Surface Electromyography Making Progress in Dysphagia Rehabilitation
Dr. Catriona Steele, Senior Scientist and Director of the Swallowing Rehabilitation Research Laboratory at the Toronto Rehabilitation Institute, was the invited presenter to the SLP (Speech Language Pathology) group at Johns Hopkins Hospital in Baltimore on October 22, 2009. Dr. Steele demonstrated the latest techniques and EMG technology that she uses.
Dr. Steele is an Associate Professor in the Graduate Department of Speech-Language Pathology at the University of Toronto. Over the past 6 years she has received particular recognition for her research on tongue movements in swallowing and has developed a reputation as an expert on the use of texture modifications as an intervention for dysphagia. Dr. Steele is known across Canada and internationally as an outspoken advocate of evidence-based practice by speech-language pathologists. Dr. Steele currently serves as Coordinator of the American Speech-Language Hearing Association's Special Interest Division 13 (Swallowing and Swallowing Disorders). She is Past President of the Canadian Association of Speech-Language Pathologists and Audiologists and a past board member of the Dysphagia Research Society.
To learn more about this topic, visit the BFE Library and download Dr. Steele's latest methodology:
When 2nd Lt. Jacob Gonzales first boarded an Army CH-47 Chinook, he got sick with nausea.
With a history of motion sickness, the officer said he had to figure out a way to control it to be an effective leader. “When you’re in charge of soldiers, it’s not good for them to see their leader vomiting in front of them,” he said from Fort Sill in Oklahoma, where he is awaiting deployment to Afghanistan.
Last year, while completing his psychology degree, Gonzales signed up for Maureen Haney’s biofeedback class, where he learned to control motion sickness.
“After I learned about biofeedback and techniques for concentrating, breathing and relaxing, I was able to use it, and it worked,” Gonzales said. “I also use it when I’m running five miles a day. It helps me with the pain so I’m able to push through to the end.”
Haney, lecturer in health science and director of the university's Psychophysiology Lab, said biofeedback is a learning process in which people are taught to improve their health and performance by observing signals generated by their own bodies. Her students learn to use biofeedback equipment and skills — such as deep breathing, relaxation, autogenics (self-hypnosis of the central and autonomic nervous system) and visualization — for changing physiological functions.
Biofeedback involves measuring brain waves, blood pressure, heart rate variability, skin temperature, sweat glands and muscle tension via sensors, or electrodes, placed on the skin, Haney said. The information is conveyed through computerized graphs and charts on state-of-the-art biofeedback equipment made up of Thought Technology's Infinity units and EmWave units by HeartMath.
Biofeedback therapy is used by such agencies as NASA, the military, hospitals and alternative medicine clinics.
“It’s very intensive training,” Haney said about the process. Her classes, Health psychophysiology I and Health Psychophysiology II, and a related research lab were created in 2006 and 17, mostly undergrads, have enrolled. The students this semester include a couple of registered nurses, a psychology major, two health science majors, two kinesiology majors and a graduate student majoring in gerontology.
“You can learn to self-regulate with biofeedback by using your mind,” Haney said. “It’s not a quick fix, but you can train yourself to control physiological responses to such things as anxiety, anger, pain or stressful conditions or situations.”
Director's Drive
Haney, who has scoliosis, should know.
She employed what she knew about biofeedback therapy after undergoing two painful surgeries.
"I had a 12-inch steel rod inserted in my back along my spine and segments of seven ribs were removed in 1978," Haney recalled. "Spinal segmentation was not as advanced then, so remaining in bed for three months, post surgery, in a body cast was required. In 1992, I slipped, fell and the rod was dislodged and I had another surgery.
"I requested minimal pain medication after my first 13-hour surgery but never activated the patient-controlled analgesia pump, following my second surgery," she added. "The initial surgery was especially difficult. My first thought was to quickly request pain medication. Fortunately, I was able to refocus and utilize self-regulation skills that allowed me to deal with the intensity of the post-surgical pain."
The experience, she said, "makes me passionate about the power of the mind to regulate physiology."
That explains why she pursues biofeedback research and is a strong advocate for it. She said plans are underway for clinical trials ranging from heart rate variability biofeedback for various medical conditions to resilience training for military personnel. The studies will involve collaboration with multiple agencies.
"The field has many possibilities and opportunities," Haney said, adding that interest in complementary medicine continues to grow and career options in biofeedback are expanding.
From Training to Workforce
Lee Zambrana, one of Haney’s first biofeedback students, completed his bachelor’s degree in psychology last semester and recently landed a job in St. Jude Medical Center’s Chronic Pain Program as a biofeedback specialist. He now is planning on taking the Biofeedback Certification Institute of America exam for national certification.
Haney’s “classes really prepared me for my job,” Zambrana said. “The demand for biofeedback therapy is on the rise with patients seeking alternative methods for dealing with pain.”
Indeed, said Haney, who offers biofeedback services to community members, ranging from those with general stress disorders to individuals dealing with fibromyalgia, through her lab’s Energy Management Training Program. The program consists of six sessions and costs $100.
Military Aid
For the university’s Army ROTC cadets, the lab offers its Performance Enhancement/Resilience Training Program. Cadets in the program are given a psychophysiological stress profile and biofeedback training sessions designed to modulate stress reactivity and promote automatic nervous system flexibility.
“It is a skills building program that fosters the development of emotional and physiological self-control,” Haney said.
Having biofeedback training available on campus benefits the students, as well as the community, said Roberta E. Rikli, dean of the College of Health and Human Development.
"We offer this great service that helps people with their stress issues, while teaching our students how to use the equipment and preparing them for specialized jobs in the field," she said.
"We're one of the few schools in the country that provides the biofeedback certification program, thanks to Maureen's hard work setting up and offering the courses and the lab," Shari McMahan, professor and chair of health science and director of the university's Center for the Promotion of Healthy Lifestyles and Obesity Prevention.
Maureen Haney joined Cal State Fullerton as a lecturer in health science in 1988. In 2006, she became the director of the newly created Psychophysiology Lab.
Previously, Haney worked as director of research, education and marketing at St. Jude Heritage Health Foundation in Fullerton, director of psychology and biofeedback at Fullerton Internal Medicine Center, a behavior education counselor for Nutri/System Weight Control Center in Huntington Beach and a research associate with the Veteran's Administration Medical Center in Long Beach.
She is a certified biofeedback practitioner and a certified stress management educator.
Haney, who received her master's in clinical psychology from Cal State Long Beach and her bachelor's in psychology from the College of New Jersey, has made presentations on her biofeedback research nationwide. Her most recent talk was delivered at the War-Related Illness and Injury Study Center in East Orange, N.J.
I first mentioned the "G-word" to Abhinav after a training session at my house in South Africa in early July. I don't often talk about results to clients, but we had just completed an advanced respiration session (using a technique I had learnt from Bruno Demichelis from AC Milan) that demonstrated such a close link between control of heart-rate and shooting outcome, that I finally began to feel that we had cracked the code of shooting success, and a gold medal was a possibility.
As a sports psychologist, disappointment and failure is part of the job. I have been greenside at the British Open and watched a client's putt slide past the hole, causing him to miss the cut, and I have commiserated with a sprinter who ran fractions of a second too slow to make it into the Olympic team. I've even worked with a hockey team who missed every single shot in a penalty shootout - and were the only team with a sports psychologist at the tournament!
Obviously there are successes also, but in any career, being part of an Olympic gold medal team is a highlight. I do want to say though, that for 10 years as a sports psychologist, I have been saying that character counts more than results, and when I think of Abhinav, it is his character that I admire rather than his gold medal. Talent, hard work and good planning gives you a chance, and from there, sometimes it goes your way, sometimes it doesn't. This one went our way.
Abhinav and I were introduced in December 2007, and began working together in South Africa in February 2008. Our Olympic plan was formulated at a kitchen table in my mother's house. The team grew to include a doctor, chiropractor, physiotherapist, dietician and two shooting coaches in addition to myself. Looking back, I would say the crucial ingredients were a combination of bloody mindedness and flexibility.
Abhinav is an athlete who will stop at nothing to achieve success - one of the two or three most determined athletes I have ever met. So it was a privilege to work with someone who would implement whatever he was asked to do. As someone who grew up in the 80s watching the A-Team, I have to say that I love it when a plan comes together.
In 2006, PGA teaching professional John Dickson and I began to formulate a theory of how and why emotional states impede technical skill execution. We called this theory psykinetics. It draws upon evolutionary psychology, sensory integration and psychophysiology, and once you're talking psychophysiology, you need to be practicing with biofeedback.
I use a FlexComp Infiniti hardware system with BioGraph 4.0 software. Shooting is a peculiar sport because of the lack of movement, and air rifle is the most precise and exacting of the shooting sports. I chose the FlexComp because it allowed me to seamlessly move between training modalities and multimodalities, and the BioGraph software because of its ability to measure and provide feedback. The system plus my laptop is small enough to pack into a Pelican carry case, which is useful for travelling.
The psychophysiological requirements of shooting include:
Controlled breathing and heart-rate
No excess tension in muscles
No fluctuation between sympathetic/parasympathetic states during triggering (shooters can shoot in sympathetic or parasympathetic, but don't want to be surprised by which state they are in)
No interior monologue
Sharp focus and good reactions to trigger at the moment when the sight image is correct.
Abhinav and I started with the biofeedback slowly. I believe breathing is the best place to start a biofeedback programme, then skin conductivity and temperature control. We distinguished between training 'in the chair' and while shooting. Looking back, I would have started even slower, and with more time in the chair. But something that worked well for us was my consultative approach. Abhinav was already a world champion when he came to see me, and has the highest degree of body awareness that I have come across in an athlete. So I was able to get a wealth of information from him, and continually adapt the programme to the requirements of the time.
In the end, Abhinav accumulated over 150 hours of training on the various modalities. We found that the sport was too subtle for EMG and SC, but EEG and HRV gave useful information. Shooters hold their breath during triggering, and need to learn how to have a controlled parasympathetic response just before triggering, even though they may feel short of air. In the EEG, we found alpha training at T3 useful, and after lots of experimenting, ended up mainly rewarding 15-18 at Cz and squashing 26-30. We also trained Pz and Oz. The balance was to find a state that had him muscularly relaxed, but still allowed him the sharpness of reaction to trigger at the right moment.
I came to feel that with biofeedback, you do not train the athlete to execute the skill; you train the athlete to prepare to execute the skill. I.e. you should be training for the state prior to skill execution (3-5 seconds before) rather than the state of skill execution. Skill execution itself is short, subtle and instinctive, and difficult to describe or quantify … and really is best left alone. Rather train the athlete to lay the foundation for skill execution.
Importantly, we did an extensive QEEG study, and discovered amongst other things, a T3 alpha ERD with triggering. Given that we were investigating an elite athlete, a researcher may have concluded that this ERD was appropriate, but Abhinav's interpretation of the data was that he was still shooting suboptimally, and wanted an alpha ERS at triggering. It is useful to note that even elite athletes often have lots of room for improvements in their cognitive and neurological processes.
We did neurofeedback training 'in the chair' and while shooting.
The other modality that was powerful was EKG + respiration. The best predictor of a bad shot was heart rate and breathing being out of phase. We trained this in the chair and while shooting also. In the chair, Abhinav would breathe at 2.5 - 3.5 breaths per minute, or would breathe at about 8 breaths per minute, and then breath-hold for 40 seconds, while controlling his heart rate.
While I am an experienced sports psychologist, I am relatively new to biofeedback. It is a strange experience sending a biofeedback trained athlete into a competition, because there's much less to do at the competition venue. You don't need the inspirational little comments, or the relaxing jokes, because the athlete has the tools to do the job, and you can pretty much leave him to get on with it.
It was a privilege working with Abhinav, because of the quality of the feedback I got from him, and also because of the generosity of his sponsor, which allowed us undivided time together in 5 countries and 3 continents. I am a much, much better sports psychologist now than when I started working with him just 6 months ago. Sometimes learning so fast is scary because it makes you realize how much you don't know, but my father always used to say, "You've got to know what you don't know", and it's exciting to be in a field where there is so much to learn.
“Just as surgery and pharmaceuticals were important to medicine in the 19th & 20th century, Behavioral Medicine will take its place in the 21st century and biofeedback is an important component of Behavioral Medicine.”Dr. John Basmajian, Member of the Order of Canada
Montreal, Canada – One of the World’s Leading Sport Psychologists that trained Canada’s top Olympic athletes will be teaching a workshop in Montreal on June 26th & 27th. Clinicians, psychologists, students and educators will learn about new software & specialized equipment using biofeedback & neurofeedback. This instrumentation is the same as those used in the MindRoom of AC Milan, the reigning Champions League team. It has also been used, for some time, by the Dutch Special Forces to screen and train SWAT Team recruits.
Montreal WorkshopsJune 26th & 27th
The seminar will take place at the University of Quebec at the downtown Montreal Campus. The first workshop will be led by the internationally-recognized sports psychologist and York University professor, Dr. Vietta (Sue) Wilson.
Her workshop will describe assessment and training techniques for peak performance and provide participants with the skills to utilize in their professional settings. Specific workshop content will include how to use the latest psychophysiological assessment and training technology for high performance and rapid recovery. Mental skill training techniques such as imagery, specific goal setting, intention, and attention will be discussed.
“EXECUTIVE STRESS” WORKSHOP
Another workshop will be taught in French by Drs. Nicolina Pavlov, PhD, and Ray Pavlov, MD, PhD. Its focus will be the use of EEG biofeedback (neurofeedback) as the central component of a systematic stress program for leaders in business, industry and sports. This workshop focuses on how to improve performance and productivity and includes guidelines for individuals and groups.Both workshops have accreditation by the Biofeedback Certification Institute of America.
LEARN FROM THE BEST – International Research and Educational Project
Along with workshops in North America throughout the summer and fall 2008, there has been an explosion in distance-learning involving 30 on-line courses. They range from Heart Rate Variability Training, Stress Management, Professional Golf, Irritable Bowel Syndrome, Fibromyalgia, and Headaches. These courses are accredited by the American Psychological Association (APA) for Continuing Education Units. A complete list may be found at:WWW.BFE.ORG . Fifteen Advanced Clinical Suites are now available http://www.bfe.org/prod.html
Information: Lawrence Klein, BFE Montreal Office
(514) 489-8251 #135
Wednesday, May 28, 2008
ASSESSMENT & TRAINING FOR PERFORMANCEENHANCEMENT AND HEALTH
TWO-DAY WORKSHOP IN MONTREALat the UNIVERSITY of QUEBEC's DOWNTOWN CAMPUS JUNE 26th & 27th
The purpose of the two-day workshop is focused on the use of specialized software to train athletes and others to maintain or enhance motivation, control body and mind responses and prepare for performance under stress. The aim is to make the performance automatic and have recovery and back-up systems in place that allow athletes and professionals achieve maximum performance under pressure. The Montreal course is intended for physicians, nurses, psychologists, counselors and other health care professionals. Coaches/psychologists, educators, physical therapists with an interest in latest developments in optimal performance methodology will also appreciate attending the two-days of workshops at the University of Quebec’s downtown Montreal campus.
The workshop will be led by Dr. Vietta (Sue) Wilson, and will draw on her 30 years of teaching and research in the field of optimal performance. Her lecture will include a discussion of her research on psychophysiological profiling and EEG brain mapping of elite performers. There will also be demonstrations using Biograph Infiniti software. Participants will learn the essential skills taught to Olympic athletes for enhancing performance. These skills are also applicable for medical and psychological clients. Included in the workshop will be descriptions of assessment and training techniques for peak performance. Participants will gain the skills to use these in their professional settings. Specific content will teach how to use the latest psychophysiological assessment and training technology for high performance and rapid recovery. Assessment methods and training exercises for those without psychophysiological equipment will also be taught, as will mental skill training techniques such as imagery, specific goal-setting, intention and attention.
The workshop will also teach participants to utilize an optimum performance model to indentify areas where the client can obtain success while waiting for the effects of biofeedback and neurofeedback training to become permanent. Psychological knowledge and skills that can be practiced daily to enhance confidence and foster success behaviours will be presented.
Vietta (Sue) Wilson. Ph.D.is an internationally recognized sports psychologist and professor at York University in Toronto, Canada, where she has been a faculty member for over 30 years. She teaches both undergraduate and graduate level courses in her areas of expertise that include sports psychology, counseling and biofeedback-assisted self-regulation. Her experience in the field of optimal performance training includes work with elite athletes and applications in education, medicine and business. Dr. Wilson has trained Olympians in many areas of competition from archery to yachting. She is currently working with private tennis clubs with elite performers (champions under 12 and professionals on tour) and also with swimmers, archers, etc. Her research has examined the QEEG of imagery, brain maps of elite performers, maintaining health at work and the effects of posture on mood states. Dr. Wilson is a Senior Fellow (General Biofeedback) and a Fellow (EEG Biofeedback) of the Biofeedback Certification Institute of America. In addition to teaching optimal performance with healthy clientele, she has also worked with cerebral palsy patients and in other clinical settings.
Dr. Patricia Norris, Monika Fuhs & Steve Fahrion, PhD.
Drs. Patricia Norris and Steve Fahrion, Ph.D.--biofeedback pioneers addressed delegates during the Annual Meeting of the Biofeedback Foundation of Europe, which was held in Salzburg, Austria.
The guest speakers investigated and created successful clinical and educational biofeedback protocols for the treatment of disorders such as drug addition and hypertension. As pioneers, they integrated complementary approaches such as imagery and Psychosynthesis with self-regulation strategies to optimize the patient’s immune competence for the treatment of cancer.
Patricia Norris, Ph.D. is a daughter and professional colleague of the Biofeedback pioneers Elmer and Alyce Green and has extensive experience with psychophysiological research from its inception. She offers a remarkable insight into integration of BF with imagery and Psychosynthesis for treatment of many disorders including cancer.
Steve Fahrion, Ph.D. is a clinical psychologist who did pioneering research with temperature biofeedback and developed the most successful non-pharmacological treatment of hypertension. More recently he was instrumental in developing success neuro- and bio-feedback treatment programs for substance abuse and addiction.
Attendees at the Annual Meeting got to practice their " Schuhplattein " skills and got quite a workout.Organizers ensured that Austrian gemutlichkeit was shared by all at the banquet & other social activities.
Surface Electromyography Making Progress in Dysphagia Rehabilitation
gnition for her research on tongue movements in swallowing and has developed a reputation as an expert on the use of texture modifications as an intervention for dysphagia. Dr. Steele is known across Canada and internationally as an outspoken advocate of evidence-based practice by speech-language pathologists. Dr. Steele currently serves as Coordinator of the American Speech-Language Hearing Association's Special Interest Division 13 (Swallowing and Swallowing Disorders). She is Past President of the Canadian Association of Speech-Language Pathologists and Audiologists and a past board member of the Dysphagia Research Society.
