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Wat is biofeedback?Biofeedback is the process of gaining greater awareness of many physiological functions primarily using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will. Some of the processes that can be controlled include brainwaves, muscle tone, skin conductance, heart rate and pain perception.Biofeedback may be used to improve health, performance, and the physiological changes which often occur in conjunction with changes to thoughts, emotions, and behavior. Eventually, these changes may be maintained without the use of extra equipment, even though no equipment is necessarily required to practice biofeedback actually.Biofeedback has been found to be effective for the treatment of headaches and migraines.DefinitionThree professional biofeedback organizations, the Association for Applied Psychophysiology and Biofeedback (AAPB), Biofeedback Certification International Alliance (BCIA), and the International Society for Neurofeedback and Research (ISNR), arrived at a consensus definition of biofeedback in 2008:“is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately 'feed back' information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.ApplicationsIncontinenceMowrer detailed the use of a bedwetting alarm that sounds when children urinate while asleep. This simple biofeedback device can quickly teach children to wake up when their bladders are full and to contract the urinary sphincter and relax the detrusor muscle, preventing further urine release. Through classical conditioning, sensory feedback from a full bladder replaces the alarm and allows children to continue sleeping without urinating.Kegel developed the perineometer in 1947 to treat urinary incontinence (urine leakage) in women whose pelvic floor muscles are weakened during pregnancy and childbirth. The perineometer, which is inserted into the vagina to monitor pelvic floor muscle contraction, satisfies all the requirements of a biofeedback device and enhances the effectiveness of popular Kegel exercises.Research has shown that biofeedback can improve the efficacy of pelvic floor exercises and help restore proper bladder functions. The mode of action of vaginal cones, for instance involves a biological biofeedback mechanism . Studies have shown that biofeedback obtained with vaginal cones is as effective as biofeedback induced through physiotherapy electrostimulation.In 1992, the United States Agency for Health Care Policy and Research recommended biofeedback as a first-line treatment for adult urinary incontinence.Clinical effectivenessResearchMoss, LeVaque, and Hammond (2004) observed that “Biofeedback and neurofeedback seem to offer the kind of evidence-based practice that the health care establishment is demanding. From the beginning biofeedback developed as a research-based approach emerging directly from laboratory research on psychophysiology and behavior therapy, The ties of biofeedback/neurofeedback to the biomedical paradigm and to research are stronger than is the case for many other behavioral interventions” (p.?151).The Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neurofeedback and Research (ISNR) have collaborated in validating and rating treatment protocols to address questions about the clinical efficacy of biofeedback and neurofeedback applications, like ADHD and headache. In 2001, Donald Moss, then president of the Association for Applied Psychophysiology and Biofeedback, and Jay Gunkelman, president of the International Society for Neurofeedback and Research, appointed a task force to establish standards for the efficacy of biofeedback and neurofeedback.The Task Force document was published in 2002, and a series of white papers followed, reviewing the efficacy of a series of disorders. The white papers established the efficacy of biofeedback for functional anorectal disorders, attention deficit disorder, facial pain and temporomandibular disorder, hypertension. urinary incontinence, Raynaud's phenomenon, substance abuse, and headache.A broader review was published and later updated, applying the same efficacy standards to the entire range of medical and psychological disorders. The 2008 edition reviewed the efficacy of biofeedback for over 40 clinical disorders, ranging from alcoholism/substance abuse to vulvar vestibulitis. The ratings for each disorder depend on the nature of research studies available on each disorder, ranging from anecdotal reports to double blind studies with a control group. Thus, a lower rating may reflect the lack of research rather than the ineffectiveness of biofeedback for the problem.EfficacyYucha and Montgomery's (2008) ratings are listed for the five levels of efficacy recommended by a joint Task Force and adopted by the Boards of Directors of the Association for Applied Psychophysiology (AAPB) and the International Society for Neuronal Regulation (ISNR). From weakest to strongest, these levels include: not empirically supported, possibly efficacious, probably efficacious, efficacious, and efficacious and specific.Level 1: Not empirically supported. This designation includes applications supported by anecdotal reports and/or case studies in non-peer reviewed venues. Yucha and Montgomery (2008) assigned eating disorders, immune function, spinal cord injury, and syncope to this category.Level 2: Possibly efficacious. This designation requires at least one study of sufficient statistical power with well identified outcome measures but lacking randomized assignment to a control condition internal to the study. Yucha and Montgomery (2008) assigned asthma, autism, Bell palsy, cerebral palsy, COPD, coronary artery disease, cystic fibrosis, depression, erectile dysfunction, fibromyalgia, hand dystonia, irritable bowel syndrome, PTSD, repetitive strain injury, respiratory failure, stroke, tinnitus, and urinary incontinence in children to this category.Level 3: Probably efficacious. This designation requires multiple observational studies, clinical studies, wait list controlled studies, and within subject and intrasubject replication studies that demonstrate efficacy. Yucha and Montgomery (2008) assigned alcoholism and substance abuse, arthritis, diabetes mellitus, fecal disorders in children, fecal incontinence in adults, insomnia, pediatric headache, traumatic brain injury, urinary incontinence in males, and vulvar vestibulitis (vulvodynia) to this category.Level 4: Efficacious. This designation requires the satisfaction of six criteria:(a) In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control using randomized assignment, the investigational treatment is shown to be statistically significantly superior to the control condition or the investigational treatment is equivalent to a treatment of established efficacy in a study with sufficient power to detect moderate differences.(b) The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner.(c) The study used valid and clearly specified outcome measures related to the problem being treated.(d) The data are subjected to appropriate data analysis.(e) The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers.(f) The superiority or equivalence of the investigational treatment has been shown in at least two independent research settings.Yucha and Montgomery (2008) assigned anxiety, chronic pain, epilepsy, constipation (adult), headache (adult), hypertension, motion sickness, Raynaud's disease, and temporomandibular disorder to this category.[9]Level 5: Efficacious and specific. The investigational treatment must be shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings. Yucha and Montgomery (2008) assigned urinary incontinence (females) to this category. ................
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