applied psychophysiological interventions (biofeedback...
TRANSCRIPT
Applied Psychophysiological InterventionsApplied Psychophysiological Interventions(Biofeedback)(Biofeedback)
for for Survivors of Traumatic Brain Injury: Survivors of Traumatic Brain Injury:
Acute and Chronic StagesAcute and Chronic Stages
Robert A. Fels, Psy.D. , LMFT, BCIAC-EEG
IntroductionIntroduction
l Introduction to Biofeedbackl Contemporary Collaborative Issuesl Acute and Chronic Casesl Review and More Questions
Alternative Alternative Integrative Integrative
ComplimentaryComplimentaryHolisticHolistic
l Healingl Reduction of sufferingl Encourage enhanced quality of life
History of Biofeedback 1History of Biofeedback 1
l The Muscles:It was Luigi Galvani (1786) who first
discovered the critical role of electrical energy muscle movement. He demonstrated that a normal muscle movement is accomplished by a detectable change in electrical activity.
Edmund Jacobson utilized electromyography (EMG) to look for objective measures of muscle relaxation.
History of Biofeedback 2History of Biofeedback 2
l The Cardiovascular System:During the 1890’s, an Italian criminologist
named Cesare Lombroso, started taking blood pressures of suspects while they were being interrogated by the police. He was one of the first to suggest that blood pressure measurements were useful in studying psychological processes.
Applied Psychophysiology Applied Psychophysiology andand
Biofeedback Biofeedback
l Biofeedback Research Society (Santa Monica, 1969)
l What is Applied Psychophysiology and Biofeedback?. Applied Psychophysiology and Biofeedback,(1999) 24, 3-54.
Applied Psychophysiological and Applied Psychophysiological and Biofeedback ModalitiesBiofeedback Modalities
l Surface Electromyographyl Skin Temperature l Skin Conductance Levell Diaphragmatic Breathing Instructionl Guided Muscle Relaxationl Guided Visualization
Growth and LearningGrowth and Learningl Appropriate Axonal Regeneration
Risk and OpportunityRisk and Opportunity
l Boundary Awareness: Professional/Personall Collaborationl Cooperationl Non Threatening
Assessment Informs InterventionAssessment Informs Intervention
Mobile Biofeedback InstrumentsMobile Biofeedback Instruments
Acute StageAcute Stage
l Intensive Care Unitl Immediate Intervention Required
Pain ManagementPain ManagementSedation WithdrawalSedation Withdrawal
l 29 year old married female l Multiple trauma from MVA l Loss of consciousnessl 18-19 weeks pregnantl Trachea Intubated, 2 Nasogastric tubesl Diaphragmatic Breathingl Muscle Relaxation
Ventilator WeaningVentilator WeaningPain ManagementPain Management
l 23 year old single malel Multiple trauma from MVA,l Trachea Intubated, 2 Noseogastric tubes,
Intracranial pressure monitorl Glasgow Coma Score (6) 16 daysl Diaphragmatic Breathing Instructionl Guided Muscle Relaxationl Guided Visualization/Imagery
Head TraumaHead Traumal 21 year old single femalel MVA: l C1-C2 fracturel Cervical strain/sprain
Chronic StageChronic Stage
l Rehabilitation/Restoration of Functionl Long term deficits
Restoration of Motor FunctionRestoration of Motor Function
l 32 year old female with history of alcoholisml Compressed Brain Stem, midline shift, double
visionl Approximately 30 days unconsciousl Wheeled in with restrained arms and legs for
safety and comfort.
Electromyography SensorsElectromyography Sensors
Surface EMGSurface EMGLow ActivityLow Activity
Initial Volitional EMGInitial Volitional EMG
Sustained Surface EMGSustained Surface EMG
Surface EMGSurface EMG
“My Muscles Are Alive”“My Muscles Are Alive”
“My Muscles Are Alive”“My Muscles Are Alive”
“My Muscles Are Alive”“My Muscles Are Alive”
“My Muscles Are Alive”“My Muscles Are Alive”
“My Muscles Are Alive”“My Muscles Are Alive”
Skin Conductance SensorsSkin Conductance Sensors
Cholinergic Fibers/AcetylcholineCholinergic Fibers/Acetylcholine
Eccrine Sweat GlandEccrine Sweat Gland
Letting GoLetting Go
Skin Temperature SensorSkin Temperature Sensor
Increased VascularityIncreased Vascularity
EMG Enhanced Intervention EMG Enhanced Intervention for Dysphagiafor Dysphagia
l 26 year old married female l Anoxic Encephalopathyl One year post incident
Nasolaryngeal ImageNasolaryngeal Image
Initial ContractionInitial Contraction
Sustained ContractionSustained Contraction
Lip MusclesLip Muscles
SwallowingSwallowing
Pain Management GroupPain Management Group
l Basic patient informationl Subjective pain levels 0-10l Muscle relaxationl Diaphragmatic breathingl Guided practicel Debriefing: Tell me about your experience.
Helpful Self Statements Helpful Self Statements 11l My body is either sitting or lying in a comfortable
position…l I am here at this moment…l There is nothing that I need to accomplish…l In this moment I can be inside without
expectations…l Thoughts that circulate through my mind are OK…l I can allow them to circulate without blame,
criticism or guilt…
Helpful Self Statements Helpful Self Statements 22
l I feel quiet…l My feet feel heavy and relaxed…l My ankles, my knees and my hips feel heavy,
relaxed and comfortable…l My abdomen and torso feel relaxed and quiet…l My hands, my arms and my shoulders feel
heavy, relaxed and comfortable…l My breaths occur almost effortlessly…
Helpful Self Statements Helpful Self Statements 33
l My neck, my jaw and my forehead feel relaxed. They feel comfortable and smooth…
l My whole body feels quiet, heavy, comfortable and relaxed…
l I notice the air breathing for me as it enters and leaves my body…
l My hands are warm…l Warmth is flowing into my hands, they are warm,
warmer…
Helpful Self Statements Helpful Self Statements 44
l I can feel the warmth flowing down into my arms and hands…
l My hands are warm, relaxed and quiet…l Still breathing breath after breath almost
effortlessly… l My whole body feels quiet, comfortable and
relaxed…l I withdraw my thoughts from the surroundings and
I feel serene and quiet…
Helpful Self Statements Helpful Self Statements 55
l My thoughts are tuned inward and I feel at ease…l I am alert, but in an easy, quiet, inwardly comfortable
way…l I can rest in this comfortable manner whenever I
wish…l Gently and gradually move your fingers, toes, breath,
stretch, open your eyes.
Future Development Future Development
l Cognitive and Perceptual Deficits
Where to Get More InformationWhere to Get More Information
l Association for Applied Psychophysiology and Biofeedback (303) 422-8436 http://www.aapb.org
Annual meeting, state societies, journal and newsmagazine.
l Biofeedback Certification Institute of America (303) 420-2902 http://www.bcia.org/ Information about certification requirements and to locate certified therapists.
Contact: Robert A. Fels, Psy.D.Contact: Robert A. Fels, Psy.D.
l Email: [email protected]
l www.clinicalbiofeedbacktherapy.coml www.humanpsychophysiology.coml Telephone: (888) 925-2362l Address: 20423 SR 7, # 231
Boca Raton, Florida 33498 USA