Biofeedback Tablet and Smart Phone Apps and Sensors for clinical and personal use 1,2

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1 Mitose, J., Harvey, R., Peper, E., Rogers, E., & Liu, S. (2014). Biofeedback apps for clinical and personal use. Submitted to the 45th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Savanah, GA, March 19 22, Biofeedback Tablet and Smart Phone Apps and Sensors for clinical and personal use 1,2 Jasmine Mitose, Rick Harvey, Erik Peper, Emily Rogers, & Sandy Liu San Francisco State University I am overwhelmed by all the apps that are available for tablets and smartphones, how do I select which one to use or recommend. I felt agitated and wanted to relax. I breathing pacer on my smartphone allowed me to slow my breathing and hold my passive focus. After three minutes I felt more centered. I was able to track my walking and each day, the pedometer count motivates me to increase the number of steps. After having done this for a week, I feel more energy. I never realized that my heart rate went up when I was thinking about work. When I thought about my partner, my skin conductance increased-i never saw any sweat on my hands, yet my body reacted. I practiced feeling the sensations inside my hand without effort and three minutes later my hands warmed up 4 degrees F. My God, I can control my body (autonomic nervous system). Along with the growing use and availability of affordable smartphones and tablet computers, biofeedback software that utilizes internal sensors (e.g. smartphone cameras) or allows external sensors, are becoming increasingly common. The purpose of this poster is to identify and evaluate software and/or hardware tools used for self-regulation tasks (e.g. self-monitoring or, providing reminders or other feedback, useful in behavior/habit change). Search terms used during personal interviews with biofeedback equipment distributers as well as searching computer data bases included biofeedback, self-monitoring, heart rate, heart rate variability, physical monitoring, wearable medical devices, skin conductance, breathe rate, respiration, stress reduction, lifestyle change, and temperature sensor. Several software applications ( Apps ) 1 We thank Brian Milstead, Steve Stern, and Harry Campbell for their contributions. 2 Correspondence: Erik Peper, Ph.D., Institute for Holistic Health Studies, Department of Health Education, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA epeper@sfsu.edu web: blog:

For example, an adjunctive sensor that could be useful by biofeedback practitioners is the esense for

2 were identified for the Apple and Android smartphone platforms via their respective app stores. Some stand-alone hardware or software systems were also identified. For example, an adjunctive sensor that could be useful by biofeedback practitioners is the esense for temperature and skin response monitoring, which costs around $99. The InnerBalance sensor for heart rate variability monitoring, is available for $99 as well.

Advantages of apps and portable biofeedback Drug free Economical Easy to use Accessible anywhere The purpose of the poster: Identify apps and physiological sensors that

Solicit recommendations from clinicians/educators/researchers for apps that they are presently using or possibly would like to use.

3 Advantages of apps and portable biofeedback Drug free Economical Easy to use Accessible anywhere The purpose of the poster: Identify apps and physiological sensors that clinicians/educators/researchers/technicians and clients/patients/students can use to psychophysiological control. Solicit recommendations from clinicians/educators/researchers for apps that they are presently using or possibly would like to use. Receive summarized list of apps Biofeedback-related Apps that were found fall into the following categories: Utilize the built in sensors in the phone or tablet (e.g., camera, direction sensor, or GPS (global position sensors). Require additional sensors purchased separately. Focus on behavior change using interruptions, reminders or, suggestions. Focus on actively logging or tracking of events (e.g. heart rate changes) when they occur or requiring the user to log or track events (e.g. electronic diary).

Up and coming health systems Examples of Apps/Sensors Utilizing the built in sensors in the phone or tablet (e.g., camera, direction sensor, or GPS/ global position sensors) Motion X 24/7 Sleep Cycle MotionX-24/7 is the first professional level activity tracker and sleep monitor for the iphone.

24/7 is the first solution for the iphone that measures and correlates resting heart rate, includes advanced sleep cycle monitoring with smart alarms, snore recording, and power naps, and

4 Up and coming health systems Examples of Apps/Sensors Utilizing the built in sensors in the phone or tablet (e.g., camera, direction sensor, or GPS/ global position sensors) Motion X 24/7 Sleep Cycle MotionX-24/7 is the first professional level activity tracker and sleep monitor for the iphone. 24/7 encapsulates seven years of research and development in the biomechanics of natural human motion and sleep optimization. 24/7 is the first solution for the iphone that measures and correlates resting heart rate, includes advanced sleep cycle monitoring with smart alarms, snore recording, and power naps, and incorporates "Get Active" alerts. All these tools help improve sleep in a natural and non-invasive manner. Cost: $0.99 Link: Rating: 4.5 Stars Cardio Scan With cardio scan app you can get an overview of cardiovascular parameter, fast and very easy. The present app determines continuously the heart beat and heart rate variability. The continuously measurement of the heart rate variability allows a better assignment of alterations in vegetative nervous system, than the measurement via heart rate about 60 sec. The system calculate and illustrate the most important parameter of heart rate variability (SDNN, rmssd, NN50) immediately and simultaneous. In result assessment is very easy and with the present results you can detect diseases of the body. Link: Rating: 5 Stars Belly Bio

Monitors breathing rate with the gyroscope from the iphone. Place it on your abdomen and the gyroscope. Great app for practicing slow deep breathing at home. Only for iphone Link: http://www.

com Interactive breathing Rating: 4 Sensors purchased separately esense Skin Response/Temperature The Mindfield esense Skin Response is a small sensor to measure your skin conductance using two

5 Monitors breathing rate with the gyroscope from the iphone. Place it on your abdomen and the gyroscope. Great app for practicing slow deep breathing at home. Only for iphone Link: Interactive breathing Rating: 4 Sensors purchased separately esense Skin Response/Temperature The Mindfield esense Skin Response is a small sensor to measure your skin conductance using two electrodes and the microphone input of your Android smartphone or tablet. Your skin conductance depends directly on your state of relaxation or stress, making it a commonly used and very precise stress indicator. With the esense Skin Response, you can precisely identify your stress level and reduce it with biofeedback training. Cost: Sensors: $99 Link: onse Rating: 5 Stars BioZen BioZen is one of the first mobile applications to provide users with live biofeedback data from multiple wearable body sensors covering a range of biophysiological signals, including electroencephalogram (EEG), electromyography (EMG), galvanic

skin response (GSR), electrocardiogram (ECG or EKG), respiratory rate, and temperature biofeedback data and display it on a mobile phone. Link:https://play.google.com/store/apps/details?id=com.

The purpose of the Inner Balance app is to teach you HeartMath's Quick Coherence technique. The three steps are to focus on your heart; breathe slowly and deeply; and recall good feelings.

6 skin response (GSR), electrocardiogram (ECG or EKG), respiratory rate, and temperature biofeedback data and display it on a mobile phone. Link: Rating: 4 Stars Inner Balance Measure heart rate variability and coherences. Easy to use with iphone and Ipad. The purpose of the Inner Balance app is to teach you HeartMath's Quick Coherence technique. The three steps are to focus on your heart; breathe slowly and deeply; and recall good feelings. With practice, the Quick Coherence technique should be able to move you from an agitated to a calm and focused state in about a minute. Cost: $99.00 Link: Rating: 4 WujiBrainwave A personal brainwave feedback system that combines realtime brainwave technology combined with 3D animated software to help the brain works to improve inner calm, joy attention and peak performance. Very easy to use. Cost: $119 Link: Rating: 5 Fitbit Stylish wrist band or clip which wirelessly connects to smartphone and tablet. Tracks steps, distance, and calculates calories burned. At night, it tracks sleep quality and wakes you silently in the morning. Androids and IPhones, Mac and windows computers/tablets Cost: $99.95 Link:

Link: https://play.google.com/store/apps/details?id=com.saagara.universalpranayamafree Rating: 4 Stress Releaser Guides you through paced breathing between 5.5 and 6.

7 Rating: 5 Focus on behavior change using interruptions, reminders or, suggestions Pranayama For teaching deeper level breath training. Not recommend for beginners, cardiac patients, or the highly anxious as the breaths are spaced in such a way they might leave someone feeling starved for air. Link: Rating: 4 Stress Releaser Guides you through paced breathing between 5.5 and 6.5 breaths per minute. You are able to set up your own breath pace and practice timer. Android application Cost: $ 4.99 Link: Rating:4.5

Tactical Breather Used to gain control over physiological and psychological responses to stress.

help with nearly any stressful situation in life. Android and iphone application. Link: http://www.t2.health.

boost your energy level, and help guard against Repetitive Strain Injuries (RSIs).

8 Tactical Breather Used to gain control over physiological and psychological responses to stress. Techniques were developed primarily for the warfighter during intense combat situations, anyone can benefit from the ideas taught in this application to help with nearly any stressful situation in life. Android and iphone application. Link: Rating: 4+ Stretch Break A team of healthcare professionals developed Stretch Break to increase circulation, relieve tension, boost your energy level, and help guard against Repetitive Strain Injuries (RSIs). Once installed on your hard drive, Stretch Break gently reminds you to take periodic breaks while using your computer. You are invited to perform a series of low-impact stretches illustrated on the screen. Then Stretch Break returns you to your current Windows application. Cost: $44 Link: Rating: 5 Stars Habit Streak Pro

9 Habit Streak helps you achieve your goals (or New Year's Resolutions) in exercise, diet or other areas of your life. Each day you report on whether you succeeded yesterday, building up streaks of habits and ingraining the activities into your life." After a few days you'll have a chain. Just keep at it and the chain will grow longer every day. You'll like seeing that chain, especially when you get a few weeks under your belt. Your only job next is to not break the chain" (Jerry Seinfeld) Habit Streak has two key advances on Jerry Seinfeld's original technique. Firstly it allows you to build several chains up at once. Secondly it (optionally) prompts you every day to report on your success (whereas one could easily forget to update or look at a physical calendar). Cost $2.99 Link: Rating: 4.5 Stars

emotions for anxiety, depression, head injury, stress, posttraumatic stress and a user s general well being. and lets you share this information with a healthcare provider.

10 Focus on actively logging or tracking of events (e.g. heart rate changes) when they occur or requiring the user to log or track events T2 Mood Tracker Tracks your emotional experience overtime and records a range of emotions for anxiety, depression, head injury, stress, posttraumatic stress and a user s general well being. and lets you share this information with a healthcare provider. Originally developed as a tool for service members to easily record and review their behavior changes, particularly after combat deployments. The data is saved in a graphical or spreadsheet file which can be transferred by e mail or other wireless connection. Available for Android and iphone. Link: mood tracker Rating: 5 Runkeeper The RunKeeper app for Android is another popular fitness based app that is geared towards runners, walkers and hikers. Like the other top running-based Android apps, RunKeeper takes advantage of the powerful GPS features built into your Android smartphone. With route tracking, a great history feature and a few other personalization features, RunKeeper can hold its own against the pack. Link: Rating: 4+ Monitor Your Weight

11 Award Winning Weight Tracker App developed as a tool mainly to help motivate a person following a diet and/or exercise program to reach their desired target weight within a predefined period. Link: Rating: 5 Stars

Up and coming integrated health systems Wello With a special designed case your Android and iphone will measure a range of vitals, including your blood pressure, electrocardiography (ECG), heart

The information then passes over to the Wello app on your smartphone to interpret, measure, and display the results.

12 Up and coming integrated health systems Wello With a special designed case your Android and iphone will measure a range of vitals, including your blood pressure, electrocardiography (ECG), heart rate, blood oxygen, temperature, and lung function. To trigger the built in sensors, you simply hold the case for a few moments while some of your key bodily functions are recorded. The information then passes over to the Wello app on your smartphone to interpret, measure, and display the results. The case can also talk to pedometers, sleep trackers, and other fitness devices to incorporate additional data. Cost: $199 Link: Please participate in updating and assessing released and/or upcoming apps and sensors that can be attached to tablets or smartphones and used by you or your clients. When we receive your suggestions, we will evaluate the information and you an update. Send the following information on useful apps and physiological sensors to: biofeedbackappdata@gmail.com App/sensor name: Manufacturer/creator/ name: Available from: Description/Purpose/function: Describe how you have used it. Comments: Name: Telephone: Please submit recommendations for apps, and sensors as well as comments using the format of the attached form and to: biofeedbackappdata@gmail.com

PEDOMETER DESCRIPTIONS

PEDOMETER DESCRIPTIONS FITBIT Fitbit Surge Fitbit Blaze GPS Tracking See distance, pace, split times, elevation climbed, and review routes PurePulse Heart Rate Get continuous, automatic, wrist-based heart