biofeedbackspring 02

Volume 30, Number 1 Spring, 2002

Special Issue

The Future ofBiofeedbackInstrumentationGuest Editor,Richard Sherman, PhD

Spring 20022 Biofeedback

The cover of this issue of the BiofeedbackNewsmagazine shows an elaborate hand-wired Coulbourn biofeedback system, typ-ical for instrumentation in the early daysof biofeedback, contrasted with today’stypical PC based biofeedback system.

This issue of Biofeedback Newsmagazinehighlights the future of technology andinstrumentation in biofeedback and clini-cal psychophysiology. Biofeedbackresearch and practice, from their begin-nings, have been intimately connectedwith advances in the technology of biologi-cal monitoring and feedback devices.Some of the founding pioneers of biofeed-back were gifted individuals whose expert-ise bridged electrical engineering,electronics, and psychophysiological sci-ence. In 1989, the Biofeedback Society ofAmerica recognized several individuals aspioneers in biofeedback instrumentation:Les Fehmi, Rex Hartzell, Jan Hoover, LenOchs, Jon Picchiottino,and HerschelToomim. Tom Budzynski also deservesmention as a unique example of the practi-tioner/engineer/ researcher, reflecting thecentral place of technology in the originsof our field.

Biofeedback instrumentation has comean enormous distance since the first con-ference of the Biofeedback ResearchSociety in Santa Monica in 1969. The

availability of high-powered micro process-es in today’s computers, and advances inthe instrumentation itself, has freed practi-tioners from many of the concerns withimpedance, artifact, and data analysis,which absorbed so much time in the earlyyears of biofeedback.

This issue draws on many of the devel-opers and vendors of instrumentation, toconvey their image of the future ofbiofeedback instrumentation. As editors,we have encouraged the authors to includediscussion of their companies, the compa-nies’ priorities in research and develop-ment, and their proudest achievements ininstrumentation, education, and training.These articles are not intended as adver-tisements. However, the companies havecontributed greatly to developing our field,and this issue conveys our recognition tothese and other biofeedback companies.

Many of the visionary ideas presented inthis special issue are already realities, andothers will be in the near future. The arti-cles range from discussions of new modali-ties, such as heart rate variability, to newmodes of delivering service, such as tele-health. Richard Sherman opens the issuewith a concern that practitioner trainingand competence remain a critical concern.Even the latest equipment is not complete-ly foolproof, given the dismal depths of

human folly! Sebastian Striefel has alsocontributed a helpful article on profession-al ethics and standards governing the selec-tion and use of biofeedbackinstrumentation.

The Association News and EventsSection includes the first message fromAAPB’s new President Paul Lehrer, thefinal message from Past-President DonaldMoss, as well as other Association news.Of special importance, we include a sum-mary of the new joint AAPB/SNR TaskForce Report on Methodology forEmpirically Supported Treatments inApplied Psychophysiology. The full text ofthe report will be published in the AAPBjournal, Applied Psychophysiology andBiofeedback, as well as in the SNR Journalof Neurotherapy, as well as on the AAPBwebsite. The results of the elections forAAPB’s new officers are also included inthis issue.

Proposals and Abstracts are invited forspecial issues on: Applied Psycho-physiol-ogy and the Performing Arts for Fall 2002(Editor Marcie Zinn, PhD), andMind/Body Pediatrics for Spring 2003.The editor also welcomes proposals forfuture special issues of the BiofeedbackNewsmagazine.

FROM THEEDITORS

Special Issue: The Future ofBiofeedback InstrumentationGuest Editor, Richard Sherman, PhD, andNewsmagazine Editor, Donald Moss, PhD

The articles in this issue reflect the opinions of the authors, and do not reflect the policies or official guidelines of AAPB, unless stated otherwise.

Donald Moss, PhDRichard Sherman, Ph.D

Spring 2002 3Biofeedback

Biofeedback is published four times per year anddistributed by the Association for Applied Psycho-physiology and Biofeedback. Circulation 2,100.ISSN 1081-5937.

Editor: Donald Moss PhDAssociate Editor: Theodore J. LaVaque, PhDsEMG Section Editor: Randy Neblett, MAEEG Section Editor: Dale Walters, PhDReporter: Christopher L. Edwards, PhDReporter: John Perry, PhDManaging Editor: Michael P. Thompson

Copyright © 2002 by AAPB

Editorial StatementItems for inclusion in Biofeedback should be for-

warded to the AAPB office. Material must be in pub-lishable form upon submission.Deadlines for receipt of material are as follows:

• November 1 for Spring issue, published April 15.

• March 15 for Summer issue, published June 15.

• June 1 for Fall issue, published September 15.

• September 1 for Winter issue, published January 15.

Articles should be of general interest to theAAPB membership, informative and, where possi-ble, factually based. The editor reserves the right toaccept or reject any material and to make editorialand copy changes as deemed necessary.

Feature articles should not exceed 2,500 words;department articles, 700 words; and letters to theeditor, 250 words. Manuscripts should be submittedon disk, preferably Microsoft Word or WordPerfect,for Macintosh or Windows, together with hard copyof the manuscript indicating any special text for-matting. Also submit a biosketch (30 words) andphoto of the author. All artwork accompanyingmanuscripts must be camera-ready. Graphics andphotos may be embedded in Word files to indicateposition only. Please include the original, high-res-olution graphic files with your submission – at least266dpi at final print size. TIFF or EPS preferred.

AAPB is not responsible for the loss or return ofunsolicited articles.

Biofeedback accepts paid display and classifiedadvertising from individuals and organizations pro-viding products and services for those concernedwith the practice of applied psychophysiology andBiofeedback. Inquiries about advertising rates anddiscounts should be addressed to the ManagingEditor.

Changes of address, notification of materials notreceived, inquiries about membership and othermatters should be directed to the AAPB Office:

Association for AppliedPsychophysiology and Biofeedback10200 West 44th Ave., No. 304Wheat Ridge, CO 80033-2840Tel 303-422-8436Fax 303-422-8894E-mail: [email protected]: http://www.aapb.org

Richard Sherman, PhD and Donald Moss, PhD 2

Ethics and Instrumentation 4Sebastian Striefel, PhD

Hooray! The Revolution is Here! 7Richard Sherman, PhD

A Living Compendium of Information on Biofeedback Devices 8Richard A. Sherman, PhD, BCIAC, Nanny H. Christie, MA, LPC, BCIAC,Amy Coleman

Morphing Beyond Recognition: The Future of 14Biofeedback Technologies

Olafur S. Palsson, PsyD, and Alan T. Pope, PhDWhere is Biofeedback Heading? 19

Lawrence Klein New Developments Leading EEG Biofeedback into the New Millennium 22

Thomas F. Collura, PhD, P.E.Heart Rhythm Coherence – An Emerging Area of Biofeedback 23

Rollin McCraty, PhDBiofeedback Over the Web 26

Irene J. Sleight, MS, BCIAThe Future of Biofeedback 28

R. Adam Crane Translating the Future 30

David Joffe

Review of S. Mense, & D. G. Simons (with I. J. Russell). (2001). 35Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment

Reviewed by Stuart Donaldson, PhD

The AAPB Year in Review 1ADonald Moss, PhD

From the Executive Director’s Desk 2AFrancine Butler, PhD

From the President 3APaul Lehrer, PhD

In Memory: Pioneer Researcher, Educator, Neal Miller 4AWhite House Panel Issues Recommendations on Complementary and 5AAlternative Medicine

Michael P. ThompsonMaria Eugenia Carmagnani Fattovich, PhD 5A

Susana A. Galle, PhD, ND, CCN and Gabriel E. Sella, MD, MPH, MSc, PhD

AAPB Winners 6ANew Mind-Body-Spirit Interest Group 7A

About the Authors 34

FROM THE EDITORS

PROFESSIONAL ISSUES

BOOK REVIEWS AND BRIEF REPORTS

ABOUT THE AUTHORS: PROFILES OF CONTRIBUTORS

BiofeedbackVolume 30,No 1Spring, 2002

FEATURE ARTICLES

AAPB NEWS AND EVENTS


Abstract: A number of ethical and legalissues related to instrumentation exist. First, isthe importance of buying equipment that issafe and effective. FDA approval is one way ofensuring that the equipment is safe and effec-tive. Second, practitioners are responsible formaintaining the equipment that they buy andbeing competent in its use. Third, practitionersshould be aware of the potential risks associat-ed with allowing clients to take equipmenthome for home training and with the rareoccurrence of adverse reactions associated withbiofeedback in general. Fourth, practitionersdoing neurofeedback should be aware that theuse of pre and post treatment EEGs and/orQEEGs is still a decision that needs to bemade by individual clinicians since little sys-tematic data is available in this area. Last,those practitioners doing telebiofeedbackand/or electronic billing should be familiarwith relevant laws and procedures for ensuringclient confidentiality.

IntroductionWhen biofeedback equipment is used for

treatment purposes, it is generally classifiedby the Food and Drug Administration(FDA) as a Class II Medical Device(www.fda.gov/cdrh/dsma/dsmaclas.html).Medical devices have varying levels of risksand benefits and the degree of regulation isbased on the level of control that the FDAconsiders necessary to assure the safety andeffectiveness of the device. There are threelevels of classification. Class I devices havethe lowest level of regulation because theypresent a minimal level of risk for harm.General controls such as registration, fol-lowing the Good Manufacturing Practices,and labeling are considered sufficient forensuring safety and effectiveness. About93% of Class I devices are exempted fromthe premarket notification process. Class II

devices are those for which special controlsare considered necessary by the FDA forassuring safety and effectiveness and wherethere are existing methods for providingsuch assurances. Special controls caninclude guidance documents, special label-ing requirements, mandatory performancestandards, and post market surveillance(www.fda.gov/cdrh/dsma/dsmaclas.html).There is a process for getting the FDA to classify a Class II device as exempt from the 510(K) Premarket Notificationrequirements. As of September 1998, 62devices are exempt from the PremarketNotification requirements (See the FDAModernization Act Information atwww.fda.gov/cdrh/dsma/dsmaclas.html).These Class II devices are listed on theFDA’s Medical Device Exemptions page(www.fda.gov/cdrh/dsma/dsmaclas.html).Class III devices require the most stringentregulation because insufficient informationexists for assuring safety and effectivenessand these devices are generally those thatsupport or sustain human life. Because of the difficulty associated with writingabout the complex and confusing FDArequirements, I am presenting informationfrom FDA sources and am referring readersto those sources for clarifications and moreinformation. For example, it is unclear to me based on what I have read, whetherthe FDA has any authority or regulationsthat pertain to the use of biofeedbackequipment if it is used for non treatmentpurposes.

For biofeedback equipment first manu-factured after 1976 (Medical Devices Act of1976, www.rsna.org/REG/research/regulatory/monsein2ii.html), unless exemptedfrom the requirements, manufactures aregenerally required to file a 510(k) Premarket

Notification so that the FDA can determineif the equipment is “substantially equiva-lent” to a legally marketed device that doesnot require premarket approval. “Unlessexempted from premarket notification require-ments, persons may not market a new device,under section 510(K), unless they receive asubstantial equivalence order from the FDA oran order reclassifying the device into Class I orClass II (section 513(I) of the Act).”(www.fda.gov/cdrh/modact/frclass2.html,p.2). There is now one exception, and thatis for the selling of battery operatedbiofeedback equipment used for relaxationtraining or muscle reeducation. The FDAhas the regulatory authority to exempt aClass II device from the 510(k) requirementand has done so for battery operatedbiofeedback equipment, which it evidentlyconsiders to be safe and effective(www.fda.gov/cdrh/modact/frclass2.html).Other FDA requirements must still be met. One FDA website(www.fda.gov/cdrh/ode/143.html) states, and I quote, “Biofeedback devices to be pro-moted for indications other than relaxationrequire prescription legend pursuant to Title21, Code of Federal Regulations, Section801.109…” The FDA rules are far toocomplex to discuss further here and addi-tional regulations that pertain to biofeed-back exist. As such, readers are referred tothe FDA website (www.fda.gov).

Manufacturer andPractitionerResponsibility

So what does this mean for the practi-tioner? It means that if a piece of equip-ment has been exempted or receivedPremarket Approval from the FDA, it isconsidered by the FDA to be safe and effec-

PROFESSIONALISSUES

Ethics and InstrumentationSebastian “Seb” Striefel, PhD, Logan, UT


tive for the purposes filed with the FDA.Biofeedback equipment has been approvedfor relaxation training and muscle reeduca-tion. Biofeedback equipment that is to be marketed for other purposes requires aseparate Premarket Notification, a prescrip-tion legend or FDA approval(www.fda.gov/cdrh/ode/143.html). Allbiofeedback equipment manufactures arestrongly encouraged to go through the anyrequired FDA Premarket Notificationand/or approval processes and thus reducetheir own legal risk, help ensure that thepublic is protected, and to help practition-ers in ensuring that the equipment theypurchase is in fact considered to be safe andeffective by the FDA. Legally, the selling ofa device classified by the FDA as a Class IIMedical Device without meeting theirrequirements is a violation of law. Violationof existing law is also an ethical violation.At minimum, manufacturers should informthose who are considering purchasing apiece of equipment, of its FDA status, i.e.,Premarket Notification filed and accepted(approved), Premarket Notification filedand pending, exempted, SubstantialEquivalence Received, or PremarketNotification not yet filed.

Buy Approved EquipmentPractitioners are encouraged to ensure

that the equipment that they buy has gonethrough the appropriate FDA process andhas been approved or exempted by the FDAfor the intended use(s). Why take anunknown and uncertain risk when goodequipment that has gone through the FDAprocess is available? If a practitioner pur-chases a piece of biofeedback equipmentthat has not been approved by the FDA orexempted by them and it turns out that theequipment is defective in some way and notsafe, e.g., a client gets an electrical shockbecause of faulty optical isolation, the prac-titioner shares in liability and could readilybe considered negligent because he or she isethically and legally responsible for what heor she does or fails to do.

Most, if not all, FDA approved Class IImedical devices are supposed to be soldonly to licensed health care professionals.They are not supposed to be sold to thegeneral public. To market biofeedbackequipment to someone other than profes-

sionals require the filing of other paperworkwith the FDA and their authorization(approval) that it is safe to do so.

Responsibilities after PurchaseOnce purchased, practitioners are ethical-

ly responsible for ensuring that the equip-ment is properly maintained (e.g., no frayedelectrical cords, periodic recalibration asappropriate, etc.), used in accordance withexisting ethical principles and practiceguidelines and standards (e.g., AAPB, 1995;Striefel et al., 1999), and used in accor-dance with relevant law.

Practitioners are also expected to be com-petent in all aspects of using their equip-ment with clients. This means at minimum,reading the manual and practicing with theequipment until it can be used competently,before using the equipment with clients.Some equipment is either complex to use orthe data obtained is complex to understand(e.g., EEGs). As such, practitioners shouldobtain additional training, supervision, orconsultation, as needed. If fact, initially itmay be a good idea to have ongoing super-vision or even have someone else completecomplex tasks. For example, removing arti-facts and interpreting EEGs and/or QEEGscorrectly requires considerable skill. Somegroups offer such services for a fee. Oneuseful training task is to have a competent,external source, conduct the EEG artifact-ing and interpretation of a protocol whileone also does it oneself and then comparethe results to see if they are the same or verydifferent. The more similar the results, themore likely it is that the task has been com-pleted correctly.

Home TrainingShould biofeedback equipment be sent

home with clients so they can practice athome and thus speed up the treatmentprocess? The answer to this questiondepends on a number of factors related toclient risk. Fortunately, adverse reactions tobiofeedback training are overall rare, andwhen they occur they are relatively transientor readily dealt with by competent practi-tioners (Hammond, 2001; Schwartz &Schwartz, 1995). How can a practitionerdeal with an adverse reaction if the practi-tioner is not available? Relaxation inducedanxiety is reported to occur in up to 40%of individuals getting some form of relax-

ation training and the anxiety may be a signof underlying pathology (Smith, 1985).Theta training can reportedly induce bothseizures and extremely traumatic material(Stockdale & Hoffman, 2001), or evendepression (Nash, 2001). Theta brain statescan occur as a result of direct training usingEEG biofeedback or it can occur as a resultof deep relaxation training via some othermode of biofeedback training.

Clearly, before home training is consid-ered, a practitioner should have a good clin-ical history; should have ruled out a historyof seizures, post-traumatic stress disorder,identity disorders, or other conditions thatmight result in predictable, adverse sideeffects; and should have conducted enoughoffice-based sessions to minimize the risk ofadverse reactions during home training. Inaddition, informed consent should havebeen obtained that indicates that adversereactions may occur, even if rare, and that ifthey occur, clients are to stop the hometraining and consult with the practitioner todetermine the next step or steps in treat-ment. Sometimes, reassurance is all that isnecessary, and other times, interventionrequires that a practitioner have a goodbackground in psychotherapy. Nash (2001)recommends that practitioners unlicensedin a mental health discipline, not providetreatment for DSM IV diagnostic condi-tions unless supervised by someone who isso licensed and thus competent to interveneif and when adverse reactions occur.

To Use or not Use an EEGand/or QEEG1

One special area related to instrumenta-tion is concerned with whether or not apractitioner doing neurofeedback trainingshould first obtain a multi-site EEG (rawdata) and/or a QEEG (computerized EEGanalysis). Several practitioners have reporteda variety of adverse reactions associated withneurofeedback training (Ayers, 2001;Hammond, 2001; Nash, 2001; Stockdale &Hoffman, 2001). Fortunately, the adversereactions that do occur, are generally tran-sient and easily dealt with when detected.Little is known about the frequency of suchadverse reactions, but they appear to berare. Rare or not, practitioners should makea concerted effort to detect adverse reac-tions. Perhaps they can be more easily


detectable if one has both a pre and postEEG and/or QEEG, and perhaps not. Ifpotential or actual adverse reactions can bedetected, it should help avoid harm to theclient, and help the practitioner select theappropriate treatment protocol and/or takeappropriate corrective action.

One might also be able to detect poten-tial problems through a thorough clinicalhistory, careful observation of clients, byobtaining regular feedback from the client,or by looking at raw EEG date duringtraining, for the training site only, or formultiple sites. Based on the limited infor-mation currently available about adversereactions, most of which is anecdotal, aboutall that can be said with any certainty, isthat it is important for practitioners to takespecial care to do all that is possible toavoid harm to clients. Clearly more researchis needed concerning the frequency andtypes of adverse reactions that are encoun-tered by practitioners conducting neuro-feedback training and more information isneeded on how to deal with such adversereactions if they do occur.

At minimum, it seems important toobtain a client’s informed consent concern-ing the potential risks of doing neurofeed-back and to systematically collect dataconcerned with detecting any negative sideeffects. Whether or not to obtain an EEGand/or a QEEG, is at present, a decisionthat each clinician must make based on thespecific issues associated with the presentingclient’s problems and the belief system ofthat clinician. The more serious the client’spresenting problem, the more important itis to take extra precautions and to considerthe possibility that raw EEG data, a QEEG,or more careful and regular feedback fromthe client might be helpful. Systematicresearch on the pros and cons of obtaininga multi-channel, pre and post EEG and/orQEEG is also needed.

Telebiofeedback and ElectronicData

A number of groups are now doingbiofeedback training at great distances usingtelephone lines and/or satellite system con-nections (Striefel, 2000a). Such practition-ers must ensure that they are in compliancewith both the laws of the state in whichthey operate and in the state(s) in which theclient who is receiving services is located(Striefel, 2000b). In addition, they musttake extra precautions to ensure that clientconfidentiality is not compromised by inad-vertently allowing unauthorized persons toaccess the session or client’s data from thesession. Carefully documented informedconsent is also important when doing suchtraining, e.g., if one is hundreds of milesfrom the client and he or she has an adversereaction, how will it be dealt within an ethi-cal and legal manner? See Striefel (2000a& b) for more info. By the way, Medicarewill now pay for some telehealth psy-chotherapy services (Ballie, 2001). Itrequires two-way, audio and video, real-time interactive communication betweenthe patient and practitioner and the patientmust be receiving the service in a healthcare setting, such as a clinic, hospital, ordoctors office.

Those who use computerized storage ofdata or electronic billing must also take pre-cautions to ensure that unauthorized accessto confidential information does not occurand that one does not send the informationto the wrong email address. Encryptingfiles, passwords, and storing data on discsthat can be taken out of the computer andlocked up in storage files are all part of theprocess for ensuring confidentiality of clientinformation.

ReferencesAAPB (1995). Ethical principles of applied psy-

chophysiology and biofeedback. Wheat Ridge, CO:Author

Ayers, M. E. (2001). Question: Have you seenany negative effects associated with EEG neurofeed-back? Journal of Neurofeedback, 4(4), 63-65.

Ballie, R. (2001. Medicare will now cover sometelehealth psychotherapy services. Monitor onPsychology, 32(10), 84-65.

Hammond, D. C. (2001). Adverse reactions andpotential iatrogenic effects of neurofeedback train-ing. Journal of Neurofeedback, 4(4), 57-62.

Nash, J. (2001). Stockdale, S., & Hoffman, D.A. (2001). Question: Have you seen any negativeeffects associated with EEG neurofeedback? Journalof Neurofeedback, 4(4), 65-69.

Smith, J. C. (1985). Relaxation dynamics: Nineapproaches to self-relaxation. Champaign, IL:Research Press.

Schwartz, M. S., & Schwartz, N. M. (1995).Problems with relaxation and biofeedback: Assistedrelaxation and guidelines for management. In M. S.Schwartz (Ed.), Biofeedback: A practitioner’s guide(pp. 288-300). New York: Guilford Press.

Stockdale, S., & Hoffman, D. A. (2001).Question: Have you seen any negative effects asso-ciated with EEG neurofeedback? Journal ofNeurofeedback, 4(4), 62-63.

Striefel, S. (2000a, Summer). Telehealth uses inbiofeedback and applied psychophysiology.Biofeedback, 28(2), 8-10.

Striefel, S. (2000b, Summer). Ethical and legalissues in telehealth. Biofeedback, 28(2), 4-5, 10.

Striefel, S., Butler, F., Coxe, J. A., McKee, M.G., & Sherman, R. A. (1999). Practice guidelinesand standards for providers of biofeedback and appliedpsychophysiological services. Wheat Ridge, CO:AAPB.

Footnote1 Several members of AAPB raised questions

about an earlier draft of this article that I becameaware of indirectly and. two individuals contactedme directly, Margaret Ayers and Lynda Kirk. Thequestions and comments were useful in makingsome needed revisions in the article to make itmore helpful to readers. I thank all of you.


Abstract: The author praises the sophistica-tion of today’s biofeedback instrumentation,which provides many features simplifying clin-ical practice in biofeedback. He cautions onthe continued need for adequate practitionertraining, and careful adherence to basic quali-ty control, including such principles as skinpreparation, equipment maintenance, physio-logically appropriate electrode placement,bandwidth selection, and use of up to dateassessment protocols. He applauds the future ofbiofeedback but warns that incompetence willundermine that future.

Here’s how I was going to start this reallyupbeat article: “Remember the days whenyou used to have to scrape the top layer offpatients’ skins with abrasive soap and sandpaper in order to get impedance down lowenough to get good EMG and EEG record-ings? We all gave thanks to the manufac-turers when those days disappeared foreverso all anybody had to do to get a decent sig-nal was rub the skin with some alcohol andpush in a bit of conducting gel. With thenew equipment and sensors you don’t evenhave to do that! There’s been another revo-lution! All you need to do is wash thepatient with soap and water – or perhapsnot even that. No more messy jells to worryabout drying out. No more need for lots ofdouble stick tape to hold on weird littlecups. Lots of systems don’t have noise gen-erating, tangling wires – some don’t evenhave wires at all. Just slap on the sensorsand go for it. And that’s just the beginning.These gems can tell you when the signal isbad, operate without noisy / tangling wires,tell you where to plug sensors into theequipment, and still more! The new equip-ment will just take your breath away.”

But I’m not going to start that way. Want

to know why? It’s mostly because I got areal punch in the head from reality a coupleof weeks ago -- direct from a therapist whohas been doing “biofeedback” for umpteenyears. This therapist sent me a patient whohas mysterious headaches. She has no obvi-ous traumatic onset, no trigger points, rea-sonable posture, tenses her jaw when shegets upset, has an apparently normal jawjoint but grinds her teeth at night, and feelsher shoulders and neck tense up before herheadache begins. From the symptoms, thetherapist thought the headaches should beat least somewhat related to muscle tensionin the jaws and shoulders. Wouldn’t you?But when the therapist did sEMG record-ings of the jaws and shoulders, the muscleswere virtually silent. So what could be caus-ing the pain? Thus, the referral to me.Communication being what it is, I didn’tget the word that an exam incorporatingsEMG recordings had been done. So, afterhearing the patient’s symptoms, I did mytypical recordings of the jaw and shoulders.The jaw muscles were three times normaland the upper traps were four times normal– and she couldn’t recognize tension in norrelax them to normal levels with coaching.When I compared notes with the referringtherapist, we were both surprised to findthat we had both apparently done the sameevaluation and had gotten very differentresults.

So, what happened? Was the patient justtense as a charging rhino for me but looseas a sleeping puppy for the therapist? Couldhave been – but it wasn’t. What really hap-pened was a whole litany of fiascos that ledto a “garbage in - garbage out” result. First,the therapist didn’t do any site preparationat all. Skin impedance was so high that the

signal was attenuated to about one tenth ofits actual size - so the values looked prettynormal. Second and third, the sensors werenot applied along the bodies of the musclesof interest – just in the general area. Theywere partially over irrelevant muscles and atrandom angles to their lengths so all kindsof extraneous signals crept into the record-ing – which accounted for most of thepower the sensors picked up. Fourth, thetherapist had not checked to see if themachine and sensor cables were intact andworking properly for years. One of the leadstuned out to have an intermittent looseconnection at the sensor head. Fifth, thedevice was set to the wrong bandwidth toshow proportional tension in the trapeziusmuscle. Sixth, the patient was just sittingthere during the recording. No stressresponse profile, no movements, no postur-al adjustments were done to elicit muscularresponses relevant to the situation at hand.I’ve got to tell you that this just about mademe want to drop biofeedback equipmentinto a hole. Here our manufacturers are cre-ating nearly miraculous equipment which:

• checks itself for improper functioningand noise – if you run the sub-routine.

• shows you the raw signals (even withpower spectra) for each signal so youcan easily spot artifacts – if you look.

• has displays showing which leads go towhich parts of the body and plug intowhich socket on the equipment – if youlook at the display.

• has displays which show when leads areout of impedance range – if you runthat routine before starting your record-ing.

FEATURE ARTICLE

Hooray! The Revolution Is Here! (But Don’t Stop It in Its Tracks)Rich Sherman, PhD, Suquamish, Washington

Rich Sherman, PhD

continued on Page 18

It has been nearly ten years since AAPB’s research & instrumentation committee compiled a list of available biofeedback devices andtheir characteristics. An incredible amount has happened during that decade. Instruments – especially their sensors, software, and capabili-ties – have undergone a revolution so even the questions on the old list are obsolete.

Questions for the new survey of equipment capabilities were generated by the authors and then sent for comment by three manufactur-ers. The highly revised list of questions was incorporated into a survey sent to all biofeedback equipment manufacturers known to AAPB.Data from the respondents has been incorporated into a spread sheet which is summarized below and which will be available on AAPB’sweb site (www.aapb.org) indefinitely.

A major strength of maintaining the survey on the web site is that manufacturers can update the information as their equipmentchanges and as new equipment comes out. One of the first columns in the spread sheet is the date the data were updated so readers willknow how current the information on the particular item is.

The spreadsheet is vertically organized into four categories:A. Computer-Based, Multichannel Systems not intended for ambulatory or

home useB. Ambulatory / Home TrainersC. Stand alone Single / Dual parameter non-computer based systemsD. Software not supplied with the equipmentWithin each section, each of the spreadsheet’s rows is used for one item of

equipment. A manufacturer selling several devices within one category wouldhave one row for each device. The questions for each category are spaced horizon-tally across the width of the spreadsheet. The full list of questions are shown onthe following page, followed by an abbreviated sample of the spreadsheet whichappears on AAPB’s website.


FEATURE ARTICLE

A Living Compendium ofInformation on BiofeedbackDevicesRichard A. Sherman, PhD, BCIACChair, AAPB Research and Instrumentation CommitteeBehavioral Medicine Research and Training FoundationSuquamish Washington

Nanny H. Christie, MA, LPC, BCIACWeatherford, Texas

Amy ColemanChapman University, Bangor Washington

Nanny H. Christie, MA, LPC, BCIAC

Richard Sherman, Ph.D

Manufacturers please note:If we failed to contact you or somehow didn’t

include your information, please contact thesenior author ([email protected]) for a sur-vey and we will add your information to thespreadsheet appearing on the website.

If you want to change or add material, justcontact the senior author and the new materialwill be incorporated.

Amy Coleman

Association for Applied Psychophysiology and BiofeedbackSurvey of Instrumentation and Software for Biofeedback/Applied PsychophysiologySection 1: Biofeedback Devices

A. Computer-Based, Multichannel Systems not intended for ambulatory or home use1. Name of manufacturer: __________________________________________________________________________________________________________

Phone number: ____________________________________ e-mail: ______________________________________________________________________

2. Power Source (circle all that apply): Battery AC power line power from computer other _______________________________________________

3. Types of biofeedback provided (circle all that apply): audio / visual computer monitor vibration other __________________________________

4. Visual display output (circle all that apply): raw sEMG other raw data bar graph moving line digital templates games other: ____________

5. Audio output: pulsed tone pitch music CD other ___________________________________________________________________________

6. Parameters recorded (circle all that apply): EEG EMG TEMP GSR RESP BVP UI HR ECG Pressure BP other __________

7. Are there isolated inputs for external equipment? yes noCan the system be used to turn on external equipment such as a stimulator? yes no If yes, what? __________________________________________

8. Number of channels of input: ___________________________________ Number which have high speed A/D: ____________________________________Number with slow speed: _______________________________________ Maximum sample Rate per channel: ____________________________________Digital resolution (12, 14, 16 bits): _________________________________________________________________________________________________

9. Flexibility of channel settings: yes no

10. Scanning Option: yes no

11. Can this device use only the sensors provided by the manufacturer? yes no

12: Skin preparation requirements for EMG: _____________________________________________ EEG: _________________________________________

13. Method of transmitting the signal from the sensors to the device: wires fiber optic telemetry other __________________________________________

14. Built in quality checks for:loose sensors: yes no impedance: yes nobattery: yes no other: _________________________________________________________________________________________

15. Computer requirements: _________________________________________________________________________________________________________

16: Warranty period (years): _________________________________________________________________________________________________________

17. Usual turn around time for repairs: ________________________________________________________________________________________________

18: Availability of technical (software advice, hardware advice) support:during warranty: _______________________________________________________________________________________________________________after warranty:_________________________________________________________________________________________________________________

19. Are firmware/software updates accomplished via (circle all that apply): Diskette CD Factory reconfiguration modem protocol internet protocol other _______________________________________________________

20. Which computer operating systems are supported by the system? _____________________________________________________________________________________________________________________________________________________________________________________________________

21. How is the biofeedback device interfaced with the computer? ____________________________________________________________________________

22. What kind of data can be stored in the computer (average, raw, etc.)? _____________________________________________________________________

23. Can the data be accessed by standard programs (spreadsheets, word, etc.)? yes no

24. How long has this device been on the market? ________________________________________________________________________________________

25. Does the device have FDA approval? yes no If yes, what is it labeled for? ___________________________________________________________

26. Suppliers of this unit: ___________________________________________________________________________________________________________

B. Ambulatory / Home Trainers Same questions as for "A" above.

C. Stand alone Single / Dual parameter non-computer based systemsSame questions as for "A" above.

Section II: Software not supplied with original equipment1. Name of Manufacturer: __________________________________________________________________________________________________________

2. Name of software: ______________________________________________________________________________________________________________

3. Intended Use: Data storage Biofeedback Reports Statistics Other: __________________________________________________________________

4. What does this software package do that the software supplied with the unit does not do? Be very specific:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Screens: Default Create your own

6 Same questions as for "A" above.Training Protocol?: Yes No

7. HRV / RSA Protocols?: Yes No

8. Printable (circle): Notes Graphics Other ______________________________________________________________________________________

9. Devices supported : _____________________________________________________________________________________________________________

10. Suppliers of software: ___________________________________________________________________________________________________________



Power Source: Types ofBiofeedbackprovided:

Visual displayoutput:

Audio output: Parametersrecorded:

Are there isolated inputsfor externalequipment?

Can the system beused to turn onexternal equip-ment such as astimulator?

Flexibility of channel settings:

Scanningoption:

Can thisdeviceuse onlythe sen-sors pro-vided bythe manu-facturer?

Skin prepara-tionrequire-ments for

rechargablebattery

audio visual computer monitor vibration

other raw databar graphmoving linedigital gamesuser writtenprogramsanimations

pulsed tonepitchmusic midi synthesizer

EEG no yes photic stim-ulator

yes yes no EMG:EEG:minimalskin prepwith gel

Association for Applied Psychophysiology and BiofeedbackSurvey of Instrumentation and Software for Biofeedback/Applied PsychophysiologySection 1: Biofeedback Devices “A. Computer-Based, Multichannel Systems not intended for ambulatory or home use”

Brainmaster Technologies, Inc.”24490 Broadway Ave. #2Oakwood Village, [email protected]

Number of channels of input: 2Number which have high speed A/D: 2Maximum sample rate per channel: 120Digital resolution (12, 14, 16, bits): 8

batteryAC power line

audiovisual

bar graph CD

pitch EEGGSR

no no no no no EMGEEG:abrade

Comptronic Devices Ltd.9008-51st AvenueEdmonton, Alberta CanadaT6E [email protected]

Name of manufacturer Date dataupdated:

Number of channels of input: 1 Number which have high speed A/D:Maximum sample rate per channel:Digital resolution (12, 14, 16, bits):

AC power linepower fromcomputer

audio visual computer monitor

raw EMGother raw databar graphmoving linedigital games

pulsed tonepitchmusic

EEG, EMG no no yes no yes EMG: skinprep padsEEG:skin preppads

Biofeedback SystemsIncorporatedCAPSCAN/BFS Inc. Consortium2736 47th StreetBoulder, CO, 80301303-444-1411

Number of channels of input: 5Number which have high speed A/D:Maximum sample rate per channel: 400Digital resolution (12, 14, 16, bits): 12


audio computer monitor vibration

bar graphmoving linesgames


EEG no no no no no EMG:EEG:paste

Neurocybernics, [email protected]

Number of channels of input: 8Number which have high speed A/D: 2,slow 6Maximum sample rate per channel: 256hzDigital resolution (12, 14, 16, bits): 12


audio visualcomputer monitor

other raw databar graphmoving lineall digital realtime EEG feed-back

pulsed toneraw visual EEG

EEG no no yes no no EMG:EEG:10-20paste

Neuropathways EEG ImagingSuite 209Beverly Hills CA [email protected]

Number of channels of input:Bipolar hookupNumber which have high speed A/D: 1Maximum sample rate per channel:500,000 Digital resolution (12, 14, 16, bits): 32

battery audio visualcomputer monitor

other raw databar graphmoving linedigital

pitch MIDI tones

TEMP, GSRRESP, HR,ECG

no no no no yes EMG: n/aEEG:n/a

Thought Technology Limited(ProComp/Cardiopro 2.0)2180 Belgrave Ave.Montreal, CANADA H48 [email protected]

Number of channels of input: 6Number which have high speed A/D: 2Slow: 4Maximum sample rate per channel: 256Digital resolution (12, 14, 16, bits): 14


raw EMGgrow boxesother raw databar graph computationsmoving linegamesdigitalcountersanimation

MIDI pulsed tonespitchmusicCD

EMGEEGTEMPGSRRESPBVRHRECG

no no yes yes EMG: notfor biofeed-backEEG:nuprepand 1020paste

Thought Technology Limited(ProComp/Biograph)2180 Belgrave Ave.Montreal, CANADA H48 [email protected]

Number of channels of input: 8Number which have high speed A/D: 2Slow: 6Maximum sample rate per channel: 256Digital resolution (12, 14, 16, bits): 14


rbar graph moving line

pulsed tones EMG no no no no yes EMG: n/aEEG:n/a

Thought Technology Limited(Myotrac 3)2180 Belgrave Ave.Montreal, CANADA H48 [email protected]

Number of channels of input: 2Number which have high speed A/D:Slow: 2Maximum sample rate per channel: 250 Digital resolution (12, 14, 16, bits): 14

power fromcomputer

audio computer monitor vibration

raw EMGother raw databar graph moving linegamesdigitaltemplates

pulsed tonepitchmusicWAV file

EEG ECGEMGTEMPGSRRESPBVRHR

yes yesGeneralswitched output

yes yes no EMG:basicEEG:basic

J&J Engineering (I330C8)22797 Holgar Court NEPoulsbo, Washington 98370360-779-3853JJEngineering.com

Number of channels of input: 6Number which have high speed A/D: 8Slow: 16Maximum sample rate per channel:2048Digital resolution (12, 14, 16, bits): 16

batteryAC power linepower fromcomputer

audio visual vibration

bar graph digitalLEDS

pulsed tonepitch

activityintensity

no yes externalalarms andstimulator

yes yes yes EMG:EEG:

Ambulatory Monitoring, [email protected]

Number of channels of input: 1Number which have high speed A/D:Maximum sample rate per channel:Digital resolution (12, 14, 16, bits): 16

external powersupply

audio visual

other raw databar graph moving linegamesdigitaltomographs,compressedspectral array

pitch EEGEMGHR

no yes JJ1330 yes yes no EMG:standardEEG:standard

Lexicor Medical Technology2840 Wilderness PlaceSuite ABoulder, Colorado [email protected]

Number of channels of input: 23Number which have high speed A/D: 23 Maximum sample rate per channel: 512Digital resolution (12, 14, 16, bits): 12

AC power line computer monitor

moving linedigital

EMG pressure no yes can controlbuilt in internalstimulator

yes yes yes EMG:shaving orconduc-tive gelEEG:adhesivepatchelectrodes

Laborie Medical [email protected]

Number of channels of input: 3Number which have high speed A/D:slow: 3 Maximum sample rate per channel: 200Digital resolution (12, 14, 16, bits): 10

Number of channels of input:


Method oftransmittingthe signal fromthe sensors tothe device:

Built in qualitychecks for:

ComputerRequirements:

Warranty peri-od (years):

Usual turnaround timefor repairs:

“Availability oftechnical (soft-ware advice,hardwareadvice) sup-port: “

Arefirmware/soft-ware updatesaccomplishedvia:

Which comput-er operatingsystems aresupported bythe system?

How is thebiofeedbackdevice inter-faced with thecomputer?

What kind ofdata can bestored in thecomputer?

Can the databe accessedby standardprograms?

How long hasthis devicebeen on themarket?

Does thedevice haveFDA approval?

“If yes, what isit labeled for?”

Suppliers ofthis unit:

wires loose sensors:noImpedence: noBattery: noOther: RawEEG visible forsignal integritycheck

any windowswith externalcom port

“1, 2 yearavailable”3 months free

2 days during warrantee:“phone, emailunlimited”after warran-tee: “phone,email, limited”

disketteCDinternet protocol

WindowsApple MACwith virtual PC

optical isolatedRS-232

raw EEG statistical summaries

yes 5 years yes “EEG, biofeed-back/relaxation”

“manufacturer,distributers,affiliates”

wires Loose sensors: yesImpedance:yesBattery: yesOther:

noneand helddevices

1 2 weeks orless

during warrantee:goodafter warrantee:good

disketteCD

Windows not not 16 years no clinicians

wires loose sensors:yesImpedence:yesBattery: yesOther:

486 orPentium at 90MHZ16 MEG RAMVGA or SVGA

1 2 days during warrantee: yesafter warran-tee: yes

diskette 5 channel =DOS 6.01 channel =Windows 95and up

5 channel =A/O card1 channel =RS 232 port

raw and average

yes 5 years yes biofeedback CAPSCANCorp., BFSIncorporated,ETI

fiber optic loose sensors:noImpedence: noBattery: yesOther:

2 computersSound blasterSound cardATI video card

years: 1 48 hours during warran-tee: 8 - 5 PSTMon. - Friafter warran-tee: 8 - 5 PSTMon. - Fri

disketteCD

serial port raw summary no 11 years yes relaxation Neurocybernetics,Incorporated

wires loose sensors:yesImpedence:yesBattery:Other:

All cometogether as asingle package

years: 3 2 days during warrantee: 3years freeengineeringand teachingafter warrantee:

CD built fromscratch

All in onepackage

raw yes 5 years no Neuro-pathways EEGImaging

wires loose sensors:yesImpedence: noBattery: yesOther: EKGsignal quality

years: 1 2 weeks during warrantee:9 - 5 ESTafter warran-tee: 9-5 EST

disketteCDFactory reconfigurationinternet protocol

Windows ProSB inter-faceF.O. cable

raw statistics yes 2 years yes class 2 ThoughtTechnologyand variousdealers worldwide

wiressensor todevice = wiresdevice to computer F.O.

loose sensors:yesImpedence: noBattery: yesOther:

years: 1 2 weeks during warrantee:9 - 5 ESTafter warrantee:9-5 EST


Windows ProSB interfaceF.O. cable

raw data statistics

yes 6 years yes class 2 ThoughtTechnologyand worldwide distribution

wires loose sensors:noImpedence: noBattery: yesOther:

Windows 3.198

years: 1 2 weeks during warrantee:9 - 5 ESTafter warrantee:9-5 EST


Windows F.O. cable RMS yes 2 years yes class 2 ThoughtTechnologyand worldwide distribution

wires loose sensors:yesImpedence:yesBattery: yesOther:

PC 266 MHZor faster

years: 1 1 week during warrantee:yesafter warrantee:yes

Windows USB port raw and anyaverage

yes Dec. 01 yes biofeedbackfor relaxationand re-educa-tion of muscles

wirestelemetry

loose sensors:

Impedence:Battery: yesOther:

minimal PCsystem

years: 2 3 weeks during warran-tee: phone, faxemailafter warran-tee: phone, faxemail


IBM PC,Windows

serial connection ormodem

raw yes 21 years no AmbulatoryMonitoring

wires loose sensors:noImpedence:yesBattery: noOther:

minimum 486DX

years: 1 3 weeks during warrantee: yesafter warrantee: yes

disketteCDfactory reconfiguration

DOS Windows accessoryDSP card

raw yes 12 years yes electro-cephalography,spectral frequencyanalysis

Lexicor

wires loose sensors:noImpedence:yesBattery: n/aOther:

Pentium basedPC 133 Mhz,32MB RAM

years: 1 1 week during warrantee: yesafter warrantee: yes

CD Windows 98,ME

Serial RS-232ca ble

patients demographics average dataprotocol settings

no 1 year yes Urostymbiofeedback/Stimulationsystem for tx ofurinary inconti-nence used byurologist/uro-gynecologist

LaborieMedicalTechnologies






Can the system beused to turn onexternal equip-ment such as astimulator?


Scanningoption:



Section 1: Biofeedback Devices “A. Computer-Based, Multichannel Systems not intended for ambulatory or home use” continued

Survey of Instrumentation and Software for Biofeedback/Applied Psychophysiology Section 1: Biofeedback Devices B. Ambulatory / Home Trainers








Scanningoption:



Name of manufacturer Datedataupdat-ed:


Plug in audiovibrationvisualcustomcomputer monitor

EMG, TEMPGSR, HRRESPUI BVP systolic/diastolic pressure

yes yes standardprepara-tion

AM Biotech InformationUnicomp 1330

8 channells simultaneously and 16alternatively


audiovisual

bar graph CDpitchpulsed tone

EEGGSRAVE

no no EMGEEG:abrade

Comptronic Devices Ltd.Mind Alive9008-51st AvenueEdmonton, Alberts, CanadaT6E [email protected]

Number of channels of input:Number which have high speed A/D:Maximum sample rate per channel:Digital resolution (12, 14, 16, bits):

rechargablebattery

audio visual computer monitor vibration

other raw databar graphmoving linedigital games

pulsed tonepitchmusic midi synthesizer

EEG no yes yes no EMG:EEG:minimalskin prepwith gel

Brainmaster Technologies, Inc.”24490 Broadway Ave. #2Oakwood Village, [email protected]

Number of channels of input: 2Number which have high speed A/D: 2Maximum sample rate per channel: 120Digital resolution (12, 14, 16, bits): 8

battery audio visual

digital analogmeter

pulsed tone EMGTEMPGSR

no no yes yes EMG: skinprep padsEEG:

Biofeedback Systems IncorporatedCAPSCAN/BFS Inc. Consortium2736 47th StreetBoulder, CO, 80301303-444-1411

Number of channels of input: 1Number which have high speed A/D:Maximum sample rate per channel:Digital resolution (12, 14, 16, bits):


audio computer monitor

bar graphmoving linesgames


EEG no no no no EMG:EEG:paste

Neurocybernics, [email protected]

Number of channels of input: 2Number which have high speed A/D: 2,slow 6Maximum sample rate per channel: 256hzDigital resolution (12, 14, 16, bits): 12

batterypower fromcomputer


other raw databar graphmoving linedigital templatesfast fouriertransforms,spectrograms

pitchmusic

EEG no no no no EMG:EEG:sensorbands,sensorphones

Peak Achievement TrainingSingle Channel PeakAchievement Trainer1103 HollendaleGoshen, Kentucky 40026

Number of channels of input: 1Number which have high speed A/D:slow 1Maximum sample rate per channel: 128hzDigital resolution (12, 14, 16, bits): 8

batterypower fromcomputer


other raw databar graphmoving linedigital templatesfast fouriertransforms,spectrograms

pitchmusic

EEGEMGGSRHR

no yes no no EMG:cleaningwith prepEEG:sensorbands,sensorphones

Peak Achievement TrainingTwo Channel Peak Achievement Trainer1103 HollendaleGoshen, Kentucky 40026

Number of channels of input: 3Number which have high speed A/D:slow 3Maximum sample rate per channel: 128hzDigital resolution (12, 14, 16, bits): 8

power fromcomputer

computer monitor

bar graphmoving linegames

none HRHRV

no no no yes EMG: n/aEEG:n/a

HeartMath Freeze-Framer14700 West Park AvenueBoulder Creek, CA 95006

Number of channels of input: 1Number which have high speed A/D:slow 1Maximum sample rate per channel: n/aDigital resolution (12, 14, 16, bits): n/a


rbar graph moving linedigitalRMSEMG

pulsed tone EMG no no no yes EMG: pre-gelledelectrodesEEG:n/a

Thought Technology Limited(U Control)2180 Belgrave Ave.Montreal, CANADA H48 [email protected]

Number of channels of input: 1Number which have high speed A/D:Slow: `Maximum sample rate per channel:20s/sec Digital resolution (12, 14, 16, bits): 14


EMG, EEG yes yes Prep padsAM Biotech InformationCAPSCAN Prism 5

5 channells (four channel sychrony plusa single amplitude 80 built in)


EMG, EEG yes yes Prep padsAM Biotech InformationCAPSCAN C80

5 channells (1 amp four bandwidthssimultaneously)
































cablestelemetryoption andcustom

loose sensors:yesImpedence:yesBattery:Other:

DOS Windows years: 1 technical sup-port by phoneinternetas necessaryin person

AmericanBiotechCorporation

wires Loose sensors: yesImpedance:yesBattery: yesOther:

none 1 2 weeks orless

during warrantee:goodafter warrantee:good

disketteCD

Windows AVE otbiofeedbackcamera

16 years no clinicians

wires loose sensors:noImpedence: noBattery: noOther: RawEEG visible forsignal integritycheck

any windowswith externalcom port

“1, 2 year con-tracts avail-able”3 months free

2 days during warrantee:“phone, emailunlimited”after warran-tee: “phone,email, limited”


WindowsApple MACwith virtual PC

optical isolatedRS-232

raw EEG statistical summaries

yes 5 years yes “EEG, biofeed-back/relaxation”

“manufacturer,distributers,affiliates”


n/a 1 2 days during warrantee: yesafter warrantee: yes

n/a n/a serial port none no 10 years yes biofeedback BFSIncorporated,ETI

fiber optic loose sensors:noImpedence: noBattery: yesOther:

2 computersSound blasterSound cardATI video card

years: 1 48 hours during warran-tee: 8 - 5 PSTMon. - Friafter warran-tee: 8 - 5 PSTMon. - Fri

disketteCD

serial port raw summary no 3 years yes relaxation


486 DX with 4M RAMany Pentium

years: 1 2 weeks during warran-tee: freeafter warran-tee: free

diskette Windows serial port raw yes 4 years no PeakAcheivementTraining


486 DX with 4M RAMany Pentium

years: 1 2 weeks during warran-tee: freeafter warran-tee: free

diskette Windows serial port raw yes 4 years no PeakAcheivementTraining

wires loose sensors:yesImpedence:n/aBattery: n/aOther:

90 MHZPentium, CD-ROM, 32 MBRAM, 800x600screen resolu-tion, serial port

90 days 1 week during warran-tee: yesafter warran-tee: yes

CDInternet proto-col

Windows serial port HRV yes 2 years no HearthmathLLC., StensCorp.AmericanBiotech, EEGSpectrum,Phazx

wires loose sensors:noImpedence: noBattery: noOther:

n/a years: 1 2 weeks during warrantee:9 - 5 ESTafter warrantee:9-5 EST

Factory reconfigurationinternet protocol

n/a n/a n/a no 2 years yes class 2 ThoughtTechnologyand various deal-ers worldwide







continued on page 32

Abstract:: The authors provide a descrip-tion of the likely near and long-term future ofbiofeedback technologies. They predict thatbiofeedback will soon pervade everyday life,and will become an integral and expected partof the human living and work environmentsof the future. Biofeedback will be automati-cally delivered through most ordinary worktasks and embedded in recreational activities.Wearable sensors and wireless transmissionwill in the near term be important technolo-gies mediating the permeation of biofeedbackin society. Those biofeedback technologies willeventually be replaced by remote sensors builtinto human surroundings and householdobjects and controlled by omnipresent comput-er networks.

Predictions of future technologies tradi-tionally have a dismal record of accuracy.More often than not their fate is merely tobecome a source of amusement for futuregenerations. However, futurist predictionsserve a vital and generally underestimatedpurpose in any technical field. For thesedetailed visions of future realities directinnovation and encourage people to reachbeyond what is convenient or conventionaltoday to build a different tomorrow.

With this value of prognostications inmind, we will risk ridicule from our descen-dants and the attendees at the 2020 AnnualAAPB Meeting, and outline what webelieve is the foreseeable future of biofeed-back technologies. We will begin by outlin-ing the monumental change in theapplications of biofeedback which webelieve is currently on the horizon. To sumit up in one sentence, biofeedback is aboutto escape, once and for all, from our labs

and specialty clinics, to infiltrate everydaylife in myriad ways. We will then discussthe technological changes that both driveand will result from this change.

1. In the future, biofeedbacktraining opportunities will pervade the daily lives of mostpeople.

Most experts on future technologies agreethat, in the coming decades, we will live in“intelligent” home and work environments.Our homes and offices will be unobtrusive-ly run by sophisticated computers, whichwill constantly adapt and respond to theinhabitants. It is almost inevitable thatbiofeedback technology will join computersas they are woven this way into the back-ground fabric of our everyday lives. “Thecomputer of the year 2020 will basically beinvisible. It will be completely distributedand decentralized and omnipresent in allthe objects around us. It will be part ofyour clothes, of your glasses, of your shoes,of the chairs, etc. We will be continuouslyliving in this computer-based world” (Maes,2001). Biofeedback technology will disap-pear into the woodwork—in many cases,literally. Our surroundings will listen to ourbodies and brains through remote sensorsbuilt into walls and household objects, andby means of sensors in our clothes, andreact to physiological signals as well as voiceand presence to make adaptive changes inour experience. “I think in the future that ifyou were to walk into a room that didn’treact to your presence there, that didn’tknow you had come into it, and somehowdone something to customize itself for you,

or something like that, that will feel asprimitive to people then as it would feel tous now to walk into a log cabin. It will feelancient, and, I think, in some sense peoplemight even be uncomfortable in spaces likethat” (Coen, 2001).

“Life-pervasive” games, which are the lat-est hot development in computer games,provide “the thrill of being harassed by amysterious conspiracy via phone, e-mail,instant messaging and the Web” (Grossman,2001). Biofeedback in the future will simi-larly utilize a variety of objects and methodswhich will “conspire” to deliver correctivefeedback to individuals to help them main-tain the desired mental and physical states.“We are moving into a world where mostobjects will have microprocessors in them,and all these processors will interconnectwirelessly through the Internet” (CNNProductions, 2001). People will only haveto state their mental and physical goals,and, wherever they go, the recreationalgames, computer workstations, thermostats,music delivery systems, television, etc.,within their reach will band together underthe control of remote computer servers tohelp achieve and maintain those biofeed-back goals.

Just as we now take air conditioning forgranted and expect our buildings to main-tain a temperature where we can functioncomfortably, we will in the future expectour environments to help us optimize ourpsychophysiological functioning and willeventually come to think of living quarterswhich do not have those amenities as primi-tive and uncomfortable.


FEATURE ARTICLE

Morphing BeyondRecognition: The Future ofBiofeedback TechnologiesOlafur S. Palsson , PsyD,Chapel Hill, North CarolinaAlan T. Pope, PhD

Alan T. Pope, PhDOlafur S. Palsson , PsyD

The feedback provided by theomnipresent biofeedback systems of ourfuture environments will happen in manydifferent ways: by observing reactions toparticular environmental events and adjust-ing subsequent events (i.e., their nature,intensity, or frequency) accordingly; byadjusting the ambience of the environmentto drive physiological changes; by providinga reward immediately following a correctphysiological change; by giving verbal orvisual advice and coaching (your watch maysoon tell you to “watch it” if you are work-ing too hard); and by delivering stimuliknown from past data to produce specificpsychophysiological reactions in the indi-vidual. For patients with chronic healthconditions, such biofeedback may addition-ally take the form of internet-controlledadjustments in the flow rate of wearablemedication pumps and automated schedul-ing of doctor appointments when the envi-ronment detects it is timely. “Medicine willbe transformed with the introduction ofcyberspace. Not only are we going to makethe transition to preventive medicine, whereour clothes, our rings, our jewelry willmonitor our health and tell us years aheadof time what we’re going to expect in thefuture, but also surgery itself could beaffected” (Kaku, 2001).

2. In the future, biofeedbacktraining experi-ences will befully integratedinto all our pri-mary daily activi-ties.

People’s primaryactivities, in whichthey engage continual-ly for several hours andwhere they repeat thesame activity day afterday, provide the bestopportunities for sys-tematic influence withbiofeedback. Twentyyears from now,biofeedback will beembedded in mostcommon work tasks ofadults and will be inte-gral to the school

learning and play of children. Interactionswith computers or computer-controlledobjects will be the predominant daily activi-ty of both adults and children, and biofeed-back will be embedded in these activities tooptimize functioning and to maintain well-being and health.

The foreshadowing and early beginningsof this trend can already be seen, and it willgather momentum rapidly in the next fewyears. Computer software which simultane-ously trains cognitive abilities directly rele-vant to academic performance and deliversbrainwave biofeedback is used in school set-tings and is commercially available (Freer,2001). Biofeedback-enrichment of popularvideogames (Palsson et al., 2001) hasalready been demonstrated to work as wellas traditional clinical neurofeedback. AndNASA is actively working on ways to blendbiofeedback into the normal cockpit activi-ties of professional pilots (Palsson and Pope,1999; Prinzel and Freeman, 1999). Effortsare also under way to use physiologicalmonitoring and biofeedback to guide com-plex cognitive work tasks. For example, therecent proposal for NASA’s IntelligentSynthesis Environment (ISE) projectincluded an animation of a computer-aideddesign system responding to a user’s satis-faction about a design iteration, measuredvia remote sensing of brainwaves. The pro-

posal was drafted by engineers—an indica-tion of that field’s expectations for psy-chophysiological science. One PhDengineer was astounded to learn thatremote sensing of brainwaves was notalready routine.

Embedding biofeedback into people’s pri-mary daily activities, whether work or play,is a largely untapped and rich opportunityto foster health and growth. It may soon beregarded to be as natural and expected as isthe addition of vitamins to popular break-fast cereals. Toymakers of the future mightget unfavorable reviews if they offer com-puter games that only provide “emptyentertainment.” In the same vein, workerunions may frown upon computer worksta-tions that do not help safeguard the healthand well-being of employees through physi-ological monitoring and protective biofeed-back.

3. In the future, most biofeed-back training will occur in the background and out of conscious awareness.

In the coming decades, psychophysiologi-cal self-regulation skill will generally not beacquired through effort nor involve deliber-ate and time-consuming systematic practice.Conscious or effortful biofeedback learningwill typically be unnecessary because ouradaptive computer-controlled environments


Figure 1. NASA’s research at Langley Research Center in Hampton, Virginia, on integration of EEG psychophysiological monitor-ing and feedback into cockpit flight tasks, is an example of emerging efforts to build biofeedback into common work environments.


and everyday objects will train us automati-cally to maintain optimal mental and physi-cal states. Learning physiologicalself-mastery through concentrated effortwill be viewed as antiquated, impractical,and as eccentric as insisting on struggling todo math by hand instead of using calcula-tors. We have recently seen from our ownresearch (Palsson et al., 2001) that blendingbiofeedback training into an entertainingtask so that it becomes effortless and islearned automatically as a background expe-rience is as effective as the same amount ofclinical training requiring full concentra-tion. It would seem obvious that automaticand subtle biofeedback, which occurs effort-lessly in the course of doing what you wantto be doing, will be the preferred way oftomorrow.

Deliberate and effortful biofeedbacktraining will most likely exist only for high-ly specialized purposes in the future, wheremotivation and potential rewards are highenough to warrant the special efforts, andwhere the goal is achievement of physiologi-cal states far above normal health and func-tioning. Thus, outstanding athletes andhighly prized “corporate warriors” mayreceive specialized training from biofeed-back experts. Even in those situations, how-ever, systematic coaching sessions would besupplemented with automated biofeedbackin the home and work environment.

The Technologies ofFuture Biofeedback

It should be apparent from the abovedescription that the technology that will beused to deliver biofeedback in the future isnot currently lying about in our laboratoriesand clinics. However, the implementationwill not require any extraordinary techno-logical leaps. All the elements of thesefuture biofeedback technologies do, in fact,already exist. They will simply be integratedin new ways, and some will be applied tobiofeedback systems for the first time.

A. Future sensor technologies1. Wearables

“Wearable computers will be the bigdevelopment of the near future” (CNNProductions, 2001). Until remote sensingbecomes a standard component of officesand homes, and sufficiently refined forbiofeedback use, it is likely that wearable

computers will have an important role.Physiology-sensing garments and wrist-watches have already been developed forlife-signs monitoring, and, combined withwireless transmitters, they can be used forwalkabout biofeedback. These wearablesmay in the near term store the traininggoals and training history. “The main issueof a wearable is it knows so much aboutyou—it senses your everyday environment.In theory, it could know … even your emo-tional state. And that could all be stored”(Rhodes, 2001). In the near term, wirelessnetworking, enabled by Bluetooth and “Wi-Fi” (IEEE 802.11b) technologies, will allowpeople to move about unencumbered bywires while their embedded microprocessor-based wearable biofeedback appliance staysin touch with other processors for record-keeping and protocol adjustments.Lightweight wireless EEG-monitoring head-sets are currently emerging and will entirelyreplace the cumbersome wired EEG capsexcept for limited use in specialty clinicsand in research.

The demands of wearable sensor/trans-mitter devices will drive changes in the sen-sors used for biofeedback. The sensors mostcommonly used in today’s biofeedback willbe seen as unacceptable as biofeedbackspreads to homes and offices. This is alreadyforeshadowed in the convenient brush-typeEEG electrodes that are currently findingtheir way into biofeedback products.Optical sensing technology for physiologicalmonitoring holds out the promise of pho-tonic, non-contact EKG (over clothing) anddry contact EEG measurement, requiringno skin preparation, gels, or adhesives.These all-optical (optrode) sensors would beconvenient to use and well-suited to electri-cally noisy or hazardous environments. Iftheir development proceeds sufficientlyquickly, they are likely to be principal com-ponents of the wearable sensor/transmitterdevices in the transitional phase untilremote sensing takes over.

Forerunners of these ever-vigilant wear-able technologies include current web-basedphysical activity and body compositionmonitors, and Internet and telephone-basedremote vital-sign monitoring systems thatregularly contact participants to feed backtheir health status and provide coaching.

2. Remote sensingIt seems to us inevitable that the biofeed-

back sensors of the future will almost exclu-sively be remote (non-contact) sensors,following a transitional phase of the nextfew years, where wearable sensors will beutilized, as described above. The reason forthis takeover will be the convenience (theycan be built into walls and objects out ofthe way) and because they do not encumbertrainees. Although considerable develop-mental work is ahead to make remote sens-ing practical for biofeedback, it is not nearlyas much science fiction as it might sound tosome people. In fact, many of the technolo-gies needed for remote biofeedback sensingare already becoming sufficiently sophisti-cated and affordable for such use.

Thermography. Remote measurement oftemperature is already in practical use.Non-contact “point-and-click” thermome-ters for measuring the temperature of near-by objects are now available at yourneighborhood consumer electronics store.The potential of infrared thermography hasyet to be exploited in biofeedback technolo-gy for the remote sensing of skin surfacetemperature (Sherman, 1987), but its appli-cation is overdue and foreseeable as one ofthe earliest biofeedback applications ofremote sensing.

Facial scanning and remote pupillometry.Remote facial scanners are already highlyrefined and can be used by law enforcementto identify criminals from a distance in acrowd of people. A system is now underdevelopment that can scan the iris of a per-son walking ten feet from a camera. Similarpattern recognition technology can bedesigned to read facial expressions and pupilresponses and will soon be used for biofeed-back purposes to assess emotional reactionsto stimuli and the mood states of people.

Radar monitoring. A pulse-echo radarmonitor can detect the movement of inter-nal body parts such as the heart, lungs, andarteries. A prototype “flashlight” device,developed for law enforcement and rescueworkers, uses a narrow radar beam and aspecialized signal processor to discern respi-ration up to three meters behind a wall,detecting a few millimeters of movementeven through heavy clothing. This technol-ogy is likely to be used for remote sensingof respiration and heart rate for biofeedback


and physiological monitoring in the nearfuture.

Microwave back-scattering. Heart andbreathing signals may be extracted from theback-scattering of a low-intensitymicrowave beam. This capability may berealized soon for physiological monitoringand biofeedback use. It has been recentlydiscovered that pulse and breathing rate canbe detected by utilizing the Doppler shift inmicrowaves transmitted by a cell phone’santenna that bounce back to the phonefrom the user’s chest, heart and lungs. Cellphones, or the small wearable communica-tion devices which will replace them, willlikely be employed to pick up the vital signsof individuals to counter stress by adjustingtheir schedules, advising work breaks, orblending relaxing biofeedback into worktasks. Eventually, brainwave signals willsimilarly be derived from the interferencewaveform created from the modulation of atransmitted electromagnetic field by a per-son’s brain waves, enabling non-contactreading of brainwaves.

Implants. Although implants will have asmaller role than wearables and remotesensing in the future history of biofeedback,they will almost certainly be an importantelement in highly specialized medicalbiofeedback. Implantable biotelemetry sys-tems have been used in animal researchsince the 1970’s. As surgical techniquesbecome less and less invasive and sensors areminiaturized, injections of tiny but durablephysiological sensing and transmitting pel-lets coated with biocompatible materialswill soon be a simple matter. Patients withserious diseases will have implants whichmeasure blood chemistry, muscle electricalactivity, temperature, etc., and feed theinformation into receivers on the body sur-face or in the patient’s vicinity. The infor-mation from these implants will guideverbal instruction or physiological trainingof the patients by computers, adjustmentsin the environment, meals and entertain-ment, and modulation in the dose rate ofsubdermal drug delivery devices, and willalso provide health information to theirdoctors. Elite athletes are also likely to ben-efit from biofeedback implants in learningself-regulation for optimal functioning anddevelopment of their bodies, such as the

training of specific muscles and control ofnutritional intake.

B. Delivery systemsThree aspects of the biofeedback delivery

systems of the future will be different fromthe predominant use of biofeedback to dateand deserve mention here.

1. Virtual realityVirtual reality biofeedback technology is

likely to be used extensively in the comingyears to enhance training effects in special-ized types of training, especially in medicalbiofeedback and for athlete and flight crewtraining purposes, where physiologicalresponses are highly situation-specific andneed to be trained repeatedly in the simu-lated performance environment. In medicaluse, virtual reality will probably prove moremotivating and more effective in teachingself-regulation skills by helping patientsvisualize real-time physiological responses.Furthermore, virtual reality physiologicalrepresentations will also prove useful as adiagnostic aid to physicians doing physicalexamination of heart function, for educat-ing patients with physiological disorders,and for observing the progress of a diseaseprocess and the effects of a treatment inter-vention.

2. Adaptive computingUntil now, biofeedback has almost exclu-

sively relied on “brainless” computing. Inother words, biofeedback computers havenot been programmed for reasoning orlearning. This will be very different infuture biofeedback technologies. With notherapists in the loop to make decisionsabout the nature of training or adjustmentsto the interventions, biofeedback computerswill be endowed with sophisticated patternrecognition and artificial intelligence abili-ties. Biofeedback computers will in a waybecome virtual health-care or health-main-tenance providers. They will carry out ever-vigilant mental and physical healthmonitoring on all people within their reachand recommend training as they detectneeds emerging. Once they receive inputfrom each individual about the desired psy-chophysiological training goals, these com-puters will decide on the best way tointervene to help the person achieve thatgoal and then carry out and constantly

adapt the training based on observed expe-rience.

Even today, microprocessors embedded infeedback devices are capable of administer-ing adaptive protocols of biofeedback train-ing, such as shaping schedules. Suchmicrocontroller-mediated control of train-ing will be important for stand-alone train-ing devices for home and office use in thecoming years.

3. Multisystem/multilocationtraining

When network-connected remote sensinghas become the primary mode of obtainingbiofeedback information, which we antici-pate will happen within the next two orthree decades, a multitude of objects andsystems will also collaborate in the biofeed-back training of the same person as he orshe moves from room to room and buildingto building. A computer network connect-ing all these objects and systems will orches-trate the training of each person acrosstime, training modalities, and locations.

In summary, we predict that biofeedbackwill be widely employed in maintaining thehealth and well-being of coming genera-tions. Unlike the biofeedback implementa-tions we know today, almost all oftomorrow’s biofeedback will take place ineveryday life in society rather than in clinicsor labs.

The changes which will move the field inthis direction are already beginning, andthey will continue at an accelerating pacedue to the increasing availability and afford-ability of suitable technologies and the irre-sistible value of biofeedback enhancementto settings with special training demandsand to the consumer market.

It seems at the present time that the mor-phing of biofeedback into a common com-modity could happen quite separate from,and independent of, the long tradition ofclinical biofeedback. In our opinion, how-ever, it would be more advantageous forsociety if today’s biofeedback experts playan active role in guiding the evolution andimplementation of tomorrow’s biofeedbacktechnologies.

• stops the session automatically if a lead comes loose or impedance gets too high for agood signal – but can’t stop your looking at the screen when you aren’t actually record-ing so that you never realize that the machine has stopped.

The incredible new equipment can do all these great things – and more - but they can’tdefend against people who don’t record from the correct muscles, don’t put the sensorsalong the length of the muscle (or don’t keep the temperature thermistor at a constant pres-sure against the body, etc.), ignore all the great built in routines to tell them when the sys-tem isn’t working, and don’t incorporate the recording into a clinical assessment.

What I’m saying in a nut-shell is that our manufacturers are supplying us with incredibleequipment. They are going way, way out of their ways to prevent as much of the “garbagein – garbage out” syndrome as is possible – but they can’t defend against pure ignorance.We therapists still need to do our part. We need to know what we are doing – and especial-ly not treat the equipment as a black box.

Remember that the incredible new equipment still can’t put the sensors in the correctplace on the body or incorporate the recordings into a good clinical assessment. And – onelast limitation – remember that this incredibly sophisticated equipment isn’t approved bythe FDA for any more applications than show on its label. That means that most of ourapplications are still considered experimental by the FDA and you need to act accordinglywhen you use a device “off label” by telling the patient that you are doing so and giving afair and accurate description of the strengths and weaknesses of the evidence supportingyour use of the equipment for that particular application.

So, go ahead and fall in love with all the new capabilities – but use the quality routines,set the equipment to the correct bandwidth, put the sensors where they belong – yata, yata,yata (you know the drill)! So, please don’t just slap on the sensors and go for it – becauseyou’ll still get garbage out after you put garbage in!


ReferencesCNN Productions. (2001, September 11). A

History of the Future: Technology. A Jeremy IsaacsProduction for CNN Productions, Inc., Ian Holt,Series Producer/Director. Norfolk, VA: PublicBroadcasting System, WHRO.

Coen, M. (2001, September 11). A History ofthe Future: Technology. A Jeremy Isaacs Productionfor CNN Productions, Inc., Ian Holt, SeriesProducer/Director. Norfolk, VA: PublicBroadcasting System, WHRO.

Freer, P. (2001). Scientific research: Case study #1.Retrieved October 5, 2001, from http://www.playattention.com/studies.htm.

Grossman, L. (2001, August 13). Head games.Time, 158 (6), 65.

Kaku, M. (2001, September 18). A History of theFuture: Medicine. A Jeremy Isaacs Production forCNN Productions, Inc., Ian Holt, SeriesProducer/Director. Norfolk, VA: PublicBroadcasting System, WHRO.

Maes, P. (2001, September 11). A History of theFuture: Technology. A Jeremy Isaacs Production forCNN Productions, Inc., Ian Holt, SeriesProducer/Director. Norfolk, VA: PublicBroadcasting System, WHRO.

Palsson, O.S., & Pope, A.T. (1999, April 10).Stress counterresponse training of pilots via instru-ment functionality feedback. Abstract, Proceedingsof the 1999 Association for Applied Psychophysiologyand Biofeedback Meeting, Vancouver, Canada.

Palsson, O.S., Pope, A.T., Ball, J.D., Turner,M.J., Nevin, S., & DeBeus, R. (2001, March 31).Neurofeedback videogame ADHD technology:Results of the first concept study. Abstract, in press,Proceedings of the 2001 Association for AppliedPsychophysiology and Biofeedback Meeting, Raleigh-Durham, NC.

Prinzel, L.J., & Freeman, F.G. (1999).Physiological self-regulation of hazardous states ofawareness during adaptive task allocation.Proceedings of the Human Factors & ErgonomicsSociety, 43rd Annual Meeting, 1389.

Rhodes, B. (2001, September 11). A History ofthe Future: Technology. A Jeremy Isaacs Productionfor CNN Productions, Inc., Ian Holt, SeriesProducer/Director. Norfolk, VA: PublicBroadcasting System, WHRO.

Sherman, R.A., Barja, R.H., & Bruno, G.M.(1987). Thermographic correlates of chronic pain:Analysis of 125 patients incorporating evaluationsby a blind panel. Archives of Physical Medicine &Rehabilitation, 66, 273-279.

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The Revolution Is Herecontinued from Page 7

FEATURE ARTICLE

Where is Biofeedback Heading?Lawrence Klein, Thought Technology, Ltd., Montreal, Quebec

Abstract: This article identifies two trendsin the development of biofeedback instrumen-tation, toward more sophisticated systems forprofessional use, and toward simpler devicesfor home use. The author discusses the currentgeneration of equipment developed by ThoughtTechnology, and highlights breakthroughs intelemedicine and virtual reality. He reviewscurrent standards in quality assurance, andsuggests criteria for selecting instrumentationsystems. Further, he highlights the increasingopportunities for worldwide education inbiofeedback, and the emergence of new appli-cations based on today’s hardware and soft-ware systems.

In 1988, Dr. John Basmajian said in aspeech: “Just as surgery and pharmaceuticalswere important to Medicine in the 19thand 20th century, Behavioral Medicine willtake its place in the 21st century, andBiofeedback is an important component ofBehavioral Medicine” (Basmajian, 1988).This was a defining moment for me, fillingme with unbridled optimism.

Current Directions inBiofeedback Technology

There appear to be two trends in thefield: One is towards more sophisticatedand expensive systems for professionals andthe other is towards simpler, cheaper devicesfor home use.

In the professional area, there is ThoughtTechnology’s best selling ProComp+/BioGraph™ system which includes suchfeatures as automated work/rest periods,Boolean functions, a wide variety of tonesand visual displays, and easily programma-ble protocols. This system was designed bya team of clinicians and software and hard-ware engineers to ensure that the systemwould be responsive to actual clinical needs.

Because of its easy programmability,

BioGraph has opened the door of possibili-ties for creative clinicians. Since, for exam-ple, EEG bandpass nomenclature (e.g.Delta, Theta, Alpha and Beta) has beenreplaced with completely customizablebandpass settings, the Biograph has enabledclinicians to create feedback screens whichcan inhibit 3-5 Hz., and enhance 6-8 Hz.activity, while providing a ping for each 7Hz crossover, or discordant music whenproducing too much Theta. This level ofsophisticated feedback was impossible withprevious technology.

Another useful feature of BioGraph isthat, because it is Windows” based, multiplemonitors can be used to display feedbackinformation to the client while showingclinically relevant information to the clini-cian.

Clinicians will also appreciate the newestinnovation in our EEG sensors as you cannow perform an impedance check on allthree extender leads simultaneously. Thesensor, called EEG-Z, which includes the E-Z connect software, performs five imped-ance checks in 10 seconds, thenautomatically switches to a regular EEGreading mode. This obviates the need todisconnect and reconnect each of the threeleads.

We have also introduced our new Pro-SBDual Interface device; you are now able touse one ProComp+ and run the BioGraphand CardioPro software programs, simulta-neously. This gives you the ability to getreal-time EEG and HRV data in onerecording session.

For those unfamiliar with CardioPro™,it is a specialized physiological monitoringand biofeedback application for the cardio-vascular and respiratory systems. It can per-form real-time feedback on respiratory sinusarrhythmia (RSA) and heart rate variability

(HRV) from an electrocardiography (EKG)or blood volume pulse (BVP) sensor. Thesystem can also monitor other key physio-logical functions, such as respiration, tem-perature and skin conductance, for the mostcomplete view on your client's physiology.With a simple graphic user interface andcomprehensive reporting features,CardioPro lets you easily flow through thesteps of recording, reviewing, and analyzingdata. CardioPro is powerful enough forresearch applications, yet remains flexiblefor clinical work.

I believe it is also important to mentionthat our products, most notablyProComp+, are used with numerous 3rdparty software and hardware peripherals,which offer a wide variety of innovations.Some of these include: BioResearch’sBioIntegrator software, EEG Spectrum'sNeuroCybernetics software,Neurofeed.com’s software, BioComp’s HEGand sEMG+ by Clinical Resources.

TelemedicineSome of the more advanced applications

in biofeedback monitoring include the areaof telemedicine. One of the first to applyremote biofeedback monitoring was Dr.Ray Folen of Tripler army base. He used aProComp+/BioGraph in Hawaii to treatmilitary personnel in the Orient, by using 2telephone lines and specialized software andhardware which allowed him to control theclient’s PC running BioGraph and to pro-vide visual and auditory feedback. With theadvent of the Internet combined with someclever Java programming, clients no longerhave to leave their homes to visit their clini-cian; all they have to do is connect theirelectrodes, turn on their PC and connect toa web site. For example, Dr. Howard Glazeruses our MyoTrac 3 and Televital’s Internetservice, to assess and treat his patients with


Winter 200120 Biofeedback

pelvic floor disorders anywhere on theGlobe. No longer do his patients have tobear the expense and inconvenience of trav-eling to and residing in New York.

Other Advances inTechnology

Another area that appears to offer a pow-erful enhancement for biofeedback is thetechnology of Virtual Reality. By monitor-ing one’s physiological responses to the vir-tual scene, the program can stop or changethe characteristics of the environment when‘VR travelers’ encounter stressors whichovercome their abilities to cope.

Eye Tap, the brainchild of Dr. StevenMann, incorporates a wearable PC with avideo camera ‘inside’ the wearer’s eyeglasses.He couples this ‘broad band application’ (heis on line on the web in real time) with 8channels of physiological signals fromProComp+™, so that he, and anyonetuned in, knows, for example, which paint-ing in the gallery makes his heart race.Amusement? Perhaps, but one clinicallyrelevant application is for agoraphobics tomonitor their responses to the environmentand use biofeedback-coupled desensitizationtechniques, while a clinician monitorsprogress over the web. Another potentialapplication would be for authorities to eval-uate pedophiles’ physiological responses tochildren in their environment!

WearComp is an example of a practicalrealization of Humanistic Intelligence (HI).The apparatus consists of a battery-pow-ered, wireless, wearable, internet-connectedcomputer system with miniature eyeglass-mounted screen. The apparatus travels with

the user, either superimposing a computerscreen on top of the real world, or repre-senting the real world as a video image. (SeeFigure 1).

Using biofeedback technology provides agreater synergy between the user and theEyeTap wearable computer system. The factthat the WearComp/EyeTap apparatus isworn underneath clothing facilitates directcontact with the body, and thus encouragesfurther new forms of intelligent signal pro-cessing

Simpler TechnologiesAs leading-edge developers of biofeed-

back equipment, not only does ThoughtTechnology have to lead the trend towardssophisticated and clinical systems for profes-sionals, but also the trend towards simpler,cheaper PC-based devices for home use. Itis interesting that we are moving back intothe area from which we started in 1974with our GSR1 and subsequently ourGSR2™ home trainers (of which there aremore than 400,000 in use).

Our easy-to-use, single-channel and bat-tery-operated SEMG training device, U-Control,, allows clients to practice pelvicfloor contraction exercises in the comfort oftheir own home. Daily practice withSEMG feedback enhances their recoverytime. The U-Control is the predominanthome training device in the U.S.A,Germany, the U.K., and over 60 countries.

Quality AssuranceAt the last AAPB convention, I discov-

ered that many of our AAPB friends weresurprised to learn that the company thatHal Myers and I founded in 1975 currently

has 44 employees. We decided at our incep-tion that Thought Technology would designproducts that conform to current medicaland quality standards (removed words). Assuch, since 1998, we have achieved ISO9001, ISO 13485 and European CE certifi-cation, which assists us in maintaining thehighest level of quality and design innova-tions, which are responsive to user input,thus ensuring clinical relevance.

I believe it is important to note thatwhen you consider your purchase of equip-ment that you ask yourself the followingquestions:

1. Is the device clearly labeled as a med-ical device and does it comply withFDA 510(k) pre-market notificationrules? If not, am I open to liabilityclaims from a disgruntled patient whoclaims that I treated him with an “edu-cational device.”

2. Is the device manufactured by a com-pany or by a few individuals? What arethe long-term prospects for service andsupport?

3. Is there good technical support? Trycalling technical support before yourpurchase to see what type of responseyou get.

4. Is there a 30-day return privilege?5. What is the reputation of the compa-

ny? Speak to users. If you don’t knowany, ask for references.

6. Does the company offer training in itsequipment and clinical applications?

Thought Technology is pleased to provideinstrumentation on a loan basis to manyuniversities and colleges for their studentsand to clinicians for teaching purposes.

Worldwide Education forPractitioners

To change medical practice in the worldis a tall task, but education is the onlymethod, combined with hands-on trainingand research. Dr. Erik Peper, is the authorof Biofeedback for Repetitive Strain Injuryand Healthy Computing; a most timely sub-ject since computer related disorders havesurpassed lower back pain as the major rea-son for missing work. Not only is physio-logical monitoring useful to evaluateergonomic position it is also a valuable tool for analyzing and feeding back auto-nomic function to evaluate overall systemic

Figure 1. The WearComp Apparatus

Winter 2001 21Biofeedback

arousal. In 1992 and 1994, Erik

taught a group of ourEuropean distributorsergonomics – or “HealthyComputing” – using ourFlexComp 8-16 channel sys-tem. These were inspirationalworkshops incorporating notonly sEMG, but also tho-racic and abdominal respira-tion, HR/BVP, and SC. Eriksuggested a workshop for cli-nicians and so was born theBiofeedback Foundation ofEurope (www.bfe.org). Froma faculty of five instructors (Erik Peper –respiration; Tom Allen –EEG applications; BarbaraWoolner – sEMG for incon-tinence; Gabe Sella – sEMGDisability Evaluation, andGlenn Kasman – sEMG forPT applications], the BiofeedbackFoundation of Europe now has a facultyapproaching 50.

Attendance at the annual meeting inEurope has grown from from 35 to 150 in6 years! Next year it is at the Free Universityin Amsterdam from February 26-March2nd 2002. The BFE is now co-sponsoredby the international groups of the AAPBand ISMA. Also collaborating are a numberof international research societies and asso-ciations including: the Society of UrologicalNurses and Associates (SUNA), the 4thInterdisciplinary World Congress on LowBack and Pelvic Pain, the North AmericanSpine Society, the International Society forHeart Research and the World Assembly forMental Health.

These workshops are taught by talentedclinicians from disparate fields, who can fittheir course curriculum into a two or fourday workshop format. Their clinical skillsincorporate Biofeedback as an invaluabletechnology, teaching participants how touse this powerful tool to give them clinicalinsights they could not get otherwise.

Thought Technology also provides a 1-day workshop for beginners to feel comfort-able using the BioGraph system. All of the1-day and 2-day workshops are approved by

the Biofeedback Certification Institute ofAmerica (BCIA), for Category A accredited,continuing education for BCIA re-certifica-tion. The future of Biofeedback in medicineis assured each time a clinician is trained touse biofeedback as an integral part of theirpractice. In addition to investing in educa-tion and training, our company was proudto be congratulated recently by theAssociation of Applied Psychophysiologyand Biofeedback (AAPB) and theBiofeedback Foundation of Europe (BFE)for an equipment grant of US $100,000 forexcellence in clinical teaching and appliedresearch in their fields. The company isparticularly proud to see its devices beingused in research.

Emerging Applications Despite exciting claims made for biofeed-

back, The FDA still limits the use ofbiofeedback devices for relaxation, muscleeducation and incontinence includingstress, urge and mixed. Even when an appli-cation, like incontinence, is approved forthe use of biofeedback, it still needs to getreimbursement to be widely accepted. Forthis reason, the recent decision by theHealth Care Financing Administration(HCFA) was of great importance. A HCFApanel stated that a review of scientific evi-dence and testimony from expert witnesses

and professional organizations convincedthem to implement Medicare coverage ofbiofeedback for patients who do not benefitfrom pelvic muscle exercises (PME) alone.

Barbara Woolner, RN, CRNA, CCCN,John Perry, and several others had a majorhand in getting sEMG covered by HCFAsuccessfully. The HCFA panel noted thatmost of the studies examined by them wereinconclusive or flawed, leading them to theconclusion that there was insufficient evi-dence that biofeedback is an effective treat-ment for stress, urge, or post-prostatectomyincontinence. HCFA’s comment underlinesthe need for clinical studies to provide moreconclusive evidence, not only for inconti-nence, but for many other conditions notcurrently approved for use for biofeedbackand reimbursement.

Breakthroughs in applications come whenclinicians in twenty-four branches ofMedicine use our instruments for some ofthe most interesting applications of psy-chophysiology. Attending their courses isuplifting and enlightening; but satisfyingtheir clinical and research needs means con-tinuous software and hardware develop-ment.

Each leader teaches various subjects basedon their personal experience. By developingtheir own screens, reports and protocols,the clinician becomes familiar with theintricacies of this powerful clinical tool. Asa last word on training, we also organizeour own equipment workshops. The goal ofthese 2-day workshops is not only to makeclinicians feel comfortable using ourBioGraph system, but also to facilitate itsuse within their practice.

I coined a phrase: “Even a Stradivariusneeds a Menuhin”. (In ‘jock talk’, “Even aLouisville Slugger needs a Mark McGuire”).Thought Technology is proud to providesuperb instruments to the growing numberof health professionals, but our instrumentsare mute without their talented hands. Weare equally proud of the growing networkof highly competent professionals partner-ing with our company to develop newapplications and protocols based on thisinstrumentation.

Figure 2. Touring after the BFE 2000 meeting in Eilat: LawrenceKlein with family — Dr. Janet Shinder, Talia 12 and Ariella 7.

Abstract: The field of EEG biofeedback(“neurofeedback”) is experiencing unprecedent-ed transformation and growth, spurred on bya host of factors. These include software andtechnological developments, as well as clinical-ly motivated improvements in protocols andusage patterns. Key elements are identified anddescribed in this report, which details thechanges that are currently driving the industrytoward the next generation and beyond.

Based upon a host of technical and clini-cal developments, EEG biofeedback (alsoknown as “neurofeedback”) is experiencingan unprecedented transformation andgrowth, leading to new uses and applica-tions, both within the clinic, and in homeand business environments. Based uponnew discoveries and approaches that wereformed in the 1990’s (the Decade of theBrain), the next decade of EEG biofeedbackpromises to be revolutionary, providingbenefits to an ever-growing population cli-nicians, educators, and trainees. The keydevelopments that are facilitating this trans-formation are:

New Software and SignalProcessing Algorithms

New software and signal processing algo-rithms that exploit the latest PC hardwareand software. These include new digital fil-tering, analysis, and quantitative assessment(QEEG) methods, plus graphics and soundsuch as detailed and informative game andtechnical displays, and sound feedbackincorporating the MIDI (musical instru-ment device interface) technology, bringingmultimedia capabilities to even the lowest-cost EEG systems. In addition, neurofeed-back is now possible on any PC, includingthe ones on office and school desktops,where other applications are being used

while neurofeedback training is being done.

New ElectronicTechnology

New electronic technology, and electrodesproviding simple, robust connections to awide range of EEG electrode locations.Using new types of amplifiers, headbands,caps, and electrode attachment and elec-trolyte methods, including both dry andliquid-based electrodes, it is now easier thanever to connect a trainee to an EEG deviceand get good training results, without theneed for a trained EEG technician. Some ofthe key attributes of this new technologyare as follows:

New AmplifiersBy using very high-input-impedance

amplifiers with superior common-moderejection, it is possible to achieve good EEGsignals with electrode connections that areof much poorer quality than previously pos-sible. Thus, whereas electrode impedancesof 10KOhms or less per pair were requiredwith earlier technology, it is now possible touse electrodes with impedances of 50K ormore. This makes it possible to record with-out scrubbing the skin to remove the outerlayers. It is also possible to work with con-nections that are not as tightly secured tothe scalp, opening the possibilities forsaline-based electrodes that use sponge, felt,or other materials in place of the electrodepaste. Finally, this new technology reducesthe need to check the electrodes with animpedance meter. Current EEG biofeed-back systems also display the raw EEGwaveform on the computer screen, provid-ing a continual monitor of signal quality,ensuring effective training.

New Chemistry

The latest electrodes can use liquid elec-trolytes that are designed to conduct thetiny currents from the scalp to the elec-trodes with a minimum of impedance, andfor extended periods of time. Thus, elec-trodes may be used that are wetted or mere-ly dampened with the solution, which thencomes into contact with the skin. Thesesolutions can even work through moderateamounts of hair, so that there is less necessi-ty to clear or cut hair, to find the surface ofthe scalp.

New ElectrodesNew electrode configurations use cloth or

Velcro headbands in conjunction with plas-tic assemblies that hold the electrodessecurely enough, without having to glue orotherwise secure the electrode to the skin.Some new electrodes are “dry” and usematerials that contain the electrolyteembedded in a plastic, rubber, or othermatrix. This makes it possible to use newconfigurations that include baseball hats,retaining caps, and other devices in place ofconventional “medical” electrodes. In thefuture with further improvements, we canenvision systems where the user simply putsthe hat on, shimmies the electrodes intoplace, and good EEG connections are readi-ly made.

New ProtocolsNew protocols enhance brain functioning

for improvement of attention, concentra-tion, focus, mood, and inner balance. Theseprotocols are based on new clinical andresearch studies that show the value oftraining protocols that go well beyond thesimple “alpha” and “beta” training of thelast two decades. New methods selectively

FEATURE ARTICLE

New Developments Leading EEGBiofeedback into the New MillenniumThomas F. Collura, PhD, P.E., BrainMaster Technologies, Inc.Oakwood Village, OH




Abstract: The analysis of heart rate vari-ability (HRV), or heart rhythms, provides areliable measure of autonomic nervous systemdynamics that is particularly sensitive tochanges in psychophysiological state. Whereascommon methods of HRV analysis typicallyquantify the amount of variability in a givenrecording, additional information can begained by heart rhythm pattern analysis.Research has shown that sustained positiveemotions lead to a highly efficient and regen-erative functional mode associated withincreased coherence in heart rhythm patternsand greater synchronization and harmonyamong physiological systems. A new develop-ment in biofeedback technology is the recentintroduction of heart rhythm feedback train-ers, which monitor heart rhythm patterns andhelp people develop skills to maintain states ofincreased physiological coherence. The use ofpulse wave sensors makes this technologyextremely versatile, time-efficient, and easy touse in a wide variety of settings. Heart rhythmfeedback trainers are currently utilized inmedical, mental health, corporate, and aca-demic settings to improve clinical, psychologi-cal, and performance outcomes. Thistechnology holds promise as a powerful andpractical tool for the enhancement of healthand human potential.

Heart Rate Variability andIts Significance

Heart rate variability (HRV) is a measureof the naturally occurring beat-to-beatchanges in heart rate. The analysis of HRV,or heart rhythms, is a powerful, noninvasivemeasure of neurocardiac function thatreflects heart-brain interactions and auto-nomic nervous system dynamics (TaskForce of the European Society, 1996;McCraty et al., 1995; McCraty & Singer, in

press). HRV can be derived either from theECG (using electrodes placed on the chest)or from pulse wave recordings (using aplethysmographic optical sensor placed atthe fingertip or earlobe). ECG recordingshave the advantage of producing fewermovement-related artifacts. However, pulsewave recording devices also provide datasuitable for most biofeedback applications,and, as they require no electrode hook-up,are more easily adaptable for use in a muchwider variety of settings (e.g., workplaces,schools, etc.). Of the two main types ofpulse sensors available (fingertip and ear-lobe), the earlobe sensor is slightly lessprone to yield artifacts produced by a per-son’s movement.

Heart Rhythm PatternAnalysis

Typically, instruments used for recordingHRV analyze the signal by means of timedomain or frequency domain (spectral)analysis, both of which quantify the amountof variability in heart rate that exists in agiven recording. A new approach to HRVmonitoring and feedback, which I willdescribe briefly here, is the analysis of heartrhythm patterns. Heart rhythm patternanalysis, which analyzes the varying shapeof the HRV waveform, shows promise to bean especially useful tool in psychophysiolog-ical research and biofeedback applications.This type of analysis can be particularlyvaluable in applications that aim to illumi-nate the physiological correlates of differentmental and emotional states, assess theextensive interactions among the mental,emotional, and physiological systems inarousal-induced pathology, or examine psy-chophysiological responses to differentinterventions. There are a number of

approaches that can be applied to HRV pat-tern analysis, which provide varying degreesof insight into the autonomic and physio-logical dynamics underlying the generationof the heart rhythm. In addition to quanti-fying how much variability exists, powerspectral analysis can also be used to charac-terize certain aspects of the heart rhythmpattern. For example, spectral analysis is auseful approach for quantifying shifts inautonomic balance, vascular resonance, andentrainment, although it is not very usefulin identifying more complex patterns.Nonlinear and geometric methods can beused for more complex pattern analysis;however, a detailed discussion of thesemethods is beyond the scope of this article.

HRV and EmotionalStates

Recent research conducted at theInstitute of HeartMath (IHM) has demon-strated that HRV dynamics are particularlysensitive to changes in emotional state, andthat positive and negative emotions can bereadily distinguished by changes in heartrhythm patterns. Specifically, during theexperience of negative emotions such asanger, frustration, or anxiety, heart rhythmsbecome more erratic or disordered, indicat-ing less synchronization in the reciprocalaction that ensues between the parasympa-thetic and sympathetic branches of theautonomic nervous system. In contrast, sus-tained positive emotions, such as apprecia-tion, love, or compassion, are associatedwith a highly ordered or coherent pattern inthe heart rhythms, reflecting greater syn-chronization between the two branches ofthe autonomic nervous system (McCraty etal., 1995; Tiller, McCraty & Atkinson,1996).

FEATURE ARTICLE

Heart Rhythm Coherence – An Emerging Area of BiofeedbackRollin McCraty, PhD i, HeartMath Research Center,Institute of HeartMath, Boulder Creek, CA

Our research on HRV and emotion hasidentified a distinct mode of physiologicalfunctioning that is frequently associatedwith the experience of sustained positiveemotion. We call this mode physiologicalcoherence (McCraty & Atkinson, in press).“Coherence” is used here as an umbrellaterm to describe a physiological mode thatencompasses a range of distinct but relatedphenomena, including synchronization,entrainment, and resonance, all of whichemerge from the harmonious interactions ofthe body’s subsystems. Correlates of physio-logical coherence include a smooth, sinewave-like pattern in the heart rhythms(heart rhythm coherence), a shift in auto-nomic balance toward increased parasympa-thetic activity, increased heart-brainsynchronization (alpha rhythms becomemore synchronized to the ECG), increasedvascular resonance, and entrainment amongdiverse physiological oscillatory systems(i.e., heart rhythm patterns, respiratory,craniosacral, and blood pressure rhythms)(McCraty & Atkinson, in press; Tiller,McCraty & Atkinson, 1996).

Heart Rhythm FeedbackTrainers

A promising new development in thefield of HRV instrumentation is the recentintroduction of heart rhythm feedbacktraining devices. Heart rhythm feedbacktraining is a powerful tool to help peoplelearn to self-generate states of increasedphysiological coherence at will, therebyreducing stress and improving health, emo-tional well-being, and performance.Technologies are currently available whichenable physiological coherence to be objec-tively monitored and quantified. Theseheart rhythm feedback trainers also helpindividuals develop emotional self-regula-tion skills that increase the capacity to sus-tain coherent states and their associatedbenefits. Using a fingertip or earlobeplethysmographic sensor to detect the pulsewave, these interactive hardware/softwaresystems plot changes in heart rate on a beat-to-beat basis. Heart rhythm feedback train-ers can be used in conjunction withbreathing techniques or positive emotionrefocusing techniques that guide people inintentionally generating sustained positiveemotional states and coherent heart rhythm

patterns (Childre & Martin, 1999). As peo-ple practice the coherence-building tech-niques, they can readily see and experiencethe changes in their heart rhythm patterns,which generally become less irregular,smoother, and more sine wave-like as theyenter the coherent mode. This processenables individuals to easily develop anassociation between a shift to a morehealthful and beneficial physiological modeand the positive internal feeling experiencethat induces such a shift. These programsalso analyze the heart rhythm patterns andcalculate a coherence ratio for each session.The coherence level is fed back to the useras an accumulated score or success in play-ing on-screen games designed to reinforcecoherence-building skills. The software gen-erally includes a multi-user database to storeresults and track clients’ progress.

Because this technology uses a pulse wavemonitor and involves no electrode hook-up,it is extremely versatile, time-efficient, andeasy to use in a wide variety of settings.Heart rhythm coherence feedback traininghas been successfully used by mental healthprofessionals, physicians, educators, andcorporate executives to decrease stress, anxi-

ety, depression, and fatigue, treat childrenwith ADHD and asthma, improve academ-ic, work, and sports performance, lowerblood pressure, and facilitate healthimprovements in numerous clinical disor-ders (Lehrer, Smetankin & Potapova, 2000;Luskin, Reitz Newell, Quinn, & Haskell, inpress. 2000; McCraty, 2001; McCraty,Atkinson & Lipsenthal, in preparation;McCraty et al., 1999a; McCraty et al., inpreparation; McCraty et al., 1999b).

Many health professionals have foundheart rhythm monitoring and feedback tobe an effective tool to support and facilitatea wide variety of therapies, both conven-tional and complementary. For example,this technology is increasingly being usedby neurofeedback practitioners to calmclients and stabilize the nervous systembefore sessions. This preparation oftenallows for a shorter and more effective ses-sion. Many clinicians have found heartrhythm feedback to be an effective additionto treatment programs for chronic condi-tions that are associated with or exacerbatedby emotional stress, including fibromyalgia,chronic fatigue, hypertension, asthma, envi-ronmental sensitivity, sleep disorders, dia-


HeartMath’s Freeze-Framer™ heart rhythm feedback trainer.


betes, and cardiac arrhythmias, amongmany others. Practitioners also use heartrhythm feedback devices to monitor thereal-time psychophysiological effects of vari-ous therapeutic interventions that affectautonomic nervous system dynamics.

Because of the sensitivity of HRV pat-terns to changes in psychophysiologicalstate, many psychologists utilize heartrhythm monitoring effectively as a “cameraon the emotions.” Continuous monitoringof clients’ HRV throughout a therapy ses-sion is easily accomplished and can giveboth therapist and clients immediate insightinto clients’ emotional responses, oftenenabling a more efficient and effective ses-sion. This technology often proves helpfulin identifying subconscious feelings, reac-tions, and emotional triggers that operate ata level below an individual’s consciousawareness but are nevertheless reflected inphysiological patterns and processes. Thesensitivity of heart rhythm monitoring topsychological variables is clearly illustratedby the account of one psychologist whouses this technology with clients with mul-tiple personality disorder. This clinicianfinds that he is able to reliably distinguishbetween the different personalities hisclients manifest on the basis of distinctchanges in their heart rhythm patterns.

The Promise of HeartRhythm Feedback

In summary, heart rhythm feedback is aversatile technology that has broad-basedapplications in clinical, workplace, and aca-demic settings for the enhancement ofhealth and human performance. In thefuture, we foresee that heart rhythm feed-back training will be increasingly incorpo-rated in programs for the prevention and

treatment of cardiovascular diseases andarousal-induced pathologies. We also expectthat its use will increase in education, asmore schools incorporate programs thatseek to educate students in emotionalawareness and emotion regulation skills.Furthermore, we anticipate that futuredevelopments in research, heart rhythmmonitoring technologies, and pattern analy-sis methods will enable an even morerefined electrophysiological discriminationof emotion than is currently possible. Thismay help therapists guide clients in devel-oping greater awareness and understandingof their emotional responses, both con-scious and subconscious, and ultimately toachieve greater control over their emotionalwell-being and health.

ReferencesChildre, D., & Martin, H. (1999). The

HeartMath Solution. San Francisco:HarperSanFrancisco.

Lehrer, P., Smetankin, A., & Potapova, T.(2000). Respiratory sinus arrhythmia biofeedbacktherapy for asthma: A report of 20 unmedicatedpediatric cases using the Smetankin method.Applied Psychophysiology and Biofeedback, 25(3),193-200.

Luskin, F., Reitz, M., Newell, K., Quinn, T. G.,& Haskell, W. (in press). A controlled pilot studyof stress management training of elderly patientswith congestive heart failure. Preventive Cardiology.

McCraty, R. (2001). HeartMath learningenhancement programs improve academic perform-ance and behavior in school children. In:Proceedings of the Futurehealth Winter BrainMeeting, Miami, FL.

McCraty, R., & Atkinson, M. (in press).Psychophysiological coherence. In: A. Watkins &D. Childre (Eds.), HeartMath: The Science ofEmotional Sovereignty. Amsterdam: HarwoodAcademic Publishers.

McCraty, R., Atkinson, M., & Lipsenthal, L. (inpreparation). Emotional restructuring programenhances psychological health and quality of life inpatients with diabetes: A pilot study.

McCraty, R., Atkinson, M., Tiller, W. A., Rein,G., & Watkins, A. (1995). The effects of emotionson short term heart rate variability using powerspectrum analysis. American Journal of Cardiology,76(14) 1089-1093.

McCraty, R., Atkinson, M., Tomasino, D.,Goelitz, J., & Mayrovitz, H. (1999a). The impactof an emotional self-management skills course onpsychosocial functioning and autonomic recoveryto stress in middle school children. IntegrativePhysiological and Behavioral Science, 34(4), 246-268.

McCraty, R., Atkinson, M., Tomasino, D., &Watkins, A. (in preparation). HeartMath riskreduction program reduces blood pressure andimproves psychological well-being in individualswith hypertension.

McCraty, R., & Singer, D. (in press). Heart ratevariability: A measure of autonomic balance andphysiological coherence. In: A. Watkins & D.Childre (Eds.), HeartMath: The Science of EmotionalSovereignty. Amsterdam: Harwood AcademicPublishers.

McCraty, R., Tomasino, D., Atkinson, M., &Sundram, J. (1999b). Impact of the HeartMath self-management skills program on physiological and psy-chological stress in police officers. Boulder Creek, CA:Heartmath Research Center, Institute ofHeartMath, Publication No. 99-075.

Task Force of the European Society ofCardiology and the North American Society ofPacing and Electrophysiology. (1996). Heart ratevariability: Standards of measurement, physiologicalinterpretation, and clinical use. Circulation, 93(5),1043-1065.

Tiller, W., McCraty, R., & Atkinson, M. (1996).Cardiac coherence: A new, noninvasive measure ofautonomic nervous system order. AlternativeTherapies in Health and Medicine, 2(1), 52-65.

i Address all correspondence to Dr. RollinMcCraty, HeartMath Research Center, Institute ofHeartMath, 14700 West Park Ave., Boulder Creek,CA 95006. Phone: 831-338-8500, Fax: 831-338-1182, Email: [email protected]

Abstract: Telemedicine is a technologicalinnovation that allows for direct, real-timeinteraction between healthcare providers andtheir patients. Real-time physiological moni-toring over the Internet offers a unique solu-tion for overcoming the barriers of distanceand time, while improving continuity ofhealthcare.

In the rapidly changing world of health-care and information technology, telemedi-cine plays a vital role in building a bridgebetween healthcare providers and patients.It involves the use of telecommunicationtools such as phones, video cameras, digitalimagery, computers, and the Internet toallow for direct, real-time interactionbetween healthcare providers and theirpatients.

Telemedicine offers a high-tech solutionto the universal problem of access to health

care. Geographical isolation doesn’t have tobe an insurmountable obstacle to receivingthe basic needs of timely and quality med-ical care. The ultimate goal of telemedicineis to provide the best of available health careto anyone, anytime, anywhere. This tech-nology can create an effective “virtual” glob-al health village that makes optimal healthcare for all a real possibility.

The growth in telemedicine applicationshas given rise to the development of a hostof new technologies that can greatlyimprove healthcare. Technologies rangefrom continuous blood pressure devices,up-to-date Internet relay of cardiac datafrom a patient’s home to the physicians’offices, medical data that can be stored-and-forwarded when real-time information isnot required, and elaborate T-shirts wovenwith built-in sensors that continuously

monitor and record over 30 physiologicalsigns of health.

Telepresence surgery permits experts toeffectively guide the surgeons who are actu-ally performing the operation in a remotelocation. Telerobotics takes this a step fur-ther by allowing surgeons to remotely oper-ate on patients using strategically placedvideo cameras and telerobotic arms thatmimic every subtlety of movement made bythe surgeon at the geographic location,which is accurately reflected by the roboticarms at the patient’s end.

Current technology supports the real-time streaming and remote viewing of rawand interpreted vital sign data over theInternet. Physiological signals are typicallytransmitted over a 56K dial-up modemwith less than a second delay.


FEATURE ARTICLE

Biofeedback Over the Web Irene J. Sleight, MS, BCIATelevital, Inc., Milpitas, CAi

The computer shows the same patient’s current surface EMG and an insetbox shows the therapist.

A female patient with bilateral frontal/temporal surface EMG placementsinteracts through the Internet with a therapist 1,000 miles away.


Numerous standard biofeedback devices have already been modified to be web compati-ble and the technology currently supports a variety of physiological monitoring modalitiesincluding electromyography (EMG), heart rate (HR), heart rate variability (HRV), periph-eral skin temperature, sweat gland activity, and respiration patterns.ii Even specific pro-grams such as the Glazer-Perry protocol used for the assessment and treatment of urinaryincontinence are available through the web. The portable biofeedback unit plugs into theserial or USB port of the client’s computer. The software is completely browser-driven, sobiofeedback clinicians can literally view their client’s real-time physiological data from any-where in the world to create a virtual clinic.

At this time, clinicians and their clients sign on through the website using their personal-ly created, secure login ID and passwords. The browser-based software signals a clinicianwhen their clients are on-line and streaming live data. By clicking the “live” button, clini-cians immediately view their client’s physiology from a distance, along with the use of real-time communication tools such as videoconferencing, built-in instant messaging, or withplain old telephone service (POTS). Video conferencing fully taps the capabilities oftelemedicine by making the nonverbal components of communication available to thera-pists and clients.

While auditory and visual cues guide the patient through the entire procedure, clinicianshave complete remote control to advance through each segment of the protocol, and adjustthe gain for optimal display. After conducting a real-time remote session, healthcareproviders immediately view an auto-generated graphical and statistical summary report,which includes data fields for entering client information, clinical notes, and treatment rec-ommendations. This report can be printed locally and remotely to the client-end. All ses-sions are securely timed, dated and stored, and can be retrieved, exchanged and analyzedwith ease anytime, anywhere.

Telemedicine is a medium that will open new doors for healthcare providers. It offers aunique solution for overcoming the barriers of distance and time while improving continu-ity of healthcare.

i Direct all inquiries to Yair Lurie, MS, 1326 Piper Drive, Milpitas, CA 95035, Phone – 408-262-2665 or by Email: [email protected]

ii TeleVital is collaborating with several device manufacturers, and has recently web-enabled Thought Technology’s Myotrac3 and Procomp+, and J&J Engineering’s C-2 I330biofeedback devices to give their customers more versatile treatment options

tune and condition the brain to be focusedyet relaxed, and to sustain lasting beneficialstates well outside of the neurofeedback lab-oratory.

Multichannel RecordingUse of multichannel, particularly bilater-

al, EEG recording can facilitate the simulta-neous training of multiple brain locations,and the training of interhemispheric coher-ence and synchrony. Functions once limitedto the university laboratory are now achiev-able in simple clinical and home trainers,providing new levels of brain conditioningto the everyday user.

Integration of Systems withNetworks and the Internet

Integration of systems with networks andthe Internet provides direct and indirectassessment, supervision, and review of train-ing results. It is now possible for a clinicianor educator to monitor many trainees atonce from a single location, and to assessand monitor trainees in remote locations,using local area networks as well as theInternet. These systems provide the abilityto set up and control EEG systems fromdistant offices, and to monitor both liveand retrospective results, thus providing avirtual training capability between any loca-tions that are connected to the global infor-mation network.

BrainMaster Technologies is developingand deploying LAN and internet-basedsolutions that provide “virtual office” capa-bilities to clinicians regardless of their loca-tions. By integrating commercial serviceswith custom software developments, it isnow possible to achieve efficient, easy-to-use systems that bring clinicians and theirclients together to overcome the boundariesof time and distance.

The FutureOverall, we are seeing a transformation,

much like the personal computer revolutionof the 1980’s that saw technology broughtinto a new level of social and economicacceptance, with the development of newmethods, producing broad-based change fora wide range of benefits.

Leading EEG Biofeedbackinto the New Millenniumcontinued from Page 22


FEATURE ARTICLE

The Future of BiofeedbackR. Adam CraneAmerican BioTec Corp., Ossining, New York

“Try to develop models which are not arbi-trary and man-made but organic and natu-ral. The difference is in the intention.Arbitrary man-made models have as theirintention manipulation and control.Natural, organic models have as their inten-tion resonance and reverence.”

– Margaret MeadAbstract: Biofeedback is a technology of

self-knowledge and as such will become ubiq-uitous both in healthcare and performanceenhancement applications. ‘ConsciousnessProcessing’ technology and services will becomeone of the most robust industries on earth withboth commercial and non-profit manifesta-tions. As quantum physics unfolds technologiesof self-knowledge will become even moreimportant.

IntroductionShall I seize this opportunity to promote

our business or say what I feel and risk driv-ing potential clients into the arms of thecompetition (most of whom are myfriends)? So, my friends, open your armsbecause here comes my spin on our future.

Near TermBiofeedback Equipment Survivors are

developing telemedicine, virtual reality(VR), increasing capabilities, decreasing sizeand cost, etc. Internet applications willgrow in terms of training and diagnostics.VR Feedback will deliver some of the mosteffective self-regulation learning systemsever developed. Flight simulators and VRtraining of special forces in dangerous com-bat skills illustrate this concept. Computersare necessary in order to maximize clinicaleffectiveness. However, the market willgrow for portable, battery-operated instru-ments reminiscent of Walkmans, andPalmpilots. However, I want to invest my2,000 words discussing the somewhat

unseen possibilities of the future.Although estimated biofeedback billings

range in the hundreds of millions of dollars,manufacturing is one of the smallest nicheindustries in Healthcare. The future ofbiofeedback depends on where the cultureis headed. I love George Carlin’s humor, butthe entire culture is not ‘circling the drain.’Segments of the status quo are ‘circling thedrain’ - probably a good thing. That makesme an optimistic apocolyptist.

I do not think the terms biofeedback orapplied psychophysiology adequatelydescribe this technology. There are ‘para-digm shifts’ under way in many sciencesand we are a scientific melting pot. I preferto think of biofeedback as a Technology ofSelf-knowledge. If that is true, then biofeed-back has a huge and complex future.

The unfolding of that future depends oninvestment. Investment depends on theimportance our culture places on self-regu-lation and the nurturing of consciousness.Improving consciousness is destined tobecome a huge ‘industry’ with powerfulorganizations taking both commercial andnonprofit forms. Elmer Green’s Mind BodyPrinciple implies that enhancing conscious-ness improves health and vice versa. Buthow long will it take biofeedback to attractadequate capital to make it a mature indus-try?

Long Term Changes‘The gift of prophesy is but the flowery trap-ping of the Tao and the beginning of folly.’

– Lao TzuChanges are happening on many fronts

including clinical equipment, personalequipment, sensors, and training.

Clinical software has come a long way, butmust evolve in order to catch up to thehardware’s capabilities. We provide excep-

tional flexibility by combining Windowsand DOS, but that will not do muchlonger. Manufacturers are fighting the‘Windows Wars’ as Microsoft keeps chang-ing the rules forcing purchase of its newproducts. We’re looking into Open Sourcebut costs are daunting. Programmers mustdevelop more intuitive software andimprove flexibility so that practitioners caneasily tailor reports to payors, referrals,client learning etc. Clinicians andresearchers must be freed creatively. Weknow how to improve software systemsconsiderably. However we, like others, stalkinvestment while stretching capital.Equipment developers will continue influ-encing research by providing better tools.

Four amplifier Neurofeedback/QEEGswill emerge just as four channel EP systemsbecame common in neurology. A significantadvance is the integration of normativedata-bases into the software so that clini-cians will have a better understanding ofwhen signals are abnormal.

Artfulness Will AttractFunding

Both clinical and emerging life/perform-ance enhancement technology are alreadyahead of the current state of the art. Earlymovie technology provides an example. Ittook years before artists, writers, directors,even actors emerged who knew how to usemovie technology in a way which deliveredcompelling stories. Several computerizedbiofeedback systems have unexploited capa-bilities. We await practitioner/artists tomore fully employ existing potential. Theengineers and developers in this field, danc-ing to the beat of daily operations and busi-ness, long to contribute more to thisartistry.

Like other immature industries, fundingawaits mass acceptance, mass acceptanceawaits improved artfulness, and improvedartfulness awaits funding. We grow slowlyuntil ‘killer applications’ hit. Then we moveto more creative and economically reward-ing levels. Our field screams for more cre-ativity. Learning strategies must be so goodthat they work well without biofeedback.Then biofeedback makes them work better.The wagon worked. Then we addedengines. Instruments are limited withoutmighty ‘mind stuff ’ behind them.Instruments by themselves are like spoonswithout food. Granted, gifted practitionerscan make even sub-clinical instrumentswork. Master carpenters can make some-thing beautiful with a piece of wood and apenknife. But they more often choose touse the $80,000+ worth of tools in theirpickups.

‘Your young shall see visions. Your old willdream dreams.”

– Old TestamentPlaying prophet, I believe our field will

give birth to astounding developments. Theline between clinical biofeedback equip-ment and a popular technology of self-knowl-edge blurs. Personal instruments willbecome as ubiquitous as bathroom scalesand mirrors. If science fiction writers arecorrect, then beautiful instrumentation willbe worn like clothing and jewelry. I co-founded QTran, which invented the MoodStone - a beautiful, functional temperaturetrainer. After selling millions of dollarsworth of them (they were expensive anddurable - $150 in 1975) we were wiped outwhen costume jewelry manufacturers flood-ed the market with useless junk.$500,000,000 + worth of them were soldbefore the ‘fad’ was killed off. We attemptedto raise money for heart rate watches in1978. Others succeeded in developing asubstantial business. But these kinds of per-sonal instruments are trivial compared towhat will emerge.

We will develop fashionable and effectiveinstrumentation. Algorithms already emerg-ing will increase awareness of healthy orunhealthy influences in terms of stress, psy-choneuroimmunology, brainwaves, heartfunction, blood pressure, pulmonary func-tion etc. We can be warned if something weare eating or breathing is toxic, blood alco-

hol levels are too high, or we are toodrowsy, etc..

All detectable radiation can be fed back.Signals of relatively infinite subtlety can befed back. If the aryuvedic ‘chakras’ reflectactuality (probably reasonable third dimen-sional models of fourth dimensional phe-nomena) then why can’t ‘subtle energy’information be fed back?

As room temperature superconductorsemerge, walls will be turned into sensorsmonitoring any living thing close by creat-ing hundreds of applications (dialing 911 ifyou become unconscious) and privacy wor-ries.

Over 50% of communication is nonver-bal. Personal instrumentation can augmentthe communication between us in a moresubtle way than even telephones, since tele-phones amplify words that are basicallythoughts (abstractions) and instrumentsamplify primal signals radiating from thepsychophysiology. Lying could becomemore difficult and less fashionable.

The MissionAwakening human beings to signals that

were there all along - implies a biofeedback‘endpoint’ mission – enhanced awakening,with an applicable understanding of howthe mind/body linkage works. Paradoxically,biofeedback leads to increased sensitivity(intelligence, from the Latin Intelligere - tosee between threads finely woven) and lessneed for the instruments themselves. Themission becomes how to improve moment-to-moment quality of consciousness.

“The intention with which you approachthe problem is more important than know-ing what to do about it.”

– KrishnamurtiIf it is true that there are no practical lim-

its on the improvement of consciousness,this technology will be a moving feast forhundreds of years. We are all interconnect-ed. When we can monitor subtle energiesinterplaying interpersonally - changingworld-views will change politics. Acts ofkindness and anger spread outward like cir-cles. Biofeedback amplifies those ‘circles’,increasing sensitivity to them - decreasingdependence on biofeedback itself. Ourfocus will intensify on rediscovering, under-standing and teaching ‘deep space’ (medita-tion?) consciousness clarification. Arguably,

biofeedback’s greatest mission is increasingunderstanding of meditation. Problemswith the word meditation continue even asthe ‘real thing’ catches a second wind as anefficient way to enhance sensitivity and‘EQ’ intelligence.

Research Must EvolveAn ancient hunter was probably amusing

himself twanging a bowstring. (S)he invent-ed the forerunner of the guitar (probablythree strings) and from that the pianoevolved. Biofeedback instruments are likequality musical instruments. Everythingdepends on the artistry of the player. Ourresearch lags our artists. Quantum physics,nonlinear dynamics, neuroscience, neu-rophilosophy are leading to research trans-formation. The maxim ‘If it can’t be countedit doesn’t count’ will change to ‘That whichcounts most cannot be counted’.

Relatively few are aware of the psycholog-ical seachange. Even fewer are aware ofbiofeedback’s power to serve ‘the new sci-ences.’ Neurofeedback is an oasis where thenew sciences converge and integrate. Theintermarriages are robust and fecund.Something old is dying. Something new isbeing born.

In the 20’s the scientific establishmentknew that the entire universe was the MilkyWay Galaxy. Then Hubble proved there areother galaxies-100 billion and counting.Now, that’s a paradigm shift!

Niche markets will breed diversity. Evengreater differences will emerge in the waysimilar tools are used. A saw cuts wood orbone. Carpenters should not amputate evenif they do charge less than surgeons.

Drug War Victory?Better research will reveal biofeedback’s

power to potentiate drugs. Under enlight-ened medical supervision practitioners willachieve results with drug/biofeedback com-binations that will astonish skeptics andmotivate politicians. Inspiring applicationsto neuroimmune disorders will unfold.Animal studies are inadequate to meet ourresearch challenges, increasing pressure toinvent better research strategies. Voters willhave to lead, but as Healthcare costs esca-late pharmaceutical companies must realizethat making less drugs work better is in




FEATURE ARTICLE

Translating the FutureDavid Joffe, Lexicor Health Systems, Boulder, Colorado

Abstract: There are many exciting EEGBiofeedback technologies and applications inour future. But the effective use of these inno-vations will require tools which are capable ofextracting new and revealing EEG relation-ships from the complex underlying multichan-nel EEG dynamics. The successful applicationof this emerging technological edifice willdepend on the construction of an equally inno-vative EEG database foundation which willinvolve genetic and other physiological data,multimodal analysis, and simple intuitivedynamic displays. This will allow practitionersto map database analyses into optimized feed-back protocols, exquisitely attuned to the indi-vidual needs of each patient.

For more than twelve years, Lexicor hasadhered to the principle that physiologicaldata is like a rich mineral vein that can bemined. However, without a sufficient infra-structure to collect and process largeamounts of physiological data, in this casemultichannel EEG, this ore deposit willremain largely untapped. Lexicor has devot-ed the past decade to building such a datacollection and analysis infrastructure and isexcited about moving to the next phase –the efficient acquisition of large amounts ofdata, the discovery of new relationships inthe data using powerful signal processingtechniques, and the provision of new clini-cal services based upon this analysis.

To carry the analogy further, even orethat seems to be low grade or played outcan be further refined using sophisticatedsignal processing techniques to increase thevalue and yield. There’s gold in them tharhills! So far, this refining process hasinvolved the use of normative and othertypes of EEG databases but Lexicor feelsthat this is only the tip of the iceberg. Weare at the beginning of a revolution in the

fields ofNeurotherapy andBrainmapping,which will ultimatelyprovide a rationalbasis for the mean-ingful fusion of thesetwo importantNeurophysiologicaldisciplines.

Extracting datausing various kindsof sophisticated sig-nal processing andmathematics is, how-ever, only the firststep. In order totransform this datainto a form appropri-ate for use by healthcare professionals, aqualitative transla-tion is required. This translation willinvolve the transformation of dry numericaldata into exciting dynamical displays andrepresentations that convey the underlyingpatterns in an immediately accessible andintuitive format. To this end, Lexicor isworking on providing a dynamic hyper-linked capability to our DataLex servicewhich will provide Neurotherapists andother health care professionals the ability tomassage or explore data in their patientreports using simple but powerful on-linecapabilities.

Tools of TranslationEvolving neurodiagnostic tools such as

PET, SPECT, and fMRI technologies havealso exerted an influence on the evolutionof EEG neurodiagnostics, in that it hasbecome obvious that EEG data needs to beacquired and processed in such a manner so

as to facilitate comparisons with the otherforms of neurodiagnostics using what areoften referred to as Multimodal Imagingand Registration techniques. In particular,new EEG topographic brain mapping tech-niques and data processing algorithms havebeen developed which generate accuraterepresentations of three dimensional EEGactivity within the brain which can be relat-ed to anatomical structures.

Lexicor first entered the brainmappingand Neurotherapy markets with the intro-duction of the NeuroSearch-24 brain map-ping system. Taking complex QEEGinformation and translating the data into alanguage for the health care professionalfocused on brain disorders, Lexicor createda system that delivered useful biologicaldata that was accurate, clinically relevant,and economically viable.

Providing a sophisticated device for col-

Directional Coherence Display Complex QEEG relationships can be displayed in simple ways. Arc colors indicate band. Arc widths are proportional to coherence. Balls move in

direction of information flow.


lecting, analyzing, displaying QEEG data,the NeuroSearch-24 empowered clinicianswith a tool that provided more accuratediagnostic features while facilitating a betterunderstanding of brain disorders. ButLexicor recognizes that this is only a foun-dation that must be continually built uponto realize the potential and promise of thistechnology.

The NeuroSearch-24 EEG brain mapperand NRS2D Neurotherapy units are there-fore only part of the Lexicor’s data transla-tion vision. Lexicor introduced DataLex(meaning: the language of data) to its port-folio of services to handle QEEG dataacquisition and transmission, while provid-ing data analysis using online QEEG data-bases. DataLex removes many of theonerous tasks associated with QEEG datatranslation while offering an economicmeans to access some of the industry’s cur-rent leading comparative databases. Lexicoris now devoting considerable resourcestowards the development of automatic arti-facting, neural net driven pattern recogni-tion and the collection of larger data sets,all in the service of creating more robustand accurate data bases and services.

Developing Diagnostics-GEEG

If biological data provides measurableclues to the rules and structures of individu-als’ health and well being, perceptive insightinto the interaction of data may yieldimprovements in understanding. Lexicorbelieves that to realize the true impact ofbiological data translation, it is imperativeto understand the relationship and correla-tion between a choice set of physiologicalfeatures.

Ultimately, the role of genetics willimpact the diagnosis of many diseases,including the diagnosis of brain disorders.Lexicor believes QEEG data may provide asuitable partner to genetics in the overallprocess of brain disorder understanding andmanagement and prediction of optimaltherapeutic interventions. Lexicor will bereferring to this new union of genetics andQEEG by the acronym GEEG.

As a leader in QEEG data collection andanalysis, Lexicor is pursuing the develop-ment of a series of GEEG databases thatwill provide insight into a range of brain

disorders. This project is expected to lastseveral years, create a number of ever-improving quality databases, and deliverexceptional tools which advance our under-standing of the relationship betweenQEEG, other physiological parameters, andgenetics.

The FutureSo what does the future hold? When we

gaze into our company’s crystal ball, we seeimages that are almost overwhelming intheir promise and diversity. Even moreamazing is that much of what is seen can,and will, be accomplished using technologythat already exists today. Here are just afew of the visions that Lexicor sees asimportant for future development and plansto play a significant role in bringing tofruition.

The fusion of Neurotherapy and Brainmapping will continue, until an automatedand seamless path exists for clinicians totranslate the information acquired duringthe brain-mapping phase to effective andoptimized Neurotherapy protocols.

New three-dimensional EEG databaseswill be developed using LORETA (LowResolution Electromagnetic TomographicAnalysis), which are cross validated withother neuroimaging techniques.

Real-time neurofeedback methods willalso evolve to incorporate LORETA andother three dimensional EEG imaging tech-niques. Patients will be able to focus on spe-cific anatomical structures and/or complexcommunication pathways to effect pro-found physiological changes.

Physiological databases will be createdfrom data acquired during the presentationof various complex forms of cognitive stim-uli, as well as subject responses, to augmentthe current eyes open and closed databasesin wide use today.

These multimodal physiological databaseswill also be integrated with genetic informa-tion where appropriate, to provide clini-cians with new perspectives on therelationship of genotype and phenotype andthe relative influences of components relat-ed to nature and nurture.

In summary, biofeedback instrumenta-tion of the future will facilitate the attain-ment of more general and adaptivephysiological objectives than is currently

possible using today's one-size-fits-all proto-cols. With advances in electrode hookuptechnologies, the benefits of multichannel(8,16,24,32, etc.) EEG feedback paradigmswill be more easily realized and the knowl-edge gained from recent findings in neu-roimaging and physiological models, moreeffectively applied. The distinction betweentopographic EEG brainmapping andbiofeedback technology will begin to blur.EEG brainmapping hardware will shrink insize, and prices will drop significantly. AndEEG feedback protocols based on globalEEG dynamics will more rapidly lead to theachievement of clinical goals than currentprotocols implemented using EEG biofeed-back instruments which derive informationfrom spatio-temporally under sampledbrains.

Perhaps the most exciting advances mayyet lie in the recognition and celebration ofthe individuality of each patient, and thedevelopment of biofeedback technologywhich can deliver “designer” biofeedback,exquisitely attuned to the uniqueness ofeach person's genetics and physiologicalexpression.


Name of software: Intended Use: What does this software do that the

software supplied withthe unit does not do?

Screens: Training Protocol: HRV/RSA Protocols: Printable: Devices Supported: Suppliers of software:

BiographX animations: screensand protocols

offers additionalscreens and protocols

not included in theoriginal system

default no no n/a Procomp, Biograph,Multitrace

Thought Technologyand various

distributors worldwide

Name of manufacturer:

Thought Technology Ltd.2180 Belgrave Ave.Montreal, Canada, H4A [email protected]

Captain's LogSoundSmartSmartDriver

cognitive training (is supplied by unit)trains basic cognitiveskills- attention, mem-ory, auditory process-

ing, phonemicawareness, tracking,

reasoning, visualscanning

yes results PC Windows 98 andhigher

companion for EEGbiofeedback training

Brain TrainBrain Train727 Twin Ridge LaneRichmond, VA 23235 [email protected]

UniComp WindowsUniComp DOS

data storagebiofeedback

reportsstatistics

defaultcreate your own

yes yes new version under

development

notesgraphics

all modules connectable

American Biotech CorporationUnicomp 1330

CAPSCAN WindowsDOS


reportsstatistics

Thatcher data basecompatible


yes yes when integrated with

UniComp 1330

notesgraphics

American Biotech CorporationCAPSCAN Prism 5

CAPSCAN WindowsVEEG3


reportsstatistics

Thatcher data basecompatible


yes yes when integrated with

UniComp 1330

notesgraphics

may be integratedwith UniComp 1330which includes allpopular protocols

American BiotechCorporation

American Biotech CorporationCAPSCAN C80

Survey of Instrumentation and Software for Biofeedback/Applied PsychophysiologySection 2: Software not supplied with original equipment

Power Source: Types ofBiofeedback pro-vided:

Visual display out-put:


Are there isolated inputs forexternalequipment?


Scanningoption:



Association for Applied Psychophysiology and BiofeedbackSurvey of Instrumentation and Software for Biofeedback/Applied PsychophysiologySection 1: Biofeedback Devices “C. Stand alone Single/Dual parameter non-computer based systems”


audiovisual

digitalanalog meter

pulsed tonepitch

EEGEMGTEMPGSR

no no yes withpropersensors

yes EMG skinprep padsEEG: skinprep pads

Bio-Feedback Systems, Inc.CAPSCAN/BFS Inc. Consortium2736 47th StreetBoulder, CO 80301303-444-1411

Neuropathways EEG Imaging427 North Canon Drive, Suite 209Beverly Hills, California [email protected]

Bio-Temp Products, Inc.K. C. Khemka, Ph. D.P. O. Box 90050Indianapolois, IN [email protected]


Number of channels of input: 1 Number which have high speed A/D:Maximum sample rate per channel:Digital resolution (12, 14, 16, bits):


audiovisualcomputer monitor

all digital real timeEEG feedback

pulsed tone EEGall digital real timeEEG feedback

yes no no EMG EEG:1020paste

Number of channels of input: bipolarhookupNumber which have high speed A/D:Maximum sample rate per channel:500,00 250,000 secondDigital resolution (12, 14, 16, bits): 32

n/a visual color changes n/a TEMP no n/a n/a n/a n/an/a

Number of channels of input: n/aNumber which have high speed A/D:n/aMaximum sample rate per channel: n/aDigital resolution (12, 14, 16, bits): n/a

Thought Technology (MyoTrac)2180 Belgrave Ave.Montreal, Canada, H4A [email protected]

battery audiovisual

bar graphLED display ofEMG RMS

pulsed tone EMG no no yes EMGnone forbiofeed-backEEG: n/a

Number of channels of input: 1Number which have high speed A/D:slow: 1Maximum sample rate per channel: 20Digital resolution (12, 14, 16, bits): 14


A living compendium of information on biofeedback devicescontinued from Page 13

















wires Loose sensors: noImpedance: noBattery: yesOther: dummysubjects forEMG/EDRtemp selfcheck feature

n/a 1 2 days during warrantee: yesafter warrantee:yes

n/a n/a n/a n/a n/a 10 years yes biofeedback BFS Inc., ETI

wires Loose sensors: yesImpedance:yesBattery:Other:

all in one unit 3 years 2 days during warrantee: 3years freeengineeringand trainingafter warrantee

disketteCD

Build all fromscratch

alone unit raw yes 5 years no Neuro-pathways EEG ImagingInc.

n/a Loose sensors: n/aImpedance:n/aBattery: n/aOther: n/a

n/a 1 year n/a during warrantee: yesafter warrantee: yes

n/a n/a n/a n/a n/a 25 years Bio-TempProducts, Inc.

wires Loose sensors: noImpedance: noBattery: noOther:

n/a 1 year 2 weeks during warrantee:9 – 5 ESTafter warrantee:9 – 5 EST

factory reconfiguration

n/a n/a n/a no 15 years yes class 2 ThoughtTechnologyand worldwidedistribution

their long term interests. Entrepreneurs willcombine electromedicine with pharmaceuti-cals, decreasing costs profitably.

THE BODIES ARE ALIVE WITHTHE SOUND OF MUSIC.’

Pop star musicians will hold concerts inwhich they produce music and visual dis-plays by manipulation of their physiology.We have experimented with simple conver-sion of physiological signals to musicallycorrected sound. Amazing how like jazz itsounds. We speculate that jazz derives muchof its power from intuitive sensing of psy-chophysiology and integrating same withemotions and thematic material (We soldan early neurofeedback device to StanGetz). This has been done in crude form

but lacked the technology and artistry to beglorious. When the technology is ready theartists will appear.

What if the quality of consciousness ofthe ‘observer’ significantly influences whichone of all those potentials within any givenmoment collapses, and which manifests?Schrodinger believed consciousness is a spe-cial case, a kind of singularity, regarding thewave/particle laws. Biofeedback, the tech-nology of self-knowledge, is dedicated toimprovement of consciousness quality.What if consciousness is assisting in ongo-ing manifestation of the Universe? Walkingthe talk is not always easy, but what alterna-tive exists?

Integration of DisciplinesThe ancient Greeks considered psycholo-

gy the greatest of all sciences because itdealt with the health of the mind. Healthyminds are required to keep other sciences

‘running true’.. As science becomes moreaware of the implications inherent in inte-gration of disciplines (wholeness) a newappreciation for what has been called spiri-tual, mystical, or metaphysical is emerging.

“The most beautiful and profound emotionwe can experience is the sensation of themystical. It is the power of all true science.”

– EinsteinBohm and other scientists consider the

mystical to be the fountainhead of creativi-ty. Hawkings said, “The truth about theboundaries of our universe is that there areno boundaries.” If that makes science morechallenging, wonderful, then, to paraphraseBetty Davis, “Science ain’t for sissies.”

“Given sufficient development of advancedtechnology it is indistinguishable frommagic.”

– Arthur C. Clarke

The Future of Biofeedbackcontinued from Page 23


Nanny Christie is a Licensed ProfessionalCounselor, certified by the BiofeedbackCertification Institute of America and holdsa Certificate of Professional Studies inClinical Psychophysiology. She has over 20years combined experience as a biofeedbackpractitioner and counselor in psychiatricfacilities, pain rehabilitation and privatepractice.

Amy Coleman is a senior at ChapmanUniversity's Washington state campus. Sheresides in Bremerton, Washington with herhusband and two children. This is her firstresearch project with Dr. Richard Sherman.She looks forward to doing more research inbiofeedback with him and their colleagues.She is currently doing research on shortterm memory processes and the validity ofpsychometric devices.

Thomas F. Collura, PhD., PE, is founderand President of BrainMaster Technologies,Inc, Oakwood Village, Ohio, where he con-ducts research and development of EEGneurofeedback systems for clinical and homeuse. He received an AB in Philosophy ofScience and an Sc.B. in Biology from BrownUniversity, Providence, RhodeIsland (1973), and an MS and PhD inBiomedical Engineering from Case WesternReserve University, Cleveland, Ohio (1978).He is a registered professional engineer inOhio and Illinois, and is a Board CertifiedNeurotherapist.

R. Adam Crane is a BCIA Senior Fellow,BCIA-EEG certified, President of AmericanBioTec, Director of BioMonitoringInternational, and Founder of HealthTraining Seminars which offers BCIACertification Training. He is co-author ofMindFitness Training: Neurofeedback andThe Process. Adam and the organizations hehas founded or co-founded have served thebiofeedback and applied psychophysiologycommunity since 1971. He has recentlyformed the non-profit InternationalMindFitness Foundation that is dedicated topsychophysiological research and educationwith a particular emphasis on life and per-formance enhancement.

Stuart Donaldson, a psychologist in pri-vate practice in Calgary, Alberta, received hisPhD in 1989 at the University of Calgary.He is the director of a multidisciplinary paintreatment and rehabilitation center(Myosymmetries, Calgary). A pioneer in thefield of sEMG and chronic pain, his morerecent work has involved the integration ofsEMG, QEEG, psychological status, andchronic pain. He has published extensivelyon biofeedback, chronic pain, andfibromyalgia.

David Joffe is a founder of LexicorMedical Technology as well as a number ofother biomedical companies. David hasalways had an abiding interest in conscious-ness and the means of connecting objectiveand subjective experience. To this end, hehas focused his attention on the develop-ment of various mathematical transforms todecompose complex multichannel brainwave states, for both offline analysis andreal-time feedback. He is currently involvedin the unification of genetic and QEEGinformation for diagnostic and treatmentpurposes.

Lawrence Klein is senior Vice Presidentfor Sales and Marketing and cofounder ofThought Technology Ltd. Klein is co-authorwith Major Nory Laderoute of Mind OverMuscle, a biofeedback-aided, applied sportspsychology training program. He has beenan active member of the Association forApplied Psychophysiology and Biofeedbackfor 27 years. Klein has a BA in Psychology,is married to Dr. Janet Shinder, and has twolovely daughters, Talia and Ariella.

Rollin McCraty, PhD, is Director ofResearch of the HeartMath Research Centerat the Institute of HeartMath in BoulderCreek, California. His research interestsinclude the physiology of emotion, with afocus on the mechanisms by which heart-based positive emotions influence cognitiveprocesses, behavior, and health. Findingsfrom this research have been applied to thedevelopment of tools and technology tooptimize individual and organizationalhealth, performance, spiritual well-being,and quality of life.

Olafur S. Palsson, PsyD, is a clinical psy-chologist. He is a research associate in theDepartment of Medicine at the Universityof North Carolina at Chapel Hill, as well asthe CEO of Mindspire, LLC, a mind-bodytechnology development company.

Alan T. Pope, PhD, is a clinical psycholo-gist and a researcher at NASA LangleyResearch Center.

Richard A. Sherman, PhD, received hisdoctorate in psychobiology from New YorkUniversity in 1973 and has accrued overthirty years of experience teaching and per-forming research and clinical work in behav-ioral medicine and related fields. Dr.Sherman’s areas of interest spanning overthirty years of research and clinical work inpsychophysiology include elucidating mech-anisms and treatments for phantom limbpain, determining the effectiveness of pulsedelectromagnetic fields for treatment ofmigraine headaches, and describing tempo-ral relationships between changes in muscletension and pain. He has held numerouspositions within AAPB including chair ofmany committees and two terms on theboard.

Irene J. Sleight, MS, BCIA, received hermaster’s degree from the California Schoolof Professional Psychology in ClinicalPsychophysiology and Biofeedback. She isnationally certified by the BiofeedbackCertification Institute of America (BCIA) asa biofeedback practitioner, and is a BoardMember of the Biofeedback Society ofCalifornia (BSC). She has interned at theUCI Medical Center on a PrenatalOutcome study researching the psychosocialand physiological effects of stress on anunborn child. As part of the pain manage-ment team at Charter API BehavioralHealth, she has educated pain patients inconjunction with biofeedback treatment,and has treated patients with stress-relateddisorders at the Cybernetix MedicalInstitute. She has most recently assistedTeleVital Inc. in the launch of VitalWeb, abrowser-based open architecture softwareengine that supports real-time streaming and

ABOUT THE AUTHORS

continued next page


remote viewing of raw and interpreted vitalsign data along with audio and visual com-munication.

Sebastian “Seb” Striefel, PhD, is aProfessor in the Department of Psychologyat Utah State University. There he teachesgraduate level courses in ethics and profes-sional conduct, clinical applications ofbiofeedback, clinical applications of relax-ation training and behavior therapy. He isalso the Director of the Division of Servicesat the Center for Persons with Disabilities atUtah State University. In that role he man-ages a variety of programs, including anoutpatient clinic, a biofeedback lab and anearly intervention program. He is a pastpresident of AAPB and regularly writes thiscolumn and conducts workshops on ethics,standards, and professional conduct.

I must start out by confessing to be anardent fan of David Simons and I. JonRussell. So my expectations of this bookwere high, expecting well organized, highlyresearched materials with supporting docu-mentation. I also expect to be reading thisbook for years to come. All of these expec-tations were met.

This is not a book that can be read inone sitting. There is so much informationon biochemistry, neurophysiology, muscleactivity, and muscle patterns that reading itrequires concentration, more than a basicknowledge of physiology, and several days.

The book is divided into nine chapters,the first eight by Mense and Simons, andthe last by I. John Russell. Each chapter isself-contained (that is, you can read it byitself without having to reference otherchapters). Chapter 1 starts generally explor-ing background and basic principles ofmuscle pain. Chapters 2 to 8 are devoted toa specific aspect of muscle pain. For exam-ple there is a chapter on neuropathic pain,one on central pain and centrally modifiedpain. Each chapter explores the currentresearch on the topic at hand with an ade-quate use of figures and diagrams. Theinformation is presented in a well-organized

and sequential manner. As an added touchat the end of most chapters there is a sec-tion on medications and their effects onmuscles and pain. I. Jon Russell writeschapter 9 conducting an extensive review ofthe research and epidemology regardingfibromyalgia. All theories are covered as wellas current research.

This book is a must read for any oneconducting forensic and disability evalua-tions, for anyone conducting sEMGbiofeedback or working with the pain pop-ulace. It clearly identifies the neurophysio-logical basis of muscle pain (as it isunderstood today). It will make an excellentcompanion in court or as a rational for theinsurance companies providing the physio-logical reason for what you did (and why ittook so long). It will be difficult reading forthe novice practitioner or for someonewithout a neurophysiology background.

Of course this text does not go intobiofeedback for these conditions so has lim-ited use for treatment.

I recommend purchasing this text andusing it as the neurophysiological basis forany sEMG work and as the justification fordoing relaxation training.

Book Review ofMuscle Pain:Understanding ItsNature, Diagnosis,and TreatmentBy S. Mense, & D. G. Simons (with I. J. Russell).(2001). Philadelphia, Baltimore, New York:Lippincott Williams & Wilkins. ISBN # 0-683-05928-9.Reviewed by Stuart Donaldson PhD

BOOK REVIEW

CLASSIFIEDADS

Equipment for SaleBio Integrator – biofeedback unit. Newcondition, never used. 2 EEG, 2 EMG; 1SCL, 1 HR/BVP, 2 Temp. Box of leads/gels– 1 monitor. $3500 or best offer. For moreinfo, call 781-344-8878.

Retired—Selling remainder of J&J equip-ment: M-57 dual channel EMG; T-68 dualchannel Thermal/EDG. Three PortableEMGs: one M-59a and two M-56A. Allwork. Original cost $3000, will sell all for$950. Duane Kolilis, PhD, 503-796-9396.Neurosearch 24—caps, electrodes, gels, etc.Please call Mary Loescher, 505-255-9200 or505-299-9477.

WANTED: Certified BiofeedbackTherapist for multi-disciplinary pain clinic.Experience in musculoskeletal education,sEMG and thermal biofeedback required.Neuromuscular re-education and rehabilita-tion knowledge preferred. Send cover letterand resume to 3120 Squalicum Pkwy,Bellingham, WA 98225.

About the Authorscontinued from Page 34

Association for Applied Psychophysiology and Biofeedback

10200 W 44th Ave Suite 304,

Wheat Ridge CO 80033-2840

CanadianPublicationAgreement#1583581

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Address Service Requested

Spring 2002 1ABiofeedback

aapb News& Events

The AAPB Year in ReviewDonald Moss, PhD

It has been myprivilege to serveAAPB as president forthe past twelvemonths. I am gratefulfor the experiences ofthe past year, most ofall the opportunitiesto meet and dialoguewith so many talented

and fascinating individuals who make theirlife’s work in biofeedback and applied psy-chophysiology. In the next year AAPB willbenefit from the capable guidance ofincoming president Paul Lehrer, PhD I willnow overview for AAPB members some ofthe most important activities within theorganization in the past year.

This has been a year of AAPB expandingeducational opportunities.. We believe thatthe foundation for growth in applied psy-chophysiology lies in high quality training,and more consistency in the skills andknowledge shared by practitioners nationwide. In the past year, AAPB has begunmarketing a basic home study program toprepare individuals for BCIA certification.Doil Montgomery and Andrew Crider arecurrently managing a group of authors whoare updating this home study program.AAPB also offered an expanded series ofworkshops, under Steve Baskin’s guidance,at the annual meeting in Raleigh and inlocations including Denver, WashingtonDC, and Chicago. Andrew Crider has alsodeveloped an AAPB model curriculum forgraduate programs in applied psychophysi-ology. Fred Shaffer will now serve as oureducation chair and will continue to expand

our workshop offerings and educationalprograms.

This has also been a year of expandedsupport for students. Board memberChristine Hovanitz has gathered informa-tion for educational and work opportunitiesfor our students. Christine and Paul Lehrerhave also led fund-raising efforts, stronglysupported by our Board, for more scholar-ships for the annual meeting.

AAPB has also aggressively worked thispast year at building a stronger worldwidecommunity of biofeedback and neurofeed-back professionals.. AAPB collaboratedextensively with SNR, the Society forNeuronal Regulation this year, in severaladvocacy projects. AAPB also extendedmember rates at our annual meeting toSNR members. AAPB was a co-sponsor forthe Amsterdam conference of theBiofeedback Foundation of Europe. OurSeptember 2002 workshops will be jointlysponsored with ISARP, the InternationalSociety for the Advancement of RespiratoryPsychophysiology. Finally our Board createda new correspondence membership, with afee of only $50.00, for individuals outsideNorth America, who wish to be memberswith no voting rights and online only accessto publications. Paul Lehrer has aided us ininteracting with our international col-leagues, and we hope to increase their par-ticipation in AAPB.

This has also been continued and aggres-sive advocacy by AAPB for biofeedback.An article critical of neurofeedback waspublished in the Behavior Therapist, thenewsmagazine of the Association for theAdvancement of Behavior Therapy. AAPB

and SNR collaborated on a response, and agroup headed by Theodore LaVaque and D.Corydon Hammond wrote a persuasiveresponse for publication in the BehaviorTherapist.. A researcher named WilliamMullaly widely distributed claims, throughthe Reuters Health press service, based on asingle unpublished study, that biofeedbackis too expensive and ineffective forheadache. A team including FrankAndrasik, Angele McGrady, John Perry,Steve Baskin, and myself drafted a responsepublished in the Winter 2001 BiofeedbackNewsmagazine. Fortunately Reuters alsodistributed a new release, summarizing theevidence supporting biofeedback forheadache. Rob Kall, Seb Striefel, and JoelLubar are organizing an outreach toCHADD, to promote neurofeedback as atreatment option. Finally, John Perry hascontinued to work aggressively and tirelesslyon a variety of advocacy efforts, including anew series of issues that arose with HCFAand incontinence care this year.

This has also been a year of expandedteamwork and collaboration for AAPB..Our President Elect Paul Lehrer workedextensively with our membership chair ElizaBigham, to reach out creatively to new pop-ulations of potential members, includingstudents. AAPB worked with the IllinoisChapter in putting on workshops and anevening scientific program in Chicago inNovember 2001. As mentioned above, weare working with SNR on a series of collab-orative projects. The most important collab-oration this year was a joint AAPB/SNRTask Force on Methodology and

continued on Page 2A

It has barely been a month since our meeting in Las Vegas. Andyet time has flown. We are already well into the planning for the2003 meeting in Jacksonville , FL, March 27-30. Chair, RichSherman, has a stellar list of speakers lined up. Make your plansnow to be there. The Call for Papers will be posted on the AAPBweb site within the next few weeks. Watch for it.

On one of our evenings at the meeting we would like to have an“AAPB Cabaret” –an event totally dependent on talented AAPBmembers. So if you sing, dance, play an instrument or have anothertalent to share, please let us hear from you.

Along with the elation we celebrated upon the conclusion of asuccessful meeting, we also experienced sadness when we learned ofthe deaths of two of our revered members. Both Neal Miller andEugenia Carmagnani passed away in March. Neal Miller was anelegant researcher who paved the way for so much of the funda-mental work in Biofeedback. And left us a legacy—Be bold in whatyou try and cautious in what you claim. He was a wonderful andcharming human being—it was he on the dance floor at the AAPB

meetings when many of the younger members were resting on thesidelines.

I met the Carmagnani’s almost 25 years ago when they came tothe US on a trip and phoned the BSA (Biofeedback Society, ourformer name). We were still housed at the University of ColoradoMedical School and I happened to be in the office on a Saturdaymorning. A gentle lady—she and I remained friends over the years.She was a great force in helping to develop the AAPB Internationalsection.

This month we launch the availability of the on-line version ofour journal Applied Psychophysiology and Biofeedback. You can gainaccess via the AAPB web site. (Just click on the link atwww.aapb.org). Remember as an AAPB member you also have on-line access to the Journal of Behavioral Medicine. Also check outpresentations at the AAPB annual meeting by clicking on theDigiscript Virtual Library icon. Be sure to use all of these AAPBbenefits.

Spring 20022A Biofeedback

FROM THE EXECUTIVE DIRECTOR’S DESK

Francine Butler, PhD

Empirically Supported Treatments. TedLaVaque and D. Corydon Hammond head-ed this task force, and produced a finalreport approved by both organizations’Boards. The Report establishes a continuumof efficacy ratings, each with very clear cri-teria. The Report will be published in ourjournal and SNR’s journal.

This has also been a year for new publi-cation projects. We have added a monthlyelectronic update to our members, keepingthem posted on AAPB activities and rele-vant breaking news. AAPB has adopted anew logo and developed a new membershipbrochure. In addition AAPB has contractedfor several new publications: CarolynYucha and Christopher Gilbert will producea new Clinical Efficacy booklet. SebastianStriefel will author both a new book onStandards and Guidelines for ClinicalPractice, and a new Ethics book. Ted

LaVaque and I have also agreed to oversee anew set of White Papers on Biofeedback andNeurofeedback Applications.. D. CordydonHammond will assist on the neurofeedbackapplications. The White Papers will utilizethe new efficacy ratings developed by ourTask Force on Methodology.

While we continue our efforts to expandthe world of biofeedback, and increase ourimpact on health care, AAPB itself has suf-fered the same problems as many otherassociations in our country who are seeing adecreasing membership and lower income.AAPB experienced a financial loss in 2001,which the Board is dealing with. We havecut expenses in many areas, and are focus-ing efforts on increasing income. We askyour help in the way that can be most bene-ficial – urge a colleague to join AAPB. Ourstrength is in our numbers, and a biggerstronger organization can more effectivelyadvance our mission.

There was much more activity that I can-not cover here. However, I want to thank

our officers, our Board members, our com-mittee members, and other volunteers, aswell as the AAPB staff who have worked sohard this year on all of the routine tasksthat need to be done year after year, as wellas on so many special projects. Thank you!

AAPB Year in Reviewcontinued from Page 1A

We Encourage SubmissionsSend chapter meeting announcements,section and division meeting reports, andany non-commercial information regard-ing meetings, presentations or publica-tions which may be of interest to AAPBmembers. Articles should generally notexceed 750 words. Remember to sendinformation on dated events well inadvance (we may be able to publicizeyour event more than once if you getyour calendar to us early enough).Send Word (.doc) or text files by e-mailto the News and Events Editor: TedLaVaque, PhD [email protected] March 15 for the Summer Issue.


The good feelings of our last AAPB meet-ing are starting to fade into fond memories,and we are beginning to plan our next activ-ities. Among the many things we are hopingto emphasize in AAPB are:

More involvement of students and new pro-fessionals, and activities that may be of partic-ular help to them. To this end, we havestarted a “bank” of job and educationalopportunities, which hopefully will grow toa full-fledged “job market”. Anyone with ajob to offer, an educational program inapplied psychophysiology, or a seeker ofsuch opportunities —- think of coming toour next meeting, and making yourselfknown to us!

More involvement of regional, specializa-tion, and international groups. We would likeregional, special interest and internationalgroups (and their members) to have agreater presence within AAPB. To advanceour science, practice, and training, as well asthe general legitimacy of our field, we needto have greater “presence” —- this meansmore unity in the field, and more involve-ment of all for the common good. In recentyears there has been a tendency to a bit ofentropy in our field. This is a time to worktogether. I personally would like to reachout to specialty groups and regional groupswhose interests overlap with those of AAPB,to explore ways that we can join hands andwork more effectively together. I will writein more detail about these possibilities infuture columns.

Support innovation. The theme of ournext meeting will be “Beyond theBoundaries of Biofeedback”. Although mostAAPB members are involved specifically inbiofeedback, there is tremendous nationalinterest in other methods of self-regulation.Indeed our society was one of the first todisseminate good scientific research on vari-ous Eastern and Western meditative prac-tices. I have encouraged a group of AAPBmembers to organize a special interest groupin this area. If you are interested in joining

this bandwagon, let me know! This activitywill in no way detract from AAPB’s interestin supporting and encouraging the practicespecifically of biofeedback. However manyof these other techniques differ frombiofeedback more in details of procedurethan in over-all goals and methods. We canand should learn from each other and sup-port each other’s work.

As many of you know, my personalinvolvement in biofeedback is as a researcheras well as a clinician. The remainder of thiscolumn will be devoted to some researchissues that should, directly or indirectly,affect most of us.

A common topic of discussion amongAAPB members has been the need to bringresearch findings to various third party pay-ers and government regulators, to help legit-imize our field. This, of course, brings usface to face with the sad problem that pub-lished research in our field lags quite farbehind clinical innovation. Part of whatAAPB’s mission therefore should be to facili-tate both production and dissemination ofgood research in applied psychophysiology.Some current events may present both somehindrances and opportunities regarding thisendeavor.

I have just returned from a meeting of theFederation of Behavioral, Psychological, andCognitive Sciences (of which AAPB is amember organization), devoted to regulationof human research. One theme of the meet-ing was a bill that soon will be introduced toCongress that would place new regulationson all human research. If enacted, the billcould increase your difficulty of collectingdata from your own and your colleagues’clinical practices, unless your protocol isapproved by a duly constituted InstitutionalReview Board (e.g., at a hospital or universi-ty), and unless each participant specificallycan sign a written informed consent form.This may particularly be a problem formany AAPB clinical researchers who collecttheir observations and data from their own

records, frompatients who arenot specificallyenrolled in a research project. We all knowthat our field sorely needs more goodresearch, and that much if it will come fromongoing clinical work, because funds forlarge-scale controlled studies are often hardto come by, particularly without the kind ofindustry support that characterizes pharma-ceutical research, and generally allows gener-ous payments to study participants andclinicians alike. This is exactly the type ofresearch that may be stifled by unwise addi-tional research regulation.

Hopefully, some of my concern may even-tually be found unwarranted. Everyoneagrees that protection of the safety, dignity,and rights of participants should be theparamount consideration for all researchers(as well as everyone else involved in theresearch enterprise); and the exact provisionsof the bill are not yet public. However I sug-gest that all interested AAPB members keeptheir eye on the Congressional Register.

Consider this: Sometimes the process ofobtaining informed consent can itself beproblematic, and may be harmful. In myown work, I remember the plight of a veryinterested but minimally literate patient atan inner-city asthma clinic. She could havebenefited from the free biofeedback treat-ment and medical care we were offering, butwas daunted by the 7-page informed con-sent form required by our local InstitutionalReview Board (supposedly written on aneighth grade level, but, after doctoring byvarious legal minds, made somewhat morecomplicated). For several weeks in a row shereturned to the clinic and again asked totake home a copy of the informed consentform, so her daughter could read it andexplain it to her. I explained the procedureword for word each time, but the fear andmagic associated with a written contractwere too overwhelming. Eventually herdaughter also gave up on the task. She

FROM THE PRESIDENT

Paul Lehrer, PhD

humiliatingly disappeared. I suspect thatother people may similarly have been turnedoff by a two-page informed consent formrequired for us to administer a 10-item true-false screening questionnaire!

What about cross-cultural issues ininformed consent? What happens when wedo research abroad, where people do notthink of written contracts the same way thatwe do? As I understand it, business deals inChina are made more on the basis of mutualtrust and personal experience and obliga-tion, than on the basis of a written contract.I wonder what Chinese research participantsmight think of a 10-page contract thrustupon them by a foreign stranger, written tofulfill legal requirements of American con-tract law, to permit attachment of EEG andEKG electrodes? How much of an insultmight we be delivering? (Well, perhaps wecan pass it off humorously as one of themany incomprehensible ways that weWesterners relate to each other.) Accordingto current US regulations governing humanresearch, foreign institutions involved in col-laborative research must constituteInstitutional Review Boards fashioned

according to American standards, andrequire written informed consent for all pro-cedures. I would love to be a fly on the wallduring deliberations of one of these groups!

The particular issue that should concernus is the possibility that we may put aresearch participant at risk. This may occurin our research where participation wouldinvolve deprivation from effective medicaltreatment. However, most of us do researchwhere such treatment is routinely providedto participants, or where it may not be avail-able. In such cases the risks of biofeedbackusually are quite minimal, certainly whencompared with the risks of taking an untest-ed drug or undergoing a surgical procedure.Most Institutional Review Boards, on theother hand, are constituted in order to pro-tect people from more traditional biomed-ical research, where the risks may be quitereal. Protecting people from our minimal-risk procedures requires a different perspec-tive from protecting them from proceduresthat involve real risk!

I suggest that we seriously consider severalsuggestions coming from the Federationmeeting.

Let’s keep an eye on regulation of appliedpsychophysiology research in our own backyards. Is an applied psychophysiologist, oreven a behavioral scientist, on theInstitutional Review Board, who under-stands the procedures and risks (or lackthereof ) of participating in our kind ofresearch?

If anyone sees proposed state or federalregulations about human research that mayaffect us, let the AAPB office know about it.This concerns us vitally!

Let’s keep a collection of our own person-al “horror stories” of over-regulation ofresearch in our field, as well as special storiesillustrating how current regulations haveprotected research participants, or wherenew regulations may indeed be needed forthis purpose. Send them to me, for now. Iwill keep a compendium.

Foreign members: let us know about yourown experiences with human research, andhow research participants are best protectedin your countries. Do American-type regula-tions work for you, or are special other pro-cedures used, or appear more desirable?


Neal Miller, a former president of AAPB,and a pioneer in the field of biofeedback,passed away March 23 at the age of 92. Hispioneering research, extraordinary educa-tional activities, and unflagging advocacywere of great benefit to society, and aninspiration to his colleagues and successors.

“Neal was an extraordinary scientistwhose work has forever changed the wayman considers the capability and potentialof man. We in the field of biofeedback owehim a great debt of gratitude,” says AAPBmember Rob Kall. Rob remembers afavorite quote from Miller this way, “Bemodest in what you claim, bold in whatyou do.”

It may seem like common sense now thatfear is a learned response, or that people canbe taught to control autonomic functionssuch as blood pressure and heart rate, but itwas radical and shocking when Dr. Millerbegan advancing these concepts in the late

1950’s. His peers were aghast and he evenhad trouble getting laboratory assistants towork on his experiments. However, manyof those same peers now consider him atleast the equal of his more famous contem-porary, B.F. Skinner.

Unlike Skinner, who dealt with the psy-chological and social aspects of behavior,Miller and his colleagues experimented withthe physiological aspects, training rats tocontrol their heart rate and brain waves.Without today’s sophisticated measuringequipment, they were breaking new groundon a variety of frontiers, and radicallyadvancing our understanding of humanbehavior.

Neal Miller was far more than aresearcher, however. After attending theUniversities of Washington, Stanford andYale, he went to Vienna to study psycho-analysis with an emphasis on Freud. Hetaught for years at Yale and Rockefeller

University, and wasa past-president ofthe AmericanPsychologicalAssociation.

He was also veryinterested in the practical aspects of hiswork and spreading the benefits to the max-imum number of people. During his termas President of AAPB (then the BiofeedbackSociety of America), Dr. Miller promotedthe idea of standardized clinical data collec-tion, which could be pooled into a betterunderstanding of efficacy, and used as lever-age in reimbursement decisions.

Neal E. Miller, PhD, is survived by hiswife, Jean Shepler of Hamden, Conn.; ason, Dr. York Miller of Denver; Colo., anda daughter, Sara Miller Mauch of Ypsilanti,Mich.

In Memory: Pioneer Researcher,Educator, Neal Miller


The White House Commission on Complementary andAlternative Medicine Policy has issued final recommendationsregarding Complementary and Alternative Medicine (CAM) in theUnited States. Created by President Clinton in March, 2000, thecommission was charged with making recommendations in fourareas: (a) the education and training of health care practitioners incomplementary and alternative medicine; (b) coordinated researchto increase knowledge about complementary and alternative medi-cine practices and products; (c) the provision to health care profes-sionals of reliable and useful information about complementary andalternative medicine that can be made readily accessible and under-standable to the general public; and (d) guidance for appropriateaccess to and delivery of complementary and alternative medicine.

In its final report, the Commission made 29 specific recommen-dations regarding CAM policy in the United States, includingresearch, legislation, regulation, promotion, and reimbursement.

While the Commission was very careful to advocate research andthe use of proven therapies, two of the members, in an unusualmove, issued a dissenting statement, saying that the Commission’srecommendations “do not appropriately acknowledge the limitationsof unproven and unvalidated ‘CAM’ interventions or adequatelyaddress the minimization of risk.”

The dissenting members, Tieraona Low Dog, MD, and Joseph J.

Fins, MD, FACP, labeled some of the recommendations as “boost-erism” and said the panel tended to lump together proven andunproven therapies, which might strain funding sources and waterdown the effects of conventional medical care without improvinghealth.

James S. Gordon, MD, chair of the Commission, on the otherhand, cited teaching breathing techniques and biofeedback to chil-dren with problems concentrating as a good example of how CAMcould more cost-effectively help Americans become more healthy.

According to Dr. Gordon, the panel’s recommendations create “aroad map for discovering ways that CAM approaches might enhanceour health care in the years ahead, a guide to help the President,Congress and the American people take necessary steps to create amore effective, comprehensive, responsive and humane health caresystem.”

Several of the recommendations could impact professional associa-tions, such as AAPB, certification programs such as BCIA, andwhether individual practitioners are licensed or regulated by state orfederal government bodies. See more information at:

http://www.whccamp.hhs.gov/finalreport.htmlandhttp://www.cmbm.org/press/releases/WHC%20Report.htm

White House Panel Issues Recommendationson Complementary and Alternative MedicineMichael P. ThompsonAAPB Director of Communications

Maria Eugenia Carmagnani Fattovich, PhD(April 19, 1942-March 23, 2002)

The 2002 AAPB meeting was marked by the conspicuous absence of Eugenia and Angelo Carmagnani. With great sorrow,we learned that the absence was due to the premature loss of Eugenia’s life.

Maria Eugenia, linguist, clinical psychologist, and psycho-physiologist, died recently in Milan, Italy, as a result of a lungtumor. She and her husband, neurologist Angelo Carmagnani, had their own clinical institute in Milan. The Carmagnaniwere among the European private practitioners who pioneered the use of neuro-feedback and QEEG in their clinical work.They were members and regular attendees of the Annual AAPB meetings for several years.

With a sharp mind and enthusiastic outlook, Eugenia became a driving force behind the International Section of AAPB.Last year, she stepped down as its first president, having accomplished much to consolidate this important part of the organ-ization. Those who had the opportunity to get to know Eugenia and Angelo, enjoyed the kindness and vitality that theyradiated as a couple and the wealth of clinical knowledge they were ready to share as clinicians. Our deepest sympathy goesto Angelo at this time of grief. We will miss Maria Eugenia, and remember fondly the landmarks of her presence at AAPBand contribution to the creation of the International Section.

Susana A. Galle, PhD, ND, CCN. Gabriel E. Sella, MD, MPH, MSc, PhD,Vice-President, International Section, AAPB

Several awards were presented at the recent Annual Meeting by 2001-2002 President DonMoss. Following are the comments made by Dr. Moss as he honored the recipients.

“This year we honor Dr. Theodore LaVaque as the recipient of the Sheila Adler Service Awardfor AAPB. I want to recognize Dr. LaVaque for his major contributions to AAPB as AssociateEditor of Biofeedback, where his day-in, day-out efforts have made a difference, and as Co-Chairof the Task Force on Methodology and Empirically Supported Treatments, which is a joint effortof AAPB and SNR to develop a working consensus in an important and rapidly developing area.It is my pleasure to recognize his contributions to biofeedback by presenting the Sheila AdlerService to Dr. Theodore LaVaque

“Our second recognition goes to Frank Andrasik as the recipient of the AAPB DistinguishedScientist Award for his outstanding research on biofeedback in treatment of headache, and

biofeedback parametrics, and for his service as Editorof Applied Psychophysiology and Biofeedback during adifficult period. His exceptional commitment of timeand effort on behalf of the journal constitutes a majorcontribution to biofeedback research. AAPB is proudto confer the Distinguished Scientist Award to Dr.Frank Andrasik.

“I turn to my close friend and colleague, Eric Will-marth who chaired this year’s Annual Meeting Com-mittee. You did a wonderful job. This plaque can onlysymbolize my enduring thanks.

“The Presidential Recognition Award is presented toan individual who provides outstanding service toAAPB and to applied psychophysiology as recognizedby the President. This year, the award goes to my newfriend Jay Gunkelman, Past President of SNR, for hiscontributions to the development of closer collabora-tion between AAPB and SNR, and for his actions insupporting the joint AAPB/SNR Task Force on Empir-ically Supported Treatments, and for his role in sup-porting the joint AAPB/SNR response to the BehaviorTherapist article critical of neurofeedback. To use Jay’sown word, he has worked tirelessly this year to bringabout an atmosphere of “coopetition” between SNRand AAPB, and I believe the field of biofeedback andneurofeedback owes him a debt of gratitude. Anotherexample of Jay’s selfless generosity is his gift at thismeeting of $1,000 to the neurofeedback division. Letme acknowledge the acceptance of this applicationform and check—Jay is now our newest member ofAAPB.

“The Ken Russ Advocacy Award is presented to anindividual or group who represented AAPB or biofeed-back in an advocacy position. For their tireless effortsto secure inclusion of neurofeedback and biofeedbackin the Texas Brain Injury Bill, please welcome, Lynda


AAPB Award Winners

Eric Willmarth, alias Elvis, our 2002Annual Meeting Program Chair.

President Dan Moss thanks past PresidentDoil Montgomery for his service to AAPB.

President Moss thanks Lynda Kirk for herservice on the Board.

Robert Whitehouse is honored for his service on the Board.

Ted LaVaque

Outgoing president Dan Moss is much morerelaxed by the end of the meeting.

Since he spent so much time behind the camera, we don't have a photo of Ted LaVaque, but we still

offer him congratulations on receiving the prestigiousSheila S. Adler Service Award.

Frank Andrasik, PhD, editor of AppliedPsychophysiology and Biofeedback received

the Distinguished Scientist Award.

Kirk and SarahHarper.

“The JackJohnson Ser-vice Award ispresented to anindividual orindividualswho provideservices tostates or chap-ters. AAPB isproud to rec-ognize ValerieBraschel andKenneth Loft-land for theirrole in organiz-ing the jointAAPB/IllinoisChapter pro-gram.

“The NewVolunteerRecognitionAward goes toan individualfor dedicationand service toan AAPB com-mittee. AAPB recognized Elizabeth Bighamfor her creative and energetic actions asChair of the AAPB Membership Commit-tee.

“The Group Recognition Award is pre-sented to groups working together on aproject beneficial to the field. The recipientsof this award are Theodore LaVaque, CoryHammond, Jay Gunkelman and John Perryfor their role in initiating and leading the

Task Force on Methodology and Empirical-ly Supported Treatments.

“I want to turn now, not to the past ofAAPB but the future. Each year, AAPBhosts a number of students who attend thismeeting and are supported by the AAPBFoundation student scholarship awards.This year’s awards went to the followingstudents: Logan Justin Banks, ElizabethBigham, Joseph Ciavarella, Jessica Del Pozo,Elizabeth Durso, Brian Reidenberg, Linda

Kranitz, Adam Lipps, Brent Mruz, BlakeSchneider, Stephanie Steinman, CurtisStrokes, Kerry Towler, and Alicia Townsend.

“One of the sad events at the end of theyear is to see the term of good people onthe Board come to an end. This year BobWhitehouse concludes his service at thismeeting. Also, Doil Montgomery completeshis term as Past President. Thank you foryour service.”

Spring 2002 Biofeedback 7A

President Lehrer presents President Mosswith a clock, as a thank-you, and a remem-

brance of his term.

Jay Gunkleman, representing the Society forNeuronal Regulation and AAPB PresidentDan Moss have worked hard this year on

inter-society cooperation.

Interdisciplinary participation was the themeof this year’s meeting, with many attendees

from outside North America.

The Russian Delegation presents AAPB witha commemorative Swan.

AAPB Executive Director Francine Butlerenjoys a rare quiet moment with President

Dan Moss.

Outgoing President Don Moss (l) passes thegavel to incoming President Paul Lehrer (r),while President-Elect Lynda Kirk looks on.

If you found the content of the last Circle of the Soul AAPBconvention important and personally motivating then you maywant to participate in a proposed new Mind-Body-SpiritPsychophysiology special interest group. At the conference severalparticipants had conversations with Paul Lehrer about creating away to continue including these types of speakers and programs inthe AAPB meetings. The idea of a special interest group (SIG) wasproposed with the possibility of becoming a section if memberinterest is sufficient. This SIG would focus on applied psychophysi-ology as the interface with the emergent areas of consciousnessstudies, complementary and alternative medicine (CAM) and fron-tier medicine. This would increase the depth of AAPB participa-

tion expanding our network of creative thinkers, teachers,researchers and explorers in topical areas including meditation, dis-tant healing, prayer, hypnosis and imagery, intuition and dreams,healing with music, qi gong and much more. If you are interestedin this vision the first thing to do is to just send an email to get ona contact list. If there is sufficient interest we will organize a break-fast meeting for the next AAPB meeting in Jacksonville, Florida inMarch 2003. Send an email to: Adam Burke, PhD at<mailto:[email protected]>[email protected] or call 415-338-1774.We look forward to working with AAPB to contribute to this criti-cally important and profoundly interesting area of investigation andhuman potential.

New Mind-Body-Spirit Interest Group

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