback
BF is common in what PT practice?
pelvic health
is EMG BF a direct measure of ms’s contractility or ability to generate tension?
nope, it is a broad representation of the electrical changes occuring in the tissue under the electrodes
can surface electrodes of typical clinical EMG BF units monitor specific motor units or muscles?
nope
the surface electrodes in EMG BF generally consist of what?
3 Ag-AgCL electrodes, one reference and 2 active
t/f: the 2 active and 1 reference electrodes in EMG BF are often incorporated in one electrode
true
what can cause noise/artifact in EMG signal, making it difficult to control the BF process?
movt of the electrode and poor contact
the quality of EMG signal is influenced by the thickness of what tissues?
adipose
in EMG BF, electrical Ms activity is measured in what units?
micro-volts
what is sensitivity in EMG BF?
the ability to detect the ms activity associated with a ms contraction
what is gain in EMG BF?
the sensitivity settings in which gain and sensitivity are inversely related
gain is measured in what units?
microvolts (1-1,200mV is typical)
at the lowest gain setting (1 mV), is sensitivity lowest or greatest?
greatest
at the lowest gain setting/highest sensitivity, what contractions are detected?
smaller contractions
at higher gain setting (1000mV), is sensitivity lower or higher?
lower
at higher gain settings/lower sensitivity, what contractions are detected?
there needs to be a greater contraction to be detected
increased sensitivity=… gain
decreased gain
more sensitivity (less gain) is needed when volitional ms contraction is ____
low
when would more sensitivity (less gain) be indicated?
CVA pt’s hemiparetic side
polyneuropathy pts
ms associated with crush injury
less sensitivity (more gain) is required for ____ ms contractions
over/hyperactive
when would less sensitivity (more gain) be indicated?
CP pt’s spastic limb
poor postural control
hyperactivity with chronic pain
gain settings are based on what?
need for amplification and clinical goals
weaker ms need ____ sensitivity and ____ gain to achieve goal of NM _____
greater, lower, facilitation
more active ms need ____ sensitivity and _____ gain to achieve goal of NM ____
less, higher, inhibition
t/f: in EMG BF, electrodes monitor ms fibers closest to the electrodes
true
wider placement of electrodes in EMG BF has what effect?
greater # of ms fibers are recorded
narrow placement of electrodes in EMG BF has what effect?
smaller # of fibers recorded
what electrode placement should we choose for more active ms?
narrower placement
what electrode placement should we choose for weaker ms?
wider placement
t/f: large electrode size detects more ms fibers but doesn’t increase the amplitude of the signal
true
can we use EMG BF on denervated ms?
NO!!!
t/f: we need at least partial innervation with EMG BF
true
what is threshold in EMG BF?
the level of ms activity needed to be reached via facilitation or inhibition
for facilitation of weaker ms, what gain/sensitivity should be used?
low gain, high sensitivity
for facilitation of weaker ms, what electrode placement should be used?
wider placement
for facilitation of weaker ms, when is feedback given?
when the pt exceeds threshold
for inhibition of overactive/spastic ms, what gain/sensitivity should be used?
high gain, low sensitivity
for inhibition of overactive/spastic ms, when is feedback given?
when the pt goes below the threshold
what is the tx progression for facilitation with EMG BF using the electrode placement?
narrow the electrode placement is possible so the pt has to contract a greater # of fibers in a smaller region (pt has to elicit a greater contraction to be detected)
what is the tx progression for facilitation with EMG BF using the gain settings?
increased gain settings (reduce sensitivity)
what is the tx progression for inhibition with EMG BF using electrode placement?
widen the electrodes if possible so the pt has to relax a greater # of fibers
what is the tx progression for inhibition with EMG BF using the gain settings?
reduce the gain (increase sensitivity) so that a lower contraction level will stimulate the machine
what are the contraindications/precautions for EMG BF?
the pt needs to have volitional ms contractions
the pt needs to have a good understanding of the process
acute inflammation
once the pt has good ms activation, do we need to continue using EMG BF?
nope
what is the application technique for EMG BF (long ass list, just know generally)
Instruct pt in goals of EMG-BF rx
Clean pt’s skin, place small amount of gel on electrodes
Determine appropriate electrode location (target ms)
Apply electrodes (tape down as needed)
Attach electrodes to unit, turn unit on
Establish the baseline resting ms activity (~</=2uV)
Establish peak amplitude by asking the pt to perform a max isometric contraction
Record peak amplitude
Set the threshold at or just above the achieved peak amplitude (gain), and instruct the pt in performing isometric contractions with the goal of reaching and sustaining the threshold for a set amount of time for each contraction (“when you reach the threshold, you will hear an audible signal”)
Instruct in hold time, sets, and # of contractions
Check pt and adjust threshold as needed
On completion, remove electrodes and inspect area
Assess outcomes of treatment (be fxnal!!!)
why can we use tape with EMG BF, but not with ES?
bc very low voltage is used (just trying to pick up a signal), but NOT in ES bc it changes the voltage and can lead to burn spot
t/f: mirrors and analogs like BP cuffs and scales can be used as BF
true
