Manual Biofeedback
Dr. Philip Maffetone
ICAK-USA June 2010
Manual Biofeedback
• Addresses the full spectrum of neuromuscular
function: brain, spinal cord and muscle.
• Combines EMG- and EEG-type biofeedback.
• Both a basic and advanced procedure.
– Knowledge of MMT allows immediate use of
manual biofeedback.
– Addresses clinically difficult cases; i.e., muscles
with zero contraction (stroke, brain injury, etc.).
• Can help improve the performance of
“normal” muscles.
Manual biofeedback addresses the
full spectrum of muscle function
MUSCLE FUNCTION SCALE: 0 – 5 (Kendall)
0 – No contraction
1 – Trace of muscle movement, but no limb or joint
movement.
2 – Minimal movement but not against gravity.
3 – Movement against gravity but not against resistance
by the examiner.
4 – Movement against minimal resistance by the examiner.
5 – Movement against resistance (“normal”).
Manual Biofeedback References
–
–
–
–
–
Dr. George Goodheart (AK);
Dr. John Thie (ICAK);
Dr. Patricia Cowins (NASA);
Dr. Bernard Brucker (University of Miami);
Dr. Coralee Thompson (former Medical
Director, The Institutes);
– Dr. Diane Damiano (Washington University);
– Many others.
Manual Biofeedback Goals:
• Enhance neural plasticity: The stimulation or
recruitment of unused or underused synapses
for improved motor control;
• Implement active (vs. passive) therapy and patient
participation (“task-oriented” vs. “static”);
• Improve physical movement – one fiber at a time.
Movement…
...is a powerful therapy in itself: from
improved posture and gait to better brain
function, including speech, vision,
balance, memory and even intellect.
Muscle movement – even contraction of a
single muscle – releases myokines (a cytokine)
Brain
Liver
Muscles
Fat cells
A model to explain the
muscle-organ relationship?
Manual Biofeedback (MB)
vs.
Traditional Biofeedback
• MB integrates practitioner’s sensory
system as sensor rather than traditional
biofeedback equipment (electrodes and
mechanical sensors).
• Instead of auditory/visual feedback from
a computer, MB uses the practitioner’s
communication with the patient.
Biofeedback’s Evolutionary Role
• Important for human survival (clothing,
footwear, shelter);
• Today’s use of biofeedback:
– Taking temperature with a thermometer;
– Heart rate monitoring during exercise;
– MMT and AK;
– Other procedures: Pain control, stress
management, gut function, blood pressure
control, Kegal exercises (pelvic floor muscles).
Two Types of
Manual Biofeedback Procedures:
1. EMG-type MB
– Skeletal muscles.
2. EEG-type MB
– Brain function.
EMG-Type Manual Biofeedback
General Assumptions:
• Assessment of muscle function using MMT;
• Treatment employs very similar actions as MMT;
• Utilize full range of muscle motion as necessary;
• Differentiate between:
– “Common weakness” (2-4 on Kendall scale).
– Muscles with severe disability (0-1 or severe pain).
– “Normal” muscles (5 on Kendall scale).
Procedures for “Common Weakness”
• Assess patient for abnormal muscle inhibition;
• Treat the muscle similar to a MMT procedure:
– Patient contracts muscle with resistance: ~ 5 seconds;
– Rest for ~ 3-5 seconds;
– Repeat procedure 3-4 times with wide range of motion;
– Encourage patient to resist to their maximum each time.
• Re-assess muscle;
• Successful treatment often eliminates the need for
other treatment (NL, NV, spinal adjustment, etc.).
Procedures for Severe Muscle Disability
– PRELIMINARY TREATMENT
Stimulate the patient’s brain about the muscle’s
movement (most actions begin in the brain).
– Use your muscle to show the patient how the body
moves with muscle contraction;
– Passively move the patient’s limb through its range
of motion as if the muscle was contracting;
– Stimulate the skin and muscle with light and
moderate manual pressure for 15-20 seconds.
Procedures for Severe Muscle Disability
– TREATMENT
– Treat the muscle as per “common weakness.”
– In some cases you may have to hold the body in the normal
testing position. Or, use an alternative position, such as the
arm at the patient’s side for the middle deltoid or the head
resting on the table for the SCM.
– It may take a minute or two in the most difficult
cases to elicit a relatively minor contraction.
– The patient must re-train the muscle’s new function
at home.
Other Uses of EMG-type
Manual Biofeedback
• TMJ dysfunction:
– Treatment of “weak” instead of tight muscles.
– Use mandible as lever to contract “weak” muscles.
• Improving function of normal muscles:
– Stimulation of additional muscle fibers for
increased power or mobility.
– Athletes, musicians, inactive people, etc.
• Diaphragm muscle (see below).
EEG-Type Manual Biofeedback
EEG-Type Manual Biofeedback:
Respiratory Biofeedback
• Does not require EEG equipment.
• Three key uses of respiratory biofeedback:
– Primary treatment of patients to help reduce
secondary problems.
– Challenge.
– 5-minute self-treatment (reduce stress, balance
muscles and improve overall health).
• Respiratory biofeedback combines different
procedures that help increase alpha waves.
– Deep breathing, eyes closed, listening to music.
Brain Waves
Different levels of consciousness associated with
specific waves. Four commonly measured waves:
1.beta waves (12 – 32 Hz)
Full awareness/high cortical activity. A busy brain
(business meeting, planning a trip, multi-tasking).
2.alpha waves (8 – 12 Hz)
Relaxed alertness and high creativity (meditation,
listening to music, eyes closed). Self-regulation of
stress and expanded state of consciousness.
Brain Waves
3. theta waves (4 – 8 Hz)
Awake but dreamy state (common just before
the onset of sleep). Most prevalent in youth
but occurs during deep creativity and
meditation in adults.
4. delta waves (0.5 – 4 Hz)
Most stages of sleep. Abnormal while awake
(reduced glucose, oxygen or other nutrients,
medication side-effects, poorly functioning
neurons).
Increased alpha Waves
• Generally associated with an overall healthy
brain (relaxed, creative, meditative, happy);
• Reduces high levels of cortisol;
• Balances the autonomic system;
• Reduce pain;
• Improved: memory, learning, comprehension;
blood sugar and gut function; hormone
balance, etc.
alpha Waves
• The inability to produce alpha waves is
abnormal.
– Blood sugar problems, inadequate sleep, nutritional
imbalance and very high levels of cortisol;
• Certain “weak” muscles can impair alpha waves:
– TMJ muscles, general neck flexors, SCM, upper
trapezius (those innervated by cranial nerves).
– Correction of these structural problems can help
enable the body to produce alpha waves.
Brain wave assessment (brain map) with a
20-lead quantitative EEG (QEEG)
Normal alpha waves: eyes closed
alpha wave response to different parts
of a musical piece: The “Gallo Affect”
Respiratory Biofeedback
Treatment Procedures
1. Relaxed position – lying/slightly reclined (increases
alpha);
2. Hands/arms relaxed on abdomen (EEG-type
biofeedback effect on diaphragm and abdominal
muscles);
3. Eyes closed (increased alpha);
4. Listen to enjoyable music (headphones help keep out
distracting noise, increased alpha);
5. Breath easy and deep – most people can slowly inhale
5 to 7 seconds, and exhale the same (increased alpha).
Respiratory Biofeedback Treatment…
-- Continue respiratory biofeedback for
about five minutes.
-- Avoid falling asleep (delta waves).
-- Respiratory biofeedback corrects
muscle imbalance.
Respiratory Biofeedback Challenge
• Find a number of abnormally inhibited
muscles (and other imbalances);
• Have the patient perform respiratory
biofeedback for 20-30 seconds;
• Re-test all abnormal findings;
• If the challenge corrected many imbalances,
those remaining may be primary problems:
– Correct these using EMG-type MB or other
procedures.
Respiratory Biofeedback Challenge
• If the challenge does not improve at least
some imbalances, significantly reduced or lack
of alpha wave production may exist.
• In this case, assess and correct problems
associated with the TMJ muscles, general neck
flexors, SCM, upper trapezius (and any
others).
Manual Biofeedback Review
• Assess patient with MMT;
• Respiratory biofeedback challenge;
• Correct appropriate muscle imbalance
with EMG-type manual biofeedback:
– Remaining muscle imbalance, and/or
– Cranial nerve-related muscle imbalance.
• “Home” activities (respiratory
biofeedback, re-train severely weak
muscles, etc.).