Medical Biofeedback Physical Therapy

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Physical Therapy and Biofeedback

Physical therapy is increasingly recognized as a very important component in the treatment of chronic pelvic pain (CPP). The International Pelvic Pain Society recommends that this therapy is most beneficial for women whose pain is localized to either the right or left side of the pelvis or is very low in the stomach.

Physical therapy can help strengthen muscles that have been damaged during pregnancy and also birth or by injury to the back or pelvis. There is increasing evidence that it can also help with the pain referred to, that is, pain originating from other places but felt in the pelvic muscles.

Physiotherapist is a specialist who helps people regain physical function after an injury or illness. Their work mainly focuses on muscles. They use massage and sports techniques to strengthen muscles and reduce pain. Some exercise techniques used to treat CPP are passive, which means you relax your body while the therapist moves the legs and lowers the body through a series of movements. In other cases, the physiotherapist will teach you the exercises you can do both in your therapy session and at home. The physiotherapist will assess your condition to help decide which exercise is right for you.

Biofeedback technique

Sometimes physiotherapists use a tool often called a biofeedback machine to direct exercise. Biofeedback electronically measures the strength of your muscle contractions and gives you constant feedback about how exercise affects your muscles. This teaches you to control your body's muscles with their response. Several studies have been published which show that biofeedback is useful for women with vulvodynia and has also been shown to be useful for treating CPP. Biofeedback machines connect to the body with electrodes, which are placed on the skin, and use sound or lights to guide your practice

USING BIOFEEDBACK IN PHYSICAL THERAPY OF PELVIC FLOOR

Robyn Lowry This blog was written by Robyn Lowry, PT, MSPT.

Biofeedback is a basic tool for pelvic floor rehabilitation. Biofeedback can be used to strengthen the weak pelvic floor muscles (up training) and train the pelvic floor muscles that are too short to relax (down training). Biofeedback is defined as "A training technique that allows one to obtain some elements of voluntary control over the functioning of the muscle or autonomic muscle system using devices that produce auditory or visual stimulation" (Schwartz in 1987). Biofeedback allows physiological changes through operant conditioning, trial and error based learning methods, rewards and punishments and reinforcement through repetition.

One of the most common statements made by my pelvic floor patients is "I don't know I have muscles there!" Very often they will tell me that they have been ordered by a doctor or read in a magazine how to do a "Kegal" exercise to strengthen their pelvic floor but they do not continue to practice because they do not know if they are doing it right. Studies show that 70% of women with pelvic muscle dysfunction (PFM) cannot contract their PFM correctly only with verbal instructions and about 30% of women cause more damage with the wrong technique because of valsalva. (Bo, 2013) Biofeedback allows patients to see exactly what their muscles are doing by giving direct feedback when they are doing pelvic floor muscle strengthening exercises correctly or not. After the connection of the brain to the pelvic floor is done through biofeedback, patients can go home and repeat the exercise correctly and with greater confidence.

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Biofeedback in the clinic has several benefits for patients and also for therapists. For patients, biofeedback increases the interest in sports, motivation and "buying" which in turn produces better functional results. It also gives patients a feeling of direct control of the functional performance of their pelvic floor, increases proprioceptive and sensory awareness that are important for pelvic floor rehabilitation and can also improve patient compliance with exercise programs in their homes. For doctors, biofeedback provides a valuable source of objective information that can be documented and provides meaningful criteria for training development and modification.

Biofeedback can vary greatly in pelvic floor physical therapy. This can be as simple as teaching patients to monitor their own PFM contractions using their fingertips, the use of weighted vaginal cones (slippage from weight giving direct feedback), air pressure control devices or surface electromyography (sEMG) which is my goal. for tools in the clinic. sEMG measures the electrical activity of the pelvic floor muscles and also graphs the results. sEMG electrodes can be placed externally on the perineum, vaginally or rectally with the internal sEMG sensor. With patients who need pelvic enhancement training (stress urinary incontinence, pelvic organ prolapse, pelvic pain, postoperative rehabilitation), I instruct patients to endure pelvic floor muscle contraction, rapid movement and stairs up and down (eccentric contractions) while watching Animated graphics that are controlled by their muscle efforts. For patients who need pelvic floor training (dyspareunia, functional obstructive constipation, pelvic pain, chronic prostatitis), I instruct patients on the "base" of the pelvis, diaphragmatic breathing as well as relaxation techniques while they observe a corresponding decrease in the graph. tone of muscle breaks.

When using sEMG to evaluate patients, I measure resting basic muscle activity, latency of muscle contraction (recruitment time / increase) or how quickly a patient can recruit their pelvic floor muscles, holding back capacity (ability to resist PFM contraction during the time selected). , usually 5-10 seconds), return latency (recruitment / fall time) or the length of time needed to return to the resting level, the contraction baseline, peak microvolts and net increases. Normative data and functional outcome correlations have been established for some of these actions, the most clinically correlated measure of urinary incontinence is holding capacity, the study supports a 10-second goal to improve continuity control.

Biofeedback for pelvic floor rehabilitation is an important tool. There is evidence for biofeedback use for the treatment of incontinence. It has been shown to improve patient learning and awareness of the correct contraction of the pelvic floor muscles, accelerating the increase in pelvic floor muscle strength and increasing the motivation of patients to continue exercising when they observe measurable increases over time.

How to Use Biofeedback in Physical Therapy

Biofeedback is an extraordinary modality in physical therapy. The main mind / body technique, Biofeedback is used to train people how to improve their health by using and interpreting signals from the body. The biofeedback unit provides various ways for patients to gain control of certain physical processes that are usually considered automatic from the autonomic nervous system. This information has a therapeutic application when used in physical therapy because it helps patients regain movements and functions of daily activities.

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MYOTRAC HOME TRAINER WITH ACTIVE MYOSCAN SENSORS AND EXTENDER CABLES

MyoTrac BioFeedback Unit for Home Use

How Biofeedback works

Biofeedback (or biological feedback) uses instruments to monitor the body's response, such as muscle tension or skin temperature, when a person tries to change their response to stimulation. For example, a monitor may give feedback in a higher tone if the muscles in the face tighten and lower if the muscles relax. Another example is monitoring the increase or decrease in the temperature of patients in their hands (or feet), such as when treating patients with Raynaud's Disease.

Increased muscle tension and also at changing body temperatures are two of the body's main responses to stress and tension, the body's "fight or flight" response. By providing patients with instant and continuous information about the unconscious and unconscious processes in the body using Biofeedback, they can observe and try to modify their body's reaction to stress. After a patient uses biofeedback to develop their ability to recognize and also reduce tension in their body with physical therapy, patients will be able to take these skills and apply them when they are under pressure in their daily lives.

Use of Biofeedback in Physical Therapy

Migraine: Biofeedback has been shown to reduce the frequency and severity of migraines by approximately 45-60%. When combined with painkillers, the effectiveness of biofeedback increases to 70%.

Pelvic dysfunction: Biofeedback uses electrodes that have been placed on the body (on the perineum or area around the anus) to feel how tense or relaxed the pelvic floor muscles are and display the results on a computer or other device. These signals can help patients learn to relax the muscles.

Paralysis: Biofeedback can be used to help stroke patients regain movement in paralytic muscles. In a study published in The Journal of Neuroengineering and Rehabilitation, biofeedback improved the results of patient gait training, helped get normal speed, stepped up, and also increased ankle strength.

Chronic Pain: Response and anxiety levels due to stress often enlarge or cause chronic pain. Pain, of course, produces more anxiety which then creates more pain. By learning to relax, patients learn to limit or avoid the stress response caused by anxiety which limits their ability to create pain in the body.

Raynaud's Disease: A circulatory system syndrome that causes blood vessels to constrict, Biofeedback has proven to be very effective in treating Raynaud's Disease. Research by the Association of Applied Psychophysiology and Biofeedback shows that thermal biofeedback is effective in the treatment of primary Raynaud's disease, with over 80-90% of patients reporting increased circulation and reduced frequency of symptoms, such as numbness, throbbing and swelling.

Biofeedback is an empowering tool in physical therapy treatments. Biofeedback provides the necessary mind / body connections that are sometimes lost in our patient population. And the most positive effects that Biofeedback provides are tools that patients learn in clinics have practical applications and their impact on their daily lives, improve their quality of life even after treatment ends.