By John J. Fried
FOR almost seven years, Mrs. Andrews had been unable to move her head. Her condition-known as wryneck-had started with painful muscle spasms, which grew worse until her head was always pulled to the left. After years of going to doctors, including psychiatrists, she was referred to New York’s ICD Rehabilitation and Research Center to learn a new technique of sensory feedback (also called biofeedback) training.
“Now look at me!” Mrs. Andrews said after her fourth treatment. She slowly moved her head from side to side, then held it proudly eyes-forward. “First, the doctors explained that I could learn to relax the major muscle that turns my head. I was skeptical, but willing to try. Electrodes from a small machine were attached to my neck, and the machine made loud clicks. My job was to lower the number of clicks by relaxing my neck muscle. I can’t tell you how I did this, but I did, and the next thing I knew, I could hold my head straight.” Having learned how to relax this muscle, Mrs. Andrew is now able to do it without the aid of the machine.
Biofeedback training is based on the premise that we can modify or gain control over a range of bodily functions once thought to be totally automatic. We all use natural forms of feedback to perfect skills. For example, in learning to serve a tennis ball, we throw it in the air, hit it, and watch where it lands. If the ball sails 15 feet past the service line, seeing that constitutes a feedback on our actions. Accordingly, we modify our swing and footwork until we make the ball land where it should. Learning such a skill requires only making an effort, then seeing, hearing or feeling the results.
In many instances-if we want to relax a back muscle at will, or move a paralyzed arm, say-we cannot carry out the intention. Either nature has not provided us with a feedback mechanism, giving us signals we can use to learn that skill, or disease has destroyed a feedback system. Now, however, researchers have developed a host of sensory instruments that can help bridge the gap. For example, an instrument called an electromyography (EMG) picks up electrical activity within muscles. Other devices monitor galvanic skin response (GSR)-the resistance that skin offers a minute amount of electricity. Other instruments detect minute temperature changes. The signals that are picked up are converted into sounds or visual aids for the patient to hear or see, and to use as signposts in controlling specific processes.
The list of chronic ailments being treated-experimentally, at least-with biofeedback includes asthma, back pain, migraine and tension headache, to name a few. Some favorable results have been achieved in the areas of stroke and, to a lesser extent, epilepsy. “The potential is quite encouraging, and some results are truly amazing, especially in treating neuromuscular problems,” says Dr. Joseph Brudny, former director of the Sensory Feed-back. Therapy Unit at the ICD Center. “But I see it as a useful adjunct to our present medical tools, not as a panacea.” “It may not always work,” a New York University professor of neurology, Dr. Julius Korein, says. “But it doesn’t seem to have any harmful side effects-something you can’t say about many drugs or surgical treatments.”
Just how the technique works may be seen at Denver’s National Jewish Hospital and Research Center, where researchers are refining EMG biofeedback to help patients control asthma attacks. Although asthmatics suffer because they are sensitive to environmental agents like dust, fumes, cold, foods and certain plants, their attacks are sometimes complicated by their psychological reaction to such potential threats. An asthmatic enrolled in the hospital’s biofeedback program is placed in a comfortable, soundproof room and electrodes are connected to his forehead, to detect electrical activity in the muscles just above the eyebrow. If relaxed, he hears only slow, lethargic clicks. If he is tense, his forehead muscles knot up, and the machine bursts into frantic clicking.
The patient is asked to visualize flowers, trees, dust-whatever threatens him with an asthma attack. As he reacts instinctively to the image, the biofeedback equipment, reflecting his mounting anxiety, clicks like a Geiger counter. Hearing the crescendo, the patient knows he is lying the groundwork for an intensified asthma attack. Over the course of several training sessions, he learns to keep the click rate slow by keeping his tension down. (Just how he does this, he cannot explain, any more than he can explain exactly how he learns to ride a bicycle.) In time, patients learn to relax even without the machine.
Many doctors, especially those who deal with chronic pain and pain that defies medical analysis, are eagerly embracing biofeedback training as a way of inhibiting nonspecific pain feelings in the brain. One is Dr. Stuart H. Mann, an associate clinical professor in the Department of Rehabilitation at the University Of Southern California school of Medicine. After tests are run to rule out a discernible cause for pain (a tumor, for example), the patient is attached to a GSR device, which emits a shrill, piercing sound. “We tell the patient the sound is the pain,” Dr. Mann says. “He has to turn it off.” In time, a large percentage of Dr. Mann’s patients learn to “think” the sound down. Then, after intensive practice, even without the machine, they are able to sit down when they feel the pain coming and “work it down.” They are very proud when they can get themselves off drugs.
Even the crippling pain of migraine headache has proved amenable to biofeedback training. An instrument, highly sensitive to temperature changes, is attached to the patient’s hand and emits increasingly higher sounds as hand temperature rises-the result of increased blood flow. Patients have learned to increase blood flow to the hand enough to raise its temperature ten degrees in two minutes. As this happens, relaxation takes place-and as a side effect the migraine is aborted. Researchers who discovered this biofeedback technique at the Menninger Foundation, in Topeka, Kan., helped 80 percent of the migraine patients they first treated with it.
Physicians who deal with stroke and paralysis are also using biofeedback to help patients regain muscle function. To move an arm, there must be sensory input to the brain as well as motor output. Without input we cannot monitor our actions. A basketball player who loses his sight, for example, will not be able to make baskets consistently from a set spot on the floor. However, if a buzzer goes off every time the ball goes in, by substituting his hearing for his sight he can eventually relearn the skill. Similarly, for some stroke and paralysis patients with brain injury, whose normal feedback system has been disrupted, biofeedback instruments can serve as a substitute. The patient learns to monitor an activity through another, undamaged pathway. The instruments are used to pick up muscular electrical activity in the paralyzed limb and make it audible or visible to the patient. The patient works with the signals until he can actually begin to use the muscle.
In an initial study by Dr. Brudny and his colleagues, involving 36 patients with varying degrees of paralysis or other neuromuscular disorders, 34 achieved improvement ranging from meaningful functional gains to full recovery. One patient was a young electrician who had was a young electrician who had been left seemingly paralyzed from the neck down. With several weeks of painstaking training, the young man slowly regained use of his arms and hands to the point where he could shave, feed himself, even do leatherwork.
“ I wore a leg brace for two and a half years,” says a former stroke patient of Dr. Herbert E. Johnson, former medical director and a physiatrist at Casa Colina Hospital for Rehabilitative Medicine in Pomona, Calif. “But I had read about biofeedback training at Casa Colina, and asked to be taught it. I had to practice every day, one hour in the morning and one at night. I would practice starting and stopping the noise from the machine 100 times every ten minutes-about 600 times an hour. In three or four weeks, I had been able to strengthen my ankle and get rid of the brace.”
About 1000 medical researchers are now working with biofeedback at some of the nation’s leading medical centers, and many more are involved in clinical research outside the hospital. If you think biofeedback ay be the answer for your problem, ask your doctor if it can help you. He may be able to refer you to acceptable programs in your area. But avoid any so called “expert” who uses the devices indiscriminately and shuns proper medical supervision. The Federal Drug administration cautions that biofeedback devices used for diagnosis or treatment of disease conditions be used only by or after consulting a physician or other licensed practitioner.
Bear in mind that biofeedback is still in its early stages, not a magic cure-all or a substitute for other treatment. It is simply an adjunct which, as one research psychologist points out in connection with asthma, may help the patient feel he is back in the driver’s seat.
By John J. Fried