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An update on the recent changes of FDA regulations as it relates to Biofeedback manufacturers & users.
Dr. Anand Akerkar Alan P. Schwartz
mdi Consultants, Inc. Great Neck, NY
www.mdiconsultants.com info@mdiconsultant.com
516-482-9001 516-4820186(fax)
The Biofeedback therapies and the industry itself has always been regarded as a "black sheep" by the FDA. Could it be that the FDA just doesn’t understand the concept of the biofeedback therapies, or hasn’t taken the time to learn how it actually works. Maybe, is it that the biofeedback therapist and equipment manufacturers have made biofeedback into something other that what it really is, giving the FDA real concern on how it is sold and used. Well, no matter what you want to say about who is actually at fault, biofeedback and the FDA sometimes appear like water and oil, they just don’t mix well. With the present Congressional make up the FDA has been called the "friendly FDA" to the industry. The FDAMA of 1997 has put the FDA on notice to assure that it looks to reduce regulations on the medical device industry. The FDA has recently lost a court decision on "off label" information, there is going to be a new Commissioner appointed, the QSR with the Design Review is in full force and the 510(k) process is also under constant review. What does this all mean to the Biofeedback industry? This seminar will provide insight into the present FDA policies on the medical device industry with special emphasis on how it relates to the Biofeedback industry. Also covered will be the biofeedback product labeling requirements, the judgment against the FDA on off label use and the new guidelines that the FDA has provided on this and the how the new QSR and Design Review should be instituted by the biofeedback manufacturer. The seminar will also provide insight into the FDA 510(k) review process and the new 510(k) clearance guidelines, and how they can be of benefit to the biofeedback manufacturer. For the biofeedback companies who are marketing or want to market their instruments in the European Community, a review of the CE mark requirements and the ISO standards.
FDA Update
Dr. Anand Akerkar Alan P. Schwartz mdi Consultants, Inc. Great Neck, NY
www.mdiconsultants.com info@mdiconsultant.com
516-482-9001 516-4820186(fax)
This two hour workshop for the Biofeedback industry will cover three areas, an FDA update, the 510(k) process and GMP compliance as it relates to the Biofeedback Industry.
Topic 1. An FDA update
The biofeedback industry is one that has never been looked upon by the US FDA lightly. This review will concentrate on the present FDA’s position to the biofeedback industry, the FDA’s policy on labeling and off label use, the internet police and the present regulatory policies.
Topic 2. The 510(k) process – Original, Special or Abbreviated
An update on 510(k) strategies. This part will focus on the 510(k) process providing an update on the FDA 510(k) process, the three types of 510(k)s, third party review process as well as what is required in your strategic planning and 510(k) submission.
Topic 3. The FDA QSR(gmp) vs. ISO 9000– is these Quality Systems the same?
The US FDA has the QSR and the European Community has the ISO9000, in reality aren’t these two quality systems the same? Well, there is a case for their similarities but when you get down the basis of how these systems are audited they are completely different. This session will show you how each system is the same and different as well as provide you insight in how the systems are audited and the possible ramifications if non-compliances are found as well as the US FDA’s review of third party inspections for GMP compliance.
PS: Is Neurofeedback Treatment Effective ? You Bet Your QEEG it is !
Elsa Baehr, Ph.D.
The purpose of this case study is to demonstrate the usefulness of the Quantitative EEG (QEEG) in planning therapy and in evaluating the effects of neurofeedback treatment. The client , who was ten years, eight months old at the beginning of therapy, is the oldest of three children in an intact family. He had a mild closed head injury when he was six years old . In first grade he had difficulty reading, and sustaining his attention in t the classroom . His teachers noted poor organizational skills and difficulty in conceptualizing his thoughts and writing them down. His parents were concerned with his low grades in language arts, and his behavioral problems. He was defiant at home and procrastinated about doing his homework. He loved sports, and excelled in tennis. He was medicated with Welbrutrin for depression and anxiety when he was eight years old. His parents found him greatly improved on the medication. He discontinued the Welbrutrin and started on a course of 5mg Methylphenidate (Ritalin) when he was ten years old.
Mark was evaluated by Nancy White, PhD in Texas in November 1996
He was diagnosed by Dr. White as having an attention deficit disorder. He was referred to NeuroQuest, Inc. for treatment when he returned to Illinois. He was ten years 8 months old at that time. .
Method:
The participant was a ten year eight month old boy of average intelligence, who was in the fifth grade in a public school. He was taking 5mg of Methylhenidate daily during the course of therapy. He attended a learning development program in his school, but had no prior experience with neurofeedback.
Materials:
The neurofeedback sessions were conducted using either the Lexicore Neurosearch 24 equipment or the Autogen A620 equipment. Pre treatment assessment, administered by Dr. White included the visual TOVA continuous performance test to evaluate variables such as inattention, impulsivity, response time and variability, the Attention Deficit Disorder Symptom Checklist and a QEEG. Post treatment assessment included the TOVA test and a QEEG. A Comparison was made between the pre and post TOVA and pre and post QEEG .
Procedures:
A course of neurotherapy was planned using the QEEG as a basis for treatment. At the time of his initial evaluation the QEEG data was processed by Lexicore’s Datalex, method. Both the pre and post therapy QEEGs were processed on a Lexicor 24 channel brain mapper. The post QEEG was analyzed using thee NeuroRep V3.0 reporting system, Both systems utilized the Thatcher Reference Database. The incidence of abnormalities (Z scores greater than chance at p<0.25 ) of coherence, phase, amplitude asymmetry and relative power, were measured. The data used was obtained by recoding a ten minute segment of data, eyes closed. The material was then artifacted by visual analysis and a minimum of 60 seconds was then subjected to the computerize program analysis. A report was generated which outlined Z score deviations from the reference database.
Mark was given 35 neurofeedback sessions over a period of six months. Each session lasted approximately 50 minutes. All sessions were conducted with eyes open. Relaxation techniques to help him reduce tension producing EMG. Seventeen sessions were devoted to reducing the theta/beta ratio at CZ. Thirteen sessions focused on increasing coherence in delta and theta brainwave frequency ranges at six different sites, and five sessions were aimed at reducing phase in the alpha brainwave frequency at three different sites. Audio- visual stimulation, utilizing Mind Gear equipment, was used during two sessions.
Results and Discussion:
The objectives of therapy were reached. The theta/beta ratio was reduced from 3.43 to 1.48. Coherence was increased at all six sites in both the delta and theta brainwave frequency ranges, and phase was increased , but not to a significant degree at the three
sites .
A comparison of the pre and post therapy visual TOVA standard test scores shows significant improvement in errors of commission (impulsivity), response time and variability1 A comparison of the pre and post QEEG shows that the negative EEG coherence scores, which occurred bilaterally in the frontal-temporal and frontal parietal regions and in the right hemisphere in the temporal-occipital connections, were absent in the post treatment QEEG Negative EEG coherence Z scores may indicate reduced functional connectivity. The absence of these negative Z scores implies that connections may have been made in these regions. This finding is consistent with increase in coherence scores . The pre-QEEG Z scores in phase were deviant from the reference data base in the right hemisphere in three sites. One to three Z score deviations could occur by chance and are not considered significant. The phase deviation occurring at T6-O2 occurred in both the pre and post TOVA tests.
Conclusion:
At the conclusion of therapy his parents reported that Mark was functioning better at home. He was more cooperative, and he was more willing to do his homework on time. His grades had improved in school. Confirmation of his improvement came from Mark himself when he asked his father how old he was when he started to like reading Because of his progress, his parents wondered if the medication could be eliminated. . The TOVA test was used to evaluate the effect of Ritalin on the test variables. Figure 3 shows that response time and variability were significantly improved with the use of medication. It was recommended that Mark continue with the medication for six months and then be re-evaluated. 2
The results support the hypothesis that the QEEG is a useful tool for help in planning neurotherapy treatment, and is a valid way of objectively assessing results of therapy.
1The normal range in Standard Scores is 85-115. Scores above 115 are better than average, and scores below 85 are less than average. When comparing two protocols a Standard Score change of 7.5 is considered significant.
2Mark did not return after six months because his family moved to Texas. A recent communication from his parents stated that Mark was attending a private school with high academic standards. He is doing excellent and is "meeting the challenge".
W9Y2 The Alpha Asymmetry Depression Protocol
Elsa Baehr, Ph.D. and Peter Rosenfeld, Ph.D.
THEORETICAL BACKGROUND
1. The Relationship between mood disorders and asymmetry
A..Work of Davidson and Colleagues
B Work of Rosenfeld et al
C. Replication by Allen and Cavendar
2. Technical Details
A. The devt of a formula to define the A-score.
B. The Asymmetry Formula and Protocol.
C. Reference and electrode placement.
3. Rationale for Clinical Use of the Asymmetry Protocol
A. Normal and pathological differences in asymmetry
B Pathological asymmetry and separation in infancy
C. Heredity evidence of pathological asymmetry in adolescent females
D. Evidence that brainwave biofeedback is an effective to modify brain-wave
E. Evidence that brainwave changes are long lasting.
Clinical Use of The Asymmetry Protocol in Treating Depression
1 Technical Details
A.. Classification of Depressive Disorders
B. Characteristics of the depressive disorders studies in previous research
C. Characteristics of six subjects treated with the asymmetry protocol.
2. Procedures
A. Pre and Post therapy assessment measures
B Preparation of the client :Training in breathing techniques and autogenic relaxation techniques
C. Application of electrodes
D. Recording the data
E. Selecting displays and audio feedback
F Time allotment for brainwave biofeedback and psychotherapy
3. Psychological Factors Associated with Brainwave biofeedback Treatment
A. Changes in psychotherapeutic relationship when brainwave biofeedback is introduced in ongoing psychotherapy.
B. Negative factors in the clinical situation.
C. Abreactions during treatment
D. Temporary regression as reflected by asymmetry score and feeling state.
E. Psychotherapeutic interventions
4. Presentation of six case studies
A. Pre & post Beck Depression Scales & MMPI
B. Medication effects
C Behavioral Changes
D .Follow-up data
Demonstration Using the Asymmetry Protocol
A. Use of protocol on volunteer subject to demonstrate hook-up and procedures
B. Demonstration of effects of positive and negative thoughts on asymmetry.
Valdeane Brown
Optimal Functioning lecture
Advanced meeting lecture 21 nd 40 hz training.
4 hr Workshop on Biograph Basics
Brown, Valdeane W., Ph.D.
PS Interleaving 21 and 40 Hz Training For Peak Performance: How A Pair Can Beat A Full House (optimal functioning)
Brown, Valdeane W., Ph.D.
Most approaches to Peak Performance Training have been based on very complex paradigms. Differential placements, multiple training regimes, and arrays of adjunct procedures are combined in abstruse and arcane ways to promote what we call Optimal Flow and Function (OFF). Helping clients to Get OFF! does not need to be complex -- a simple pairing of two augments targets can do the job easily and quickly. You don’t need the "Full House" of other techniques to help clients access excellence.
This presentation describes the use of a new (21 Hz) and not often used (40 Hz) augment target to help the CNS reorganize optimally: i.e., in ways that allow us to come home to the present moment, where we can optimally flow and function. When the CNS reorganizes in terms of its underlying non-linear, dynamical structure, we lose the garbage in our own EEG: viz., the 3 & 5 Hz attractors, the 23-38 Hz hypervigilance of dredging and mulling, as well as other non-adaptive constrictions in the EEG. Whether we are Michael Jordan or not, we all have our own garbage to take out so we can flow most easily.
Fundamentals of Neurofeedback: The Period 3 Approach To CNS Functional Transformation (part of Foundations Course)
Brown, Valdeane W., Ph.D.
Clinical approaches to neurofeedback are often highly detailed and complex, leading the beginning- and even experienced practitioner, to feel less than adequate in treating the variety of disorders that walk through the clinical door.
Such complex treatment protocols stem from a viewpoint which places disorder at the hub of our interventions- a "sickness based" model which, much like western medicine, assumes disorders are discrete entities necessitating different and distinct treatment protocols. Under this model, the challenge is to discover the "right" treatment which is also likely to be "wrong" for another disorder.
The powerful yet simple strategies to be offered in this presentation stem from a way of working that places self-regulation, not disorder, at its center. We call this paradigm the Period 3 Approach. Neurofeedback is unparalleled as a vehicle for providing the brain with what it works with best- information. Given appropriate information the brain begins to self-regulate more effectively and efficiently. When this happens, a myriad of apparently disparate symptoms drop away. It doesn’t matter if you are talking about anxiety, depression, immune system dysfunction or pain- it is, after all, all the same nervous system.
Participants will be presented with a method of intervention standard for all individuals (yes, you read that right!), with the treatment emphasis being adjusted according to real time "reading of your data" as well as client symptoms. As such you are not treating according to pre-determined rules of thumb so much as where the client actually is at that time. As the client’s central nervous system becomes increasingly normalized, symptoms recede. Clients will be able to tolerate training across all frequencies regardless of presenting complaint. Inability to tolerate training at any particular frequency (e.g. beta) demonstrates that the brain is not yet appropriately self-regulating, rather than an intrinsic inability to tolerate beta per se.
Vital to the safety and success of this approach is the use of appropriate inhibits. These will be detailed as well as sequences of augments. You will also discover:
How to train two very different attentional states on the left and right side of the brain simultaneously, increasing the power of your interventions.
How "Theta" is actually composed of three targets frequencies (3, 5 & 7 Hz) each with its own role in health and dysfunction
How to target augment frequencies precisely and sequentially to treat even the most challenging clients in a safe manner
The differential effects of training Alpha (8-12 Hz), SMR (12-15 Hz), Low Beta (15-18 Hz), Aura (19-23 Hz), Peripheral Warmth (26-30 Hz) and Shear (38-42 Hz) Rhythms
The use of FFT and direct digital filtering systems and their relative roles in clinical decision making and data analysis
How dysfunction is better characterized in terms of discrete attractors within the spectrum, whereas functionality is better captured as the ability to fluidly shift amplitudes throughout the spectrum.
That the CNS can not be trained optimally with linear procedures, but requires the use of non-linear, dynamical control mechanisms.
That the CNS is non-linear, so it is designed to process and respond effectively to incredibly dense stimuli arrays in the midst of very noisy environments. Thus, feedback can be complex, differential, syncopated and simultaneous.
The Period 3 Approach is equally applicable to remediation of symptoms as well as training for personal growth, spiritual development and optimal (peak) performance. Its simple and straightforward methods will particularly resonate with:
providers interested in appealing to the "personal growth" market as a means of reducing dependency on managed care.
providers who want to ensure rapid and powerful results while effectively eliminating unwanted side effects.
providers challenged by a particularly diverse range of client problems, and
entry level neurofeedback practitioners who are excited but confused about how best to proceed with development of their own clinical practice.
PSK Non-Linear Data Analysis And 21 Hz Augmentation Training
Brown, Valdeane W., Ph.D.
The question of the appropriate mathematical tools for analyzing real-time EEG has recently become more complex and chaotic - and that is the good news. As Non-Linear Dynamical Time-Series analysis has gained more precision and acceptance, it has demonstrated interesting trends in EEG patterns as an effect of Neurofeedback - trends which could not be seen through older, linear techniques.
Even though Non-Linear Dynamical Analysis may seem more difficult, abstruse or challenging - especially to the mathematically challenged among us - clinical decision making becomes straight forward and easy. Simply being able to conceptualize a system as Non-linear has one particularly important implication for Neurofeedback: Non-linear dynamical systems can be influenced or "controlled" through the use of four distinct procedures, regardless of the specific organization, parameters or effects of the particular system being controlled. The implications of this for Neurofeedback are profound.
Using Non-linear dynamical control procedures, simple interventions can lead to profound shifts, and these shifts can be understood functionally, with no particular need for neuroanatomical localization. The recent ascendancy of wide band suppression paradigms at various sites represent one such case, as does the utility of a new augment target: viz. 21 Hz center frequency.
In this presentation, non-linear dynamical techniques will be used to demonstrate the increased and systematic spectral effects of the 21 Hz center augment, within a "quasi" wide band suppression paradigm. This direct application of Non-Linear Dynamical Control Procedures has been called the Period 3 Approach, and has broad application across the range of clinical disorders with which Neurofeedback is used. Moreover, the principles underlying this approach can be used with any kind of equipment. Thus, a seemingly complex tool (viz. NLD mathematics), can lead to a simple clinical approach for practitioners that works across the entire range of disorders that respond to Neurofeedback.
WS4 The Use Of Spectral Analysis To Fine Tune Neurofeedback: Recognizing And Utilizing Patterns In Frequency Mirror Displays
Brown, Valdeane W., Ph.D.
Clinical Neurofeedback holds great promise for many conditions; however, the protocols have been complex, confusing and even contradictory. Adding another level of complexity is the notion that QEEG must precede Neurofeedback. In this presentation you will learn to cut through the hype, dross and hubris with a clear and comprehensive approach to this exciting treatment, effective across all conditions that respond to Neurofeedback. You will learn how to use real-time spectral analysis of clinical EEG to particularize your interventions and maximize their clinical effect. Learning to recognize distinctive patterns in the spectral array, as well as how the entire spectrum responds to various kinds of training, will allow you to extend, solidify and simplify clinical decision making: you will actually know exactly what is happening with your client moment to moment. You will see how Neurofeedback can be used to treat ADD, Depression, Anxiety, PTSD, Substance Abuse, Sleep Disorder, Traumatic Brain Injury. You will also learn how to train for Peak Performance, all using a single, comprehensive paradigm: the Period 3 Approach to CNS Functional Transformation. This course is intended to develop clinical acumen and efficacy regardless of the equipment or approach you currently use.
PSK Recent Advances in the Neuro and Behavioral Sciences: Implications after central nervous system damage for Biofeedback and Neurofeedback applications to stroke, head injury, cerebral palsy and spinal cord injury.
Bernard S. Brucker, Ph.D., ABPP
University of Miami School of Medicine In the past decade there have been significant discoveries in both the neuro and behavioral sciences which have made a dramatic contribution in understanding the central nervous system, in terms of its structure, function, and recovery after trauma and disease. This presentation will provide an understanding of the structure and function of the central nervous system based on the recent discoveries from the neuro and behavioral sciences. In addition, it will provide an understanding of the mechanisms of trauma and disease, as well as the mechanism for subsequent repair of central nervous system structure. Further, this presentation will explain the latest models of plasticity in both the brain and spinal cord and the role of behavioral techniques in plasticity. Examples of operant conditioning based biofeedback applications for restoring function after central nervous system damage through plasticity models, will be presented with specific applications to stroke, head injury, cerebral palsy and spinal cord injury. Finally, new and exciting areas of current research on neuro recovery and CNS transplant will be presented along with their implications for biofeedback, neurofeedback and behavioral applications.
At the conclusion of this presentation participants will be able to:
Understand the structure and function of the central nervous system
Become familiar with recent neuroscience discoveries related to neuro plasticity
Understand operant conditioning as the basis of biofeedback
Understand the important variables in physiological measurements and equipment for biofeedback and neurofeedback applications
I. Understand the traditional neurological and operant conditioning theoretical basis of central nervous system recovery
Understand the procedures and selection criteria for biofeedback applications to patients with central nervous system damage
Introduction
Structural definition of the central nervous system
Functional definition of the central nervous system
Implications from neuroscience for structural recovery after central nervous system damage
The nature of structural damage to the central nervous system
Traditional models of recover
Repair of central nervous system tissue
Replacement of central nervous system cells
Central nervous system plasticity
Central nervous system cell duplication
Traditional theories of plasticity
Recent discoveries related to the extent of CNS plasticity
The role of learning in CNS plasticity
Operant conditioning as the basis of plasticity
Definition of operant conditioning
Establishing an operant
Shaping procedures
Application of operant conditioning for establishing learned control of physiological responses
Biofeedback as a specific behavioral approach
Instrumentation
Important measurement and feedback variables for effective biofeedback applications
The use of microprocessor technology in biofeedback applications
Operant conditioning based biofeedback applications for CNS recovery
Neurological theories of CNS disability
Traditional neuromuscular assessment
Traditional neuromuscular rehabilitation
Principles of operant conditioning based biofeedback applications in rehabilitation of CNS damage
Biofeedback applications to stroke
Etiology of stroke
Biofeedback for increasing voluntary motor neuron control
Biofeedback for controlling spasticity
Biofeedback combined with traditional treatment applications
Criteria for patient selection
Clinical effect
Implications for brain plasticity and long term recovery
Biofeedback applications to head injury
Etiology of neurological damage in head injury
Increasing motor neuron recruitment
Decreasing spasticity
Decreasing ataxia
Increasing coordinated motor neuron recruitment for increased function
Cognitive deficit tissues
Biofeedback combined with traditional treatment approaches
Criteria for patient selection
Clinical effect
Implications for brain plasticity and long term recovery
Biofeedback applications to cerebral palsy
Etiology of cerebral palsy
Traditional approaches
Behavioral approaches
Biofeedback for increasing coordination of motor neuron recruitment
Biofeedback combined with traditional treatment approaches
Biofeedback and surgery
Cognitive issues
Patient selection criteria
Clinical effect
Implications for brain plasticity
Biofeedback and behavioral applications to spinal cord injury
Etiology
Traditional assessment
EMG measurements
Functional vs Neurologically complete injuries
Theories of recovery and neuro plasticity
Biofeedback applications to increase voluntary motor neuron recruitment
EMG biofeedback combined with traditional treatment
Patient selection criteria
Clinical effect
Future Direction
Advances in microprocessor developments
Advances in treatment procedures
C. Advances from the neuroscience’s
Summary and discussion
WS-4 Biofeedback and Behavioral Applications to Rehabilitation: Variables for Successful Functional Outcome
Bernard S. Brucker, Ph.D., ABPP,
University of Miami School of Medicine
This workshop will provide a comprehensive understanding of the issues related to recovery after central nervous system damage and disease and the potential role of behavioral approaches in rehabilitation such as biofeedback and neurofeedback. More specifically, this workshop will present an understanding of the structure and function of the central nervous system and mechanisms of damage from trauma and disease. Further, it will present the issues involved with rehabilitation and the approaches taken from traditional therapeutic methods. It will also explain some of the recent findings from the neuro and behavioral sciences and their implications for recovery after central nervous system damage. This workshop will focus on the behavioral basis of biofeedback and neurofeedback applications to rehabilitation and the neurophysiological principles on which they work. Specific variables for successful functional applications in stroke, brain injury, cerebral palsy, spinal cord injury and sports medicine will be presented. Finally, areas of current research in the neuroscience’s for neuro recovery and central nervous system transplant will be discussed along with their implications for biofeedback and neurofeedback.
Introduction
A. Definition and misconceptions of biofeedback
B.Theoretical principles of biofeedback
Operant conditioning as the basis of biofeedback
A. Definition of operant conditioning
B. Establishing an operant
C. Shaping procedures
Application of operant conditioning for establishing learned control of physiological responses
Instrumentation
Important measurement and feedback variables for effective biofeedback applications
The use of microprocessor technology in biofeedback applications
Biofeedback application for rehabilitation
Neurological theories of disability
Traditional neuromuscular assessment
Traditional neuromuscular rehabilitation
Principles of operant conditioning based biofeedback applications in rehabilitation
Variables for successful biofeedback treatment
Understanding the etiology
Establishing the physiological response to be learned
Establishing the method of measurement
Determining the feasibility of learned voluntary control
Establishing functional outcome goals
Applying operant conditioning procedures
Biofeedback applications to stroke
Etiology of stroke
Biofeedback for increasing voluntary motor neuron control
Biofeedback for controlling spasticity in synergistic patterns
Biofeedback combined with traditional treatment applications
Criteria for patient selection
Clinical effect
Implications for brain plasticity and long term recovery
Biofeedback applications to head injury
Etiology of neurological damage in head injury
Increasing motor neuron recruitment
Decreasing spasticity
Decreasing ataxia
Increasing coordinated motor neuron recruitment for increased function
Cognitive deficit issues
Biofeedback combined with traditional treatment approaches
Criteria for patient selection
Clinical effect
Implications for brain plasticity and long term recovery
Biofeedback applications to cerebral palsy
Etiology of cerebral palsy
Traditional approaches
Behavioral approaches
Biofeedback for increasing coordination of motor neuron recruitment
Biofeedback combined with traditional treatment approaches
Biofeedback and surgery
Cognitive issues
Patient selection criteria
Clinical effect
Implications for brain plasticity
Biofeedback applications to spinal cord injury
Etiology
Traditional assessment
EMG measurement
Functionally vs. neurologically complete injuries
Theories of recovery
Biofeedback applications to increase voluntary motor neuron recruitment
EMG biofeedback combined with traditional treatment
Patient selection criteria clinical effect
Clinical effect
Implications for spinal cord plasticity and long term recovery
Biofeedback application to sports medicine
Theoretical basis
Increasing peak performance
Treatment of sports injuries resulting in soft tissue damage
Treatment of chondromalatia and patella dislocation
Increasing effectiveness of biofeedback applications
Understanding etiology of the symptom
Choosing the correct operant
Appropriate measurement and feedback apparatus
Appropriate use of operant conditioning paradigms
Future Direction
Advances in microprocessor developments
Advances in treatment procedures
Advances from the neuroscience’s
XIII. Summary and Discussion
Biofeedback and Behavioral Applications to Rehabilitation:
Variables for Successful Functional Outcome Workshop
Bernard S. Brucker, Ph.D., ABPP,
University of Miami School of Medicine
Introduction
Definition and misconceptions of biofeedback
Theoretical principles of biofeedback
Operant conditioning as the basis of biofeedback
Definition of operant conditioning
Establishing an operant
Shaping procedures
Application of operant conditioning for establishing learned control of physiological responses
Instrumentation
Important measurement and feedback variables for effective biofeedback applications
The use of microprocessor technology in biofeedback applications
