Application of Bio-Feedback in Neurodevelopmental Disorders

Introduction

Biofeedback (BF) uses electrical signals to monitor and amplify body functions that are too subtle for body awareness. Electronic instruments sense bioelectrical signals emitted by subliminal body behavior. They then deliver information back to the subject (feedback) via sensory modalities-usually auditory, visual, tactile, or a combination of all. When the internal visceral cues are made explicit, through practice, the client can gain control over specific body functions. Traditional medical models place the onus on the physician to ‘cure’ the illness. BF places responsibility on the patient to gain self-control. Thus, individuals can gain control over Sympathetic Nervous System, and later, on own without the help of instrumentation (Frank, Khorshid, Kiffer, Moravec, & McKee, 2010).

BF help gain greater awareness of many physiological functions by primarily using instruments that provide information on the activity of those same systems, with the goal of being able to manipulate them at will (Durand & Barlow, 2009; p. 331). There are two models of BF training: operant conditioning and psycho-physiological psychotherapy. The former is based on consequences to modify the behavior. The principles of operant conditioning, schedules of reinforcement, shaping, discrimination, generalization, extinction, and habituation apply to these procedures too. For BF, the reinforcement of the signal displays prompt for the patients to change their physiology. The latter model views the patient as an individual to combine the use of BF with stress management and other psychotherapeutic interventions. BF is training and not a treatment. Much like being taught how to ride a bicycle or a new language, individuals undergoing BF training must take an active role and practice in order to develop the skill. Rather than passively receiving a treatment by swallowing pills, the patient is an active learner. Treatment is what insurance reimbursement is traditionally designed to reimburse. An insured would not want to cover a course on BF training in as much they would not cover courses on personal development or read self-help books.

BF is an education. As sensors are placed on the patient's skin, the therapist explains what each sensor will be measuring. The patient is assured that the sensors do not cause any pain or shock. Rather, they simply record signals from the body and display them on the screen. The therapist chooses specific signal displays and explains it to the individual. This may be as simple as ‘the green line is muscle tension, the blue line is temperature’. Patients are then taught how the signals being displayed relate to their physiology. For example, the therapist may say, ‘Raise your shoulders’ or ‘Scrunch your face,’ using the muscle tension signal on the screen to point out the patient's physiological responses (Schwartz & Andrasik, 2006). How much ever sophisticated they might be, BF instruments are the only aides to the training. They are not the end of it. They are meant to monitor a physiological process, measure what is monitored, and to present what is monitored or measured as meaningful information. The common methods of BF drawn from various classical texts on the theme are listed below (Schwartz & Andrasik, 2016; Khazan, 2013; Basmajian, 1989; Rickles, Sandweiss, Jacobs, Grove, & Criswell, 1983; Beatty & Legewie, 1977; Brown, 1977):