Applied Psychophysiological Interventions (Biofeedback) for Survivors of Traumatic Brain Injury: Acute and Chronic Stages

Transcription

1 Applied Psychophysiological Interventions (Biofeedback) for Survivors of Traumatic Brain Injury: Acute and Chronic Stages Robert A. Fels, Psy.D., LMFT, BCIAC-EEG

2 Introduction Introduction to Biofeedback Contemporary Collaborative Issues Acute and Chronic Cases Review and More Questions

3 Alternative Integrative Complimentary Holistic Healing Reduction of suffering Encourage enhanced quality of life

4 History of Biofeedback 1 The Muscles: It was Luigi Galvani (1786) who first discovered the critical role of electrical energy muscle movement. He demonstrated that a normal muscle movement is accomplished by a detectable change in electrical activity. Edmund Jacobson utilized electromyography (EMG) to look for objective measures of muscle relaxation.

5 History of Biofeedback 2 The Cardiovascular System: During the 1890 s, an Italian criminologist named Cesare Lombroso, started taking blood pressures of suspects while they were being interrogated by the police. He was one of the first to suggest that blood pressure measurements were useful in studying psychological processes.

6 Applied Psychophysiology and Biofeedback Biofeedback Research Society (Santa Monica, 1969) What is Applied Psychophysiology and Biofeedback?. Applied Psychophysiology and Biofeedback,(1999) 24, 3-54.

7 Applied Psychophysiological and Biofeedback Modalities Surface Electromyography Skin Temperature Skin Conductance Level Diaphragmatic Breathing Instruction Guided Muscle Relaxation Guided Visualization

8 Growth and Learning Appropriate Axonal Regeneration

9 Risk and Opportunity Boundary Awareness: Professional/Personal Collaboration Cooperation Non Threatening

10 Assessment Informs Intervention

11 Mobile Biofeedback Instruments

12 Acute Stage Intensive Care Unit Immediate Intervention Required

13 Pain Management Sedation Withdrawal 29 year old married female Multiple trauma from MVA Loss of consciousness weeks pregnant Trachea Intubated, 2 Nasogastric tubes Diaphragmatic Breathing Muscle Relaxation

14 Ventilator Weaning Pain Management 23 year old single male Multiple trauma from MVA, Trachea Intubated, 2 Noseogastric tubes, Intracranial pressure monitor Glasgow Coma Score (6) 16 days Diaphragmatic Breathing Instruction Guided Muscle Relaxation Guided Visualization/Imagery

15 Head Trauma 21 year old single female MVA: C1-C2 fracture Cervical strain/sprain

16 Chronic Stage Rehabilitation/Restoration of Function Long term deficits

17 Restoration of Motor Function 32 year old female with history of alcoholism Compressed Brain Stem, midline shift, double vision Approximately 30 days unconscious Wheeled in with restrained arms and legs for safety and comfort.

18 Electromyography Sensors

19 Surface EMG Low Activity

20 Initial Volitional EMG

21 Sustained Surface EMG

22 Surface EMG

23 My Muscles Are Alive

24 My Muscles Are Alive

25 My Muscles Are Alive

26 My Muscles Are Alive

27 My Muscles Are Alive

28 Skin Conductance Sensors

29 Cholinergic Fibers/Acetylcholine

30 Eccrine Sweat Gland

31 Letting Go

32 Skin Temperature Sensor

33 Increased Vascularity

34 EMG Enhanced Intervention for Dysphagia 26 year old married female Anoxic Encephalopathy One year post incident

35 Nasolaryngeal Image

36 Initial Contraction

37 Sustained Contraction

38 Lip Muscles

39 Swallowing

40 Pain Management Group Basic patient information Subjective pain levels 0-10 Muscle relaxation Diaphragmatic breathing Guided practice Debriefing: Tell me about your experience.

41 Helpful Self Statements 1 My body is either sitting or lying in a comfortable position I am here at this moment There is nothing that I need to accomplish In this moment I can be inside without expectations Thoughts that circulate through my mind are OK I can allow them to circulate without blame, criticism or guilt

42 Helpful Self Statements 2 I feel quiet My feet feel heavy and relaxed My ankles, my knees and my hips feel heavy, relaxed and comfortable My abdomen and torso feel relaxed and quiet My hands, my arms and my shoulders feel heavy, relaxed and comfortable My breaths occur almost effortlessly

43 Helpful Self Statements 3 My neck, my jaw and my forehead feel relaxed. They feel comfortable and smooth My whole body feels quiet, heavy, comfortable and relaxed I notice the air breathing for me as it enters and leaves my body My hands are warm Warmth is flowing into my hands, they are warm, warmer

44 Helpful Self Statements 4 I can feel the warmth flowing down into my arms and hands My hands are warm, relaxed and quiet Still breathing breath after breath almost effortlessly My whole body feels quiet, comfortable and relaxed I withdraw my thoughts from the surroundings and I feel serene and quiet

45 Helpful Self Statements 5 My thoughts are tuned inward and I feel at ease I am alert, but in an easy, quiet, inwardly comfortable way I can rest in this comfortable manner whenever I wish Gently and gradually move your fingers, toes, breath, stretch, open your eyes.

46 Future Development Cognitive and Perceptual Deficits

47 Where to Get More Information Association for Applied Psychophysiology and Biofeedback (303) Annual meeting, state societies, journal and newsmagazine. Biofeedback Certification Institute of America (303) Information about certification requirements and to locate certified therapists.

48 Contact: Robert A. Fels, Psy.D Telephone: (888) Address: SR 7, # 231 Boca Raton, Florida USA