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biofeedback
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biofeedback - July 9, 2000 1:15:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
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Do any of you use biofeedback in your P.T. practice (surface EMG or other biofeedback modalities)? If yes, for which conditions? I'm certified and use primarily surface EMG for relaxation training and n-m re-ed, but have the capability of multimodality training including EEG. I'm curious to know who many other P.T.'s encorporate it into their practice.
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Re: biofeedback - July 9, 2000 6:10:00 PM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
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B.S.
I work with 5 other therapists in an outpatient orthopedic clinic.
We use surface EMG frequently. Primarily for neuromuscular re-ed. VMO is the most common use in the clinic, however I use it on gluteus medius, supraspinatus and rhomboids. One therapist specializes in pelvic floor and uses EMG extensively for both evaluation and treatment.
I find EMG moderately useful with the focus on helping the patient to learn biofeedback cues independent of the EMG unit (as they need to be successful at home without the EMG). Other biofeedback tools I use are production or elimination of pain/symptoms and patient self palpation.
What is certification?
Please recommend other applications of EMG and other biofeedback modalities which can quickly apply to a home program.
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Re: biofeedback - July 11, 2000 1:30:00 AM
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nicaragua
Posts: 28
Joined: July 10, 2000
From: Australia
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B.S.I would use EMg for shoulder problems and postural retraining. For VMO that is a no no. The VMO is not a separete muscle of the quadriceps group contrary to McConnell use of taping
[This message has been edited by RehabEdge (edited July 12, 2000).]
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Re: biofeedback - July 12, 2000 6:14:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
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Edilling,
Thanks for the reply. I thought about the "certified " after I posted and realized i was unclear. I'm certified as a biofeedback therapist
I've used sEMG for relaxation training for chronic pain and for tremors, with good results. The trick and of course the goal is generalization of skills to life, so we progress from relaxation in a nice quiet environment, to recovery to the relaxed baseline after discussion/visualization of stressor, or activity, introduce noise,lights, activity while the client tries to maintain their relaxed physiology (elevated hand temps, dry hands, decr. HR,
relaxed muscles, etc.), then wean off biofeedback and increase homework.
I also use it for retraining symmetry in the paraspinals during movement, and recovery training after movement or work.
Another use of sEMG is breath training. Some biofeedback instrument use strain gauges for assessment of chest versus diaphragmatic pattern. I put sensors at UT and watch the rise and fall with breathing and train from there...this is fun and clients really get it. You can also train for respiratory sinus arrythmia with breath plus heart rate monitoring. Carryover to home is good with home practice.
Thanks again for your input.
Betty
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Re: biofeedback - July 13, 2000 3:47:00 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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Betty,
What was involved in your certification? Do you feel certification is good/necessary for those using biofeedback? And one more, what types of devices/machines do you utilize?
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Re: biofeedback - July 13, 2000 3:45:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
Status: offline
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Gerry,
The Biofeedback Certification Inst. of America is the certification, rather than licensing, arm of the Association of Applied Psychophysiology and Biofeedback. When I got certified the requirements were: a degree/license in a health care field (PT, OT, RN, MD, DC, DDS, RT, counseling, rehab, PhD, etc. etc.); 60 hours of didactic biofeedback education; 10 hours of personal training; 120 hours of client training...30 hours supervised; 10 hours of case conferencing; anatomy/physiology course if not included in degree program. Once those were completed then we sat for a 3 hour written test and took a practical as well. They've done away with the practical though. I think my group was the last in California to take it...lucky us!
I think if we call ourselves Biofeedback Therapists we need to show evidence that we meet minimum standards and have satisfied the educational and practical requirements necessary to become competent, as in any profession.
However, I don't think that P.T.'s who utilize sEMG for muscle and neuro-muscular reeducation need to become certified, as it's covered in our practice act and we have the necessary education. I do feel that there's alot more to it though than we, or at least I, got in school, especially regarding instrumentation. This can be book learned though.
I have trouble with self discipline (I'd just as soon go work on may tan) so I found it very useful to go through the certification process. It kept me on task, I learned a lot, and I met some interesting folks. Many biofeedback practitioners (most?) are from a psych background.
With certification I feel comfortable selling myself not only as a PT but also as a biofeedback therapist. I've done biofeedback training with clients presenting with headache, chronic pain, lupus, hypertension, vocal strain, tremor, muscle weakness/reflex inhibition, stress management, TMD. Other indications are: incontinence, torticollis, stroke, & other rehab stuff, to ADD/ADHD, substance dependency , insomnia, epilepsy. The latter utilize EEG and I'm not proficient in that.
The instrument I use (Bio Integrator) has 2 channels of EEG, 2 channels of EMG (I hope to upgrade to 4), 2 channels of hand temperatures, 1 channel of heart rate, and 1 channel of EDR (skin sweat response). These can be used simultaneously or alone and are displayed on a computer screen with the option of some very cool graphics.
There are better instruments for exclusively muscle biofeedback which in hind sight I wish I'd gotten but I do like to be able to do all the other stuff.
Lots of web sites for biofeedback; here're 2: [URL=http://www.aapb.org]www.aapb.org[/URL] [URL=http://www.sEMG.org]www.sEMG.org[/URL]
Thanks for the interest...hope this helps.
Betty
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