24-Biofeedback

What is Biofeedback?

If you have ever taken your temperature you have participated in a form of biofeedback. "Bio" is a combining word form meaning "life". Feedback denotes giving back. Simplified, biofeedback means feeding back information about life responses: temperature, heart rate, brain wave activity, and/or muscle tension.
Biofeedback requires intensive patient participation. The patient's goal is to learn to control involuntary functions such as heart rate, blood pressure, breathing, skin temperature, and muscle tension. The biofeedback therapist teaches the patient how to affect a particular function specific to a problem through mental or physical exercises (e.g. tense neck muscles).

This treatment is not designed to take the place of a physician. The patient should continue to follow-up with their physician as prescribed.

What is the purpose of Biofeedback?

Biofeedback has helped many people combat the ill effects from involuntary muscle tension and related pain.
Other forms of biofeedback include Electromyography (EMG's) that measures muscle tension, Electroencephalographs (EEGs) that measure brain-wave activity, and Electrocardiographs (ECG's) known to measure heart rate.

How does the patient learn to apply the principles of Biofeedback?

The biofeedback therapist begins by applying sensors to specific points on the patient's body. The sensors are then connected to special equipment (e.g. computer) designed to monitor the patient's physiological responses.

The therapist teaches the patient mental/physical exercises designed to treat their disorder. For example, the patient may learn how to relax certain groups of muscles in the low back. In addition, the therapist may teach the patient visualization skills and deep breathing.
During instruction, the patient is made aware of their "bio" progress by means of the monitoring equipment. The equipment may beep, buzz, or make a dinging sound to assure the patient they are making progress in learning how to control a specific function. Some monitors are capable of providing a visual graphic.
Once the patient has learned the technique, the biofeedback equipment is no longer needed

.
Does it take a long time for the patient to learn the technique?

Biofeedback treatment may involve as few as 10 sessions to as many as 40 or 50. The number of sessions is dependent on the disorder and the patient. Each treatment will last between one-half hour and an hour. Some patients may need to attend up to 5 sessions each week.
This treatment is not for all patients. First, biofeedback does not work for everyone.

If results are not apparent after 8 or 10 sessions, that could mean the patient will not benefit. Secondly, patients with pacemakers should avoid biofeedback because the electrical impulses generated to monitor progress could interfere with the operation of a pacemaker.

Are there any side effects?
There are no known side effects from biofeedback. The treatment is non-invasive.

Biofeedback device:

The SCENAR is a biofeedback device with patented technology. Developed by the Russian space program, it is particularly effective at its US FDA accepted use of muscular relaxation and re-education.
The SCENAR/BF is a biofeedback device indicated for use in relaxation training and muscle re-education.

Muscle Re-education
-Relaxing muscle spasm.
-Preventing or retarding disuse atrophy.
-Maintaining or increasing range of motionStimulating muscles in the leg and ankle of partially paralyzed patients to provide flexion of foot and thus improve the patient's gait.

Relaxation Training
-General muscle relaxation.
-Reduction of "secondary stress" that often accompanies disabling injuries and disorders.

Contraindications:

The SCENAR may affect the operation of cardiac pacemakers, particularly demand type pacemakers. Do not use the SCENAR to stimulate directly on the eyes or over the carotid sinus.

Posted by Mostafa galal & Mohamed rizk

23-Improving Motor Outcomes through Constraint-Induced Movement Therapy

(Stephanie Combs, MS, PT, NCS University of Indianapolis,
Valerie Bush Merriman, OTR, SPT Krannert School of Physical Therapy)

Upper extremity motor disability commonly occurs following stroke. Constraint-Induced Movement Therapy (CI therapy) is a novel therapeutic approach which emphasizes recovery of upper extremity movement dysfunction through intense, short-term repetitive practice. An overview of current concepts and evidence related to CI therapy will be presented. Theoretical foundations underlying CI therapy, protocol components, and recent findings will be discussed. CI therapy procedures and protocol modifications will be explored for application to the neurorehabilitation clinical environment.

References:

-Hakkennes S, Keating JL. Constraint-induced movement therapy following stroke: A systematic review of randomized controlled trials. Australian Journal of Physiotherapy. 2005;51:221-231.

-Morris DM, Taub E. Constraint-induced therapy approach to restoring function after neurological injury. Topics in Stroke Rehabilitation. 2001;8(3):16-30.

-Winstein CJ, Miller JP, Blanton S, Morris DM, Uswatte G, Taub E, Nichols D, Wolf SL. Methods for a multi-site randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke. Neurorehabilitation and Neural Repair. 2003;17:137-152.

22-Cystic fibrosis physiotherapy

Introduction:

Cystic Fibrosis (CF) is a genetic disorder which causes mucus in the body to be very sticky, which can lead to chest infections and lung damage and can affect the way food is used by the body. In 1964 the average life expectancy of a baby born with CF was only 5 years, whereas today it is 31 years. The dramatic increase in life expectancy in a relatively short period of time has led to a shortage of specialist facilities for adults and teenagers.

What is the Autogenic Drainage & Active cycle for breathing technique ?

-Autogenic Drainage

Autogenic drainage uses the patient's own airflow to release and move secretions, through controlled, graduated inspiratory and expiratory maneuvers. This airway clearance technique does not require any assistive devices; however, it is sometimes difficult to learn how to do correctly.
-Active Cycle of Breathing (ACB) Technique

ACB is an airway clearance technique that combines the forced expiratory technique (which uses "huffing" from various lung volumes to assist in removal of secretions) and thoracic expansion exercises. ACB requires training with a respiratory therapist to learn how to do correctly.

A comparative study of autogenic drainage and the active cycle of breathing techniques with postural drainage

BACKGROUND--

Autogenic drainage has been suggested as an alternative method of chest physiotherapy in patients with cystic fibrosis. In this study autogenic drainage was compared with the active cycle of breathing techniques (ACBT) together with postural drainage.

METHODS--

Eighteen patients with cystic fibrosis took part in a randomised two- day crossover trial. There were two sessions of one method of physiotherapy on each day, either autogenic drainage or ACBT. The study days were one week apart. On each day the patients were monitored for six hours. Mucus movement was quantified by a radioaerosol technique. Airway clearance was studied qualitatively using xenon-133 scintigraphic studies at the start and end of each day. Expectorated sputum was collected during and for one hour after each session of physiotherapy. Pulmonary functions tests were performed before and after each session. Oxygen saturation (SaO2) and heart rate were measured before, during, and after each session.

RESULTS--

Autogenic drainage cleared mucus from the lungs faster than ACBT over the whole day. Both methods improved ventilation, as assessed by the xenon-133 ventilation studies. No overall differences were found in the pulmonary function test results, but more patients had an improved forced expiratory flow from 25% to 75% with autogenic drainage, while more showed an improved forced vital capacity with ACBT. No differences were found in sputum weight and heart rate, nor in mean SaO2 over the series, but four patients desaturated during ACBT.

CONCLUSIONS--

Autogenic drainage was found to be as good as ACBT at clearing mucus in patients with cystic fibrosis and is therefore an effective method of home physiotherapy. Patients with cystic fibrosis should be assessed as to which method suits them best.
Infants and toddlers suffering from Cystic Fibrosis have a difficult time loosening and coughing up the mucus that accumulates in their lungs and airways.
Here's a quick tip on how to use Postural Drainage to help your child loosen and expel the mucus to improve their breathing:
Position your child on his/her side on a pillow.
Tilt your child's head downward, with his/her bottom above the level of his/her head.
Gently tap your child's side, just under the armpit, and back.
Reverse sides and repeat until your child is able to expel some mucus and breathe easier.
zSB(3,3)


Another techniques>>

-Intrapulmonary Percussive Ventilation (IPV)
IPVis an airway clearance technique that uses compressed gas to deliver a series of pressurized gas mini-bursts to the respiratory tract usually by a mouthpiece. The IPV device is a pressurized aerosol machine that delivers aerosolized medications through a mouthpiece under pressure and with oscillations that vibrate the chest and loosen airway secretions.