BIOFEEDBACK

MPT Level Answer (20 Marks)

1. DEFINITION

• It is defined as the recording and display of small changes in the physiologic levels of a feedback parameter using electronic or mechanical instruments to relay perceptual evidence, thereby helping a person gain control over a physiologic process or function.
• The term "biofeedback" itself combines "bio" (life/biological) and "feedback" (information returned to the system).
• It is also referred to as Neurofeedback when brain activity is the parameter monitored.

2. CONCEPT OF FEEDBACK

Types of Feedback

• Knowledge of Results (KR) - feedback given after the task about the outcome
• Knowledge of Performance (KP) - feedback given during and after performance about the pattern of movement

3. THEORETICAL BASIS

Operant Conditioning (Neal Miller's Contribution)

• The fundamental basis of biofeedback is the concept that the autonomic nervous system (ANS) can come under voluntary control through operant conditioning.
• Neal Miller demonstrated that normally involuntary ANS functions are susceptible to operant conditioning using appropriate feedback.
• Using instruments, patients acquire information about the status of involuntary biologic functions (skin temperature, muscle tension, blood pressure, heart rate, brain wave activity) and then learn to regulate one or more of these physiologic states.

Mechanism of Action

• Biofeedback re-establishes sensory-motor loops "forgotten" by the patient (especially in neurological conditions).
• Sound and visual cues stimulate the brain; watching the muscle contract simultaneously assists in reopening a neural loop.
• It operates on the principle of shaping - gradual reinforcement of progressively closer approximations to the desired response.

4. BIOFEEDBACK EQUIPMENT - 3 ESSENTIAL COMPONENTS

Physiological Signal → TRANSDUCER → Signal Processor → Display (Visual/Auditory)
                                                               ↓
                                                          Patient receives feedback

1. Transducer (Detector)

• Detects the physiological variable (e.g., EMG electrical activity, blood flow, HR, electrochemical activity).
• Can be a pair of electrodes or pressure sensors.
• It produces a corresponding signal which represents the physiological variable.

2. Signal Processor

• Amplifies the signal.
• Filters out background (electromagnetic) noise.
• Rectifies the signal (makes all values positive).
• Integrates the signal (groups data into meaningful clusters).
• Averages the signal and converts it to a waveform which can be displayed and explained to the patient.

3. Display Unit

• Converts processed signals into an audible or visual output.
• Visual: meters, bar graphs, oscilloscopes, video monitors, LCD screens.
• Auditory: pitch changes, buzzers, threshold alerts.

5. TYPES OF BIOFEEDBACK

A. Electromyographic (EMG) Biofeedback

• Most common form used in physical therapy and rehabilitation.
• Detects the electrical activity associated with muscle contraction.
• Converts it to visual and/or auditory feedback.
• Promotes strength of muscular contraction OR facilitates relaxation.
• Electrode placement: 3 surface electrodes per channel (2 active + 1 reference).
  • Active electrodes detect the electrical signal.
  • Reference electrode filters non-meaningful information.

B. Electroencephalographic (EEG) Biofeedback / Neurofeedback

• Measures alpha waves from the scalp (occur in relaxed states).
• Used in: ADHD, learning disabilities, anxiety, depression, migraine, traumatic brain injury, addiction.
• Also called Neurotherapy.

C. Skin Temperature (Thermal) Biofeedback

• A sensitive skin thermometer is applied to the skin of the finger.
• The response of the skin of the finger is under sympathetic neural control, largely dependent on the general environmental temperature and emotional state.
• Used for: Raynaud's phenomenon, chronic pain, oedema, anxiety, stress, essential hypertension.

D. Galvanic Skin Response (GSR) / Electrodermal Biofeedback

• Shows decreased skin conductivity during relaxed state.
• Used for: stress-related conditions, anxiety disorders.

E. Cardiovascular / Heart Rate Variability (HRV) Biofeedback

• Measures heart rate and heart rate variability.
• Used in: asthma, COPD, depression, heart disease, fibromyalgia.
• Electrocardiogram (ECG/EKG) used to detect cardiac arrhythmias and related conditions.

F. Respiratory (Capnometry/Pneumography) Biofeedback

• Provides feedback on respiration rate, expansion, contraction of the chest.
• Monitors functional breathing patterns including diaphragmatic breathing, reverse breathing, gasping, sighing.
• Used for: asthma, COPD, dysfunctional breathing patterns.

G. Rheoencephalography / Hemoencephalography

• Measures regional cerebral blood flow and directs the patient toward change.
• Used for: chronic pain, oedema, anxiety, stress.

H. Photopletysmograph

• Measures the amount of blood flow.

6. FEATURES OF EMG BIOFEEDBACK DEVICE

7. THE BIOFEEDBACK FEEDBACK LOOP

Subject → Physiological Change (conscious/unconscious)
                     ↓
            Equipment (Transducer + Signal Processing)
                     ↓
            Audible/Visual Display
                     ↓
            Patient Perceives Feedback
                     ↓
            Patient Attempts Volitional Control
                     ↓
            Physiological Change (modified) → loop continues

8. INDICATIONS

General Indications

• Improve muscle activation for orthopaedic problems and neurological dysfunction
• Stress-related conditions
• Limb loading and monitoring
• Force platform monitoring
• Position or kinematic feedback
• Skin temperature control (biofeedback is a tool, not a standalone treatment)

Specific Conditions

• Movement disorders: muscle activity, joint displacement
• Autonomic disorders: heart rate, blood pressure, skin temperature
• Balance disorders: whole body balance
• Pelvic floor disorders: urinary/fecal incontinence
• Pain conditions: chronic back pain, headache, migraine
• Psychological conditions: anxiety, stress, phobias
• Cardiovascular: supraventricular arrhythmias, ectopic beats
• Miscellaneous: fecal incontinence, posture control

9. EMG BIOFEEDBACK - THERAPEUTIC APPLICATIONS

A. Patient Preparation and Prerequisites

• Active and attentive participation by the patient
• Patient receptiveness to the concept
• Patient motivation
• Motor planning skills
• Adequate vision and hearing
• Rehabilitation potential
• Presence of initial voluntary control (at least minimal ability to activate the muscle)

B. Recruitment Training

• Goal: To assist the patient in increasing EMG activity through shaping the muscle's EMG activity responses.
• Activating a muscle or muscles in isolation and during a functional movement task.
• Makes the patient aware of any neural connections that remain during the acute stage of injury or disease.
• Usually targeted to one muscle or an agonist-antagonist pair.
• Example: It is insufficient to target only the typically hyperactive upper trapezius for inhibition and the typically weak anterior deltoid for recruitment. Essential synergists of upper extremity elevation (serratus anterior, infraspinatus) are frequently weak and should also be targeted for recruitment.

C. Inhibition / Relaxation Training

• Goal: Decrease undesirable motor unit activity interfering with functional movement.
• Used for evaluating spasticity.
• Find the least sensitive setting that produces minimal feedback.
• Technique: Have patient relax; use techniques to lower the signal; as signal decreases, lower the gain to a more sensitive level; as patient relaxes better, continue to increase sensitivity; change positions; consider a muscle recruitment setup for the antagonist.
• Also used in:
  • Treatment of excessive EMG activity due to pain
  • General relaxation training (progressive relaxation, autogenic training)

D. Adjuncts to EMGBF

• TENS (Transcutaneous Electrical Nerve Stimulation)
• Electrical stimulation in combination with biofeedback
• Tapping to facilitate muscle activity
• Verbal assistance
• Simulation in combination with various biofeedback techniques to enhance the patient's motor performance

10. PROCEDURE - EMG BIOFEEDBACK (STEP-BY-STEP)

1. Select the muscle to be monitored
2. Prepare the skin for the surface electrode (clean, dry, possibly shave)
3. Apply electrodes to the muscle (per standard electrode placement guidelines)
4. Determine the baseline reading of the muscle to be stimulated
5. Set the appropriate gain (sensitivity) on the device
6. Elicit maximum responses using neurofacilitatory techniques or movement exercises
7. Provide visual/auditory feedback to patient
8. Clean the device and skin post-session

11. BIOFEEDBACK FOR INCONTINENCE

Indications (Pelvic Floor Biofeedback)

• Failure to inhibit detrusor contraction
• Failure to adequately contract the striated urethral sphincter/pelvic floor
• Failure to relax the urethral sphincter or pelvic floor during micturition
• Chronic pelvic pain due to hypertonicity of pelvic floor muscles

Bladder Biofeedback

• Trains patients to inhibit detrusor contraction voluntarily and to contract periurethral muscles selectively.
• Bladder pressure biofeedback treats urge incontinence by allowing the patient to watch intravesical pressure rise.
• Outcome data: 81% improvement rate was reported; 36% success rate at 5-year follow-up.

Pelvic Floor EMG Biofeedback (Pelvic Muscle Exercise - PME with EMGBF)

• Intravaginal or intra-anal EMG sensor used.
• Converts pelvic floor/urethral sphincter activity into visual or auditory signal.
• Goals:
  • Help identify pelvic floor musculature
  • Perceive difference between contraction and relaxation
  • Voluntarily relax and control pelvic floor

Glazer Protocol (Standard Protocol for Pelvic Floor Biofeedback)

12. NEUROLOGICAL APPLICATIONS

Hemiplegia

• EMG biofeedback used for:
  • Motor re-education
  • Control of spasticity
  • Balance training
  • Posture control
  • Recruiting peripheral nerve - other forms of biofeedback also used

Other Neurological Uses

• Dystonic conditions
• Recovery from peripheral nerve injury
• Learning disabilities (EEG biofeedback)

13. ADVANTAGES OF BIOFEEDBACK

• Allows real-time change to be corrected immediately
• Larger change is done before corrective feedback
• Encourages self-confidence
• Reduces sense of helplessness
• Discourages useless muscle activity
• Can be used in any kind of setup
• Creates a game-like, competitive atmosphere that motivates rehabilitation
• Transfers to real-life function post-sessions
• Non-invasive (surface EMG)

14. CONTRAINDICATIONS

• Open wounds at electrode site
• Certain cardiac conditions (demand-type cardiac pacemakers - electrical interference concern)
• Skin conditions preventing electrode application
• Patients unable to participate actively (cognitive impairment, low motivation)
• Children under 5 years (typically incapable of receiving biofeedback regularly)

15. DISADVANTAGES

• Invasive internal probes (intravaginal/intra-anal) can cause infection
• Painful and expensive procedures (e.g., bladder pressure biofeedback)
• Cannot cause infection if proper care is taken but risk exists with internal electrodes
• Variability in signals due to electrode placement, superficial vs. deep muscles, electromagnetic noise, and tissue variability
• EMG biofeedback measurements vary between brands

16. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) DIMENSION

• It emphasizes the inherent healing capacity
• Promotes personal awareness and control over the body independently of the biofeedback instrument
• Combines values of complementary medicine with evidence-based approaches
• Once learned, practice can be done without the instrument; the goal of treatment is to establish the patient's mastery over the body independently of the biofeedback instrument.
• Shares core values with the complementary and alternative medicine movement.

17. SUMMARY TABLE - BIOFEEDBACK TYPES AND CLINICAL APPLICATIONS

18. REFERENCES

1. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition
2. Campbell-Walsh-Wein Urology, 12th Edition
3. O'Sullivan and Schmitz - Physical Rehabilitation
4. Schwartz MS, Andrasik F - Biofeedback: A Practitioner's Guide, 3rd Edition
5. Misra's Clinical Neurophysiology

Recent Clinical Guidelines on Biofeedback in Neurological Rehabilitation

Overview

1. Korean Stroke Rehabilitation Clinical Practice Guideline (4th Edition, 2024/2025)

Key Recommendations

Interpretation

• Biofeedback is placed alongside whole-body vibration as a conditional recommendation - not universally superior but potentially beneficial for select patients.
• The guideline calls for larger well-designed RCTs to clarify optimal parameters, patient subgroups, and treatment duration.
• The shift from consensus-based to GRADE methodology in this 4th edition makes these the most rigorous stroke-biofeedback recommendations currently available.

2. EMG Biofeedback for Stroke Limb Rehabilitation - Meta-Analysis (2024)

3. Post-Stroke Shoulder-Hand Syndrome - Bayesian Network Meta-Analysis (2022)

4. Post-Stroke Dysphagia - Systematic Review & Meta-Analysis (2026)

5. Upper Limb sEMG-Driven Interventions in Stroke - Meta-Analysis (2022)

6. Biofeedback in Parkinson's Disease - 2025 Comprehensive Review

Key Recommendations for PD Rehabilitation

• Development of standardised certification programs and clinical guidelines for biofeedback in PD (currently absent)
• AI-enhanced, personalised biofeedback systems adapting parameters to real-time performance data
• Multidisciplinary protocols combining physiotherapy, speech therapy, and occupational therapy with biofeedback modules
• Wearable EMG biofeedback devices during gait and balance retraining as the most immediately translatable approach

7. Anthem/MPTAC Clinical Utilization Guideline CG-MED-97 (Updated May 2025)

Neurological Indications - Summary

8. Wearable Biofeedback - Emerging Evidence (2021 Sensors Meta-Analysis)

• Wearable sensor-based biofeedback significantly improves balance and gait outcomes in neurological diseases including stroke, PD, and multiple sclerosis.
• Real-time feedback via vibrotactile, auditory, or visual channels on commercially available wearables represents the frontline of clinical translation.
• Design rules proposed: feedback should be real-time, intuitive, task-specific, and patient-tolerated.

Summary of Guideline Recommendations by Condition

Critical Gaps Identified Across All Guidelines

1. Optimal dose parameters (session frequency, duration, number of sessions) are undefined for most neurological indications.
2. Patient selection criteria - who benefits most from biofeedback vs. conventional therapy alone - remain poorly characterised.
3. Long-term maintenance of gains after biofeedback discontinuation is consistently understudied.
4. Standardised outcome measures across trials are lacking, making meta-analysis difficult (different scales, different timepoints).
5. No international neurological rehabilitation guideline (e.g., from AAN, NICE, ESPRM) has issued a comprehensive biofeedback-specific document as of mid-2026; this remains a significant gap.

Bottom Line for Clinical Practice

• Use biofeedback as an adjunct to, not a replacement for, conventional neurological rehabilitation.
• EMG biofeedback is the most evidence-supported modality in stroke rehabilitation, especially for upper limb and shoulder-hand syndrome.
• Short-term gains are well-supported; long-term benefits need further RCT evidence.
• Parkinson's disease and dysphagia are active research frontiers - encourage use within structured protocols rather than as routine standard of care yet.
• EEG neurofeedback for TBI and cognitive rehabilitation remains investigational by most current standards.

🎓 BIOFEEDBACK - Taught Simply (20 Marks)

LESSON 1: What is Feedback? (Start from basics)

You throw a ball at a target. You see where it landed. That information helps you throw better next time.

Two types of Feedback:

• Your joints telling you where your arm is (proprioception)
• Feeling the ground under your feet
• Example: You close your eyes and still know if your hand is up or down

• A coach telling you "your elbow was bent wrong"
• A machine showing you your muscle activity
• Example: A physiotherapist saying "contract harder!"

Biofeedback is a type of EXTRINSIC feedback - a machine measures what's happening inside your body and shows it to you.

LESSON 2: What is Biofeedback? (The Main Definition)

Biofeedback is a technique where a machine measures something happening inside your body (like muscle activity or heart rate) and converts it into a sound or picture so YOU can see or hear what your body is doing - and then learn to control it.

• BIO = life / biological (body)
• FEEDBACK = information coming back to you

A training technique that enables an individual to gain voluntary control over muscular or autonomic nervous system functions using a device that produces auditory or visual stimuli.

Simple Analogy:

LESSON 3: The Theory Behind It (Why does it work?)

Neal Miller's Discovery

The Autonomic Nervous System (ANS) - which normally controls things automatically (heart rate, blood pressure, sweat) - CAN be brought under voluntary control if you give the person the right feedback.

• Dog does something right → gets a treat → does it more
• Patient activates the right muscle → machine makes a happy sound → patient learns to activate it more

Re-opening Neural Loops

1. Sound/visual cues stimulate the brain
2. The patient watches the muscle contract on a screen
3. This helps re-open or rebuild the neural connection

Think of it like a road that's been blocked. Biofeedback helps the brain find and use that road again.

LESSON 4: The Equipment - 3 Parts (Very Important!)

BODY → [TRANSDUCER] → [SIGNAL PROCESSOR] → [DISPLAY]
                                               ↑
                                        Patient sees/hears

Part 1: TRANSDUCER (the Detector)

• This is the sensor placed on or in the body
• It detects the physiological signal (muscle electricity, temperature, pressure)
• For EMG biofeedback: these are electrodes placed on the skin over the muscle
• Think of it like a microphone - it picks up what the body is "saying"

Part 2: SIGNAL PROCESSOR (the Computer)

1. Amplifies - makes the tiny signal bigger (like turning up the volume)
2. Filters - removes background noise (like noise-cancelling headphones)
3. Rectifies - makes all values positive (so the signal is clean)
4. Integrates - groups the data into meaningful chunks

Part 3: DISPLAY (what the patient sees/hears)

• Visual: A bar on a screen, a graph, a video game character, lights
• Auditory: A beep, a change in pitch, a buzzer
• Simple example: EMG activity low = low pitch sound; EMG activity high = high pitch sound

LESSON 5: Types of Biofeedback (Learn with "What it measures + What it treats")

Type 1: EMG Biofeedback (Most important for physiotherapy!)

• Measures: Electrical activity of muscles
• Electrodes: 3 surface electrodes (2 active + 1 reference)
• Active electrodes = pick up the signal
• Reference electrode = filters out meaningless noise
• Treats: Stroke rehab, spasticity, muscle weakness, pelvic floor problems

Type 2: EEG Biofeedback / Neurofeedback

• Measures: Brain waves (alpha waves = relaxed state)
• Electrodes on: Scalp
• Treats: ADHD, anxiety, depression, traumatic brain injury, learning disabilities
• Also called Neurotherapy

Type 3: Thermal Biofeedback (Temperature)

• Measures: Skin temperature of the finger
• How? Finger temperature drops when you are stressed (blood vessels constrict under sympathetic control)
• Sensor: A sensitive thermometer attached to the fingertip
• Treats: Raynaud's phenomenon, migraine, hypertension, stress

Type 4: GSR / Electrodermal Biofeedback

• Measures: Skin conductance (sweat)
• When stressed: You sweat more → skin conducts electricity more
• Treats: Anxiety, stress disorders

Type 5: HRV Biofeedback (Heart Rate Variability)

• Measures: Variation in time between heartbeats
• Treats: Asthma, COPD, depression, heart disease, fibromyalgia

Type 6: Respiratory Biofeedback

• Measures: Breathing rate, chest expansion
• Treats: Asthma, COPD, dysfunctional breathing patterns (like reverse breathing, gasping)

Memory trick for types:

"Every Good Therapist Has Real Results" E = EMG, G = GSR, T = Thermal, H = HRV, R = Respiratory, R = (neurofeedback)

LESSON 6: EMG Biofeedback Features (Device Settings - Exam Favourite!)

1. Gain Setting

• High gain = High sensitivity → used EARLY in rehab when muscle activity is very weak
• Low gain = Low sensitivity → used LATER when the muscle is stronger
• Think of it like the zoom on a camera - high zoom for tiny signals, low zoom when signal is strong

2. Threshold Buzzer

• You set a TARGET level of muscle activity
• The buzzer only sounds when the patient crosses that target
• This motivates the patient: "I need to try harder to hear the beep!"
• Once they exceed the threshold → they hear the sound → they want to do it again (operant conditioning!)

3. Peak Hold Facility

• Holds the HIGHEST value achieved during a contraction on the screen
• Tells the patient: "That was your best effort - now try to beat it"
• Prevents the patient from missing peak performance that happens in milliseconds

LESSON 7: The Feedback Loop (How it all works together)

Patient tries to contract muscle
         ↓
Transducer detects electrical activity
         ↓
Signal processor amplifies + filters
         ↓
Display shows bar/sound to patient
         ↓
Patient SEES/HEARS their effort
         ↓
Patient adjusts their effort
         ↓
Back to start → continuous loop

LESSON 8: The Procedure Step by Step

1. Choose the muscle to monitor (which muscle do you want to train?)
2. Prepare the skin - clean it, remove hair if needed (so electrodes stick well and signal is clear)
3. Apply electrodes on the muscle belly
4. Find the baseline - what is the muscle doing at rest? (establish starting point)
5. Set the gain (sensitivity) - high for weak muscles, lower as they improve
6. Patient starts exercising while watching/listening to feedback
7. Therapist guides the patient to increase or decrease signal as needed
8. Clean the device and skin after session

LESSON 9: Two Main Goals of EMGBF

Goal 1: RECRUITMENT Training (Train Weak Muscles)

• Stroke patient with weak wrist extensors
• Electrodes on wrist extensors
• Patient told: "Try to lift your wrist - watch the bar go up"
• Every time the bar goes up, they get positive reinforcement

• Don't just target one muscle in isolation
• Example: Don't just train anterior deltoid (weak) while ignoring serratus anterior and infraspinatus - all synergists must be trained together for functional movement

Goal 2: INHIBITION / RELAXATION Training (Calm Overactive Muscles)

• Start at LOW sensitivity setting
• Instruct patient to relax
• As signal decreases, INCREASE sensitivity (make machine more sensitive)
• This forces patient to relax even more
• Gradually change positions (sitting, standing) - make it harder
• Also can set up biofeedback on the ANTAGONIST muscle for recruitment at the same time

LESSON 10: Patient Selection - Who Can Use Biofeedback?

• Active, willing participation (it's a skill - like learning to ride a cycle)
• Motivation (lazy patients won't benefit)
• Motor planning ability (ability to try to move)
• Adequate vision AND hearing (to see/hear feedback)
• Some minimal voluntary muscle control

LESSON 11: Biofeedback for Pelvic Floor / Incontinence

Why is pelvic floor a perfect candidate for biofeedback?

• Pelvic floor muscles are DEEP - you can't see them or easily feel them
• Most people don't know which muscles to contract
• Biofeedback makes the invisible visible

Indications:

1. Can't control bladder (urge incontinence) - bladder squeezes when it shouldn't
2. Can't squeeze pelvic floor muscles hard enough (stress incontinence)
3. Can't RELAX pelvic floor during urination (dyssynergia)
4. Chronic pelvic pain (muscles too tight)

How it's done:

• An intravaginal or intra-anal EMG sensor is placed
• Patient watches a screen showing their pelvic floor muscle activity
• Goal: Learn to squeeze AND relax on command

The Glazer Protocol (Standard Protocol - Must Know!)

LESSON 12: Indications - A to Z

LESSON 13: Advantages and Disadvantages

Advantages (Why it's great):

• Real-time correction - patient knows immediately if they're doing right
• Builds self-confidence - patient sees their own progress on screen
• Reduces helplessness - patient feels in control of their body
• Non-invasive (surface EMG)
• Motivating - game-like environment
• Can be used anywhere - clinic, home, ward
• Once learned, no machine needed - the goal is independence from the device

Disadvantages (Be honest):

• Invasive probes for pelvic floor (infection risk)
• Expensive equipment
• Signal variability - electrode placement, body fat, electromagnetic interference affect readings
• Results vary between machines (no universal standardisation)
• Needs patient cooperation - doesn't work on passive/uncooperative patients
• Not effective if patient has no residual voluntary control at all

LESSON 14: Contraindications

• Open skin wounds at electrode site
• Demand-type cardiac pacemakers (electrical interference)
• Very young children (under 5 usually can't cooperate)
• Severe cognitive impairment (can't understand feedback)
• Patients with no motivation or psychiatric barriers to participation

LESSON 15: The Big Picture - How to Remember Everything

"The patient comes in with a weak or overactive muscle. The therapist attaches electrodes (the transducer) which pick up tiny electrical signals. The machine amplifies, filters, and converts these signals into a beep or bar on a screen (the display). The patient sees or hears what their muscle is doing in real time. Using this information, the patient tries to increase (recruitment training) or decrease (relaxation training) the muscle activity. Through repeated sessions, the brain re-learns the neural connection to that muscle. Eventually, the patient can do this without the machine - the goal all along."

EXAM WRITING TIPS for 20 Marks

1. Definition (3-4 lines) - 2 marks
2. Theory/basis (operant conditioning, Neal Miller) - 2 marks
3. Types of feedback (intrinsic vs extrinsic) - 1 mark
4. Equipment with diagram (transducer + processor + display) - 3 marks
5. Types of biofeedback (EMG, EEG, thermal, GSR, HRV, respiratory) - 3 marks
6. Therapeutic applications (recruitment + inhibition training with goals) - 3 marks
7. Pelvic floor/incontinence + Glazer protocol - 2 marks
8. Indications - 1 mark
9. Advantages + Disadvantages - 2 marks
10. Contraindications - 1 mark

Final Exam Mantra: "Biofeedback is a TOOL that teaches patients to VOLUNTARILY CONTROL involuntary processes by making the INVISIBLE VISIBLE through AUDITORY or VISUAL feedback - ultimately the goal is for the patient to become INDEPENDENT of the machine."